Palliative, Rehabilitation and Continuing Care

Introduction to Palliative, Rehabilitation and Continuing Care

Palliative care improves the quality of life for the patient and the family undergoing life-threatening illness by relieving and preventing suffering through early diagnosis and exquisite disease management and monitoring and other physical, psychosocial, and spiritual issues (Ghaljeh et al. 2016). Palliative care is required to respond strongly to the needs, desires, and beliefs of patients, their families, and carers.

One of the selected core values is “Advocate on behalf of the expressed wishes of the person, their family, carers and communities;" (Australia, 2018). This is one of the most important core values as advocacy help a patient with the support, they need to express their views and wishes. Sometimes patients find it difficult for a whole range of reasons to express themselves. Advocacy can help many patients with a life-limiting disease and their families access the palliative care system and offer them guidance about their rights and ways to address any problems (Sawin et al. 2019).

Literature Review of Palliative, Rehabilitation and Continuing Care

The literature review helped to find out the common themes by accessing the journal articles are the following:

Theme 1 – Communication

A key aspect of end-of-life treatment is contact between patients, families, and health care providers. Communication is the central element of all aspects of palliative nursing: the establishment of the relationship between nurse-patient and family, assessment of physical symptoms, analysis of patient care preferences, psychosocial and psychological symptoms; and implementation plan of care (Ghaljeh et al. 2016). Through incorporating the communication skills of palliative care, the healthcare staff will learn about the individual interests and beliefs of the patient, and the patient and family will obtain a greater understanding of the diagnosis of the condition and the possible treatments (Sawin et al. 2019).

Theme 2 –Handling ethical dilemmas

There are practical and legal issues that needs to be tackled. Truth-telling, location of treatment, confidentiality, antibiotic use and blood transfusion orders, diet, and advance guidance can be the important areas facing a team in palliative care (Wiegand et al. 2015). Nurses described being able to overcome the problem using available tools and strategies, including consultation on ethics, social reunions, family support, support for patient autonomy, participation in palliative medicine, clarity of care goals, participation of the family inpatient care (Quill et al. 2015).

Theme 3 –Coordinated care

Palliative care is a medical treatment that focuses on improving patient and family quality of life. Palliative care also focuses on strengthening care team coordination and communication and addressing emotional and spiritual needs (Sekse et al. 2018). Through advanced palliative care training, a nurse may assist through target sets, family gatherings, and advance care planning. A nurse in palliative care can help coordinate the treatment and make life less confusing (Schroeder and Lorenz 2018).

Theme 4 – Shared Decision Making

Shared decision-making is a central characteristic of care, enabling patients in palliative care to make appropriate end-of-life medical choices based on the patient’s values and beliefs (Baik et al. 2019). Hospital nurses focus exclusively on end-of-life treatment, providing hands-on nursing care around the clock — either in a hospital or at home of the patient. The care provider's help to family members in decision making can help patients in relieving pain and other symptoms, and help restore dignity in the course of death (Coyne et al. 2016).

Theme 5 -Protecting the vulnerable population

The "natural" care practices and policies that may exclude or stigmatize some groups, which increase the vulnerability which may result from attitudes or barriers of healthcare providers (Meneses et al. 2016). Addressing the barriers to access would ensure quality end-of-life and palliative care. It includes maintaining easily accessible hospice and palliative care facilities, as well as actively thinking about ways to incorporate those solutions in conventional settings (Donald and Stajduhar 2019).

Table: Themes in journal articles

	Authors Names and Date of Publication
Common Theme	Ghaljeh et al. 2016	Meneses et al. 2016	Wiegand et al. 2015	Sawin et al. 2019	Baik et al. 2019	Donald & Stajduhar, 2019	Sekse et al.,2018	Quill et al. 2015	Schroeder and Lorenz 2018	Coyne et al. 2016
Communication	*			*
Handling Ethical Dilemmas			*					*
Coordinated care							*		*
Shared Decision Making					*					*
Protecting vulnerable population		*				*

Discussion on Palliative, Rehabilitation and Continuing Care

The author has identified that the core values are required for the palliative care of the patient as well as the family members of the patient go through a whirlwind of feelings while the patient is in palliative care. The effective and meaningful communication skills of staff during palliative care will help patients and their family in gaining a better understanding of symptoms and potential treatments for the disease (Donald and Stajduhar 2019). It was also studied that the nurses should value patient's autonomy, participation in palliative medicine, consistency of treatment goals, and family engagement in inpatient care. A palliative care nurse can help coordinate the treatment and make life less confusing.

The authors have also discussed the core values like shared decision making in palliative care. It is a central feature of patient-centered care, allowing patients to make suitable end-of-life medical choices depending on their beliefs and desires (Quill et al. 2015). It may also help family members make choices for the good of the end-of-life care patient. It also provides opportunities to consider the patient's cultural values and needs staff to do so.

Such groups face specific challenges requiring improvements to the health care system and creative nursing models to ensure sustainable access to patient-centered care. Focusing on the needs of elderly populations, rising aging cancer populations, and improving outcomes for adolescent and pediatric cancer populations would all require new nursing resources and models of treatment. Modifies in the program, where nursing functions are essential to facilitate the move to earlier palliative care (Coyne et al. 2016).

Conclusion on Palliative, Rehabilitation and Continuing Care

The inference drawn is that the nurses' palliative care is focused on the core principle which values the patient and family members. This can be performed based on the identified five themes that are communication skills, handling of ethical dilemmas, coordinated care, shared decision making, and taking care of vulnerable populations. The nursing staff can provide the best palliative care for end-of-life care patient, and can also support family members who are going through a tough time.

References for Palliative, Rehabilitation and Continuing Care

Baik, D., Cho, H. and Masterson Creber, R.M., 2019. Examining interventions designed to support shared decision making and subsequent patient outcomes in palliative care: A systematic review of the literature. American Journal of Hospice and Palliative Medicine®, 36(1), pp.76-88. https://doi.org/10.1177/1049909118783688

Coyne, I., O'Mathúna, D.P., Gibson, F., Shields, L., Leclercq, E. and Sheaf, G., 2016. Interventions for promoting participation in shared decision‐making for children with cancer. Cochrane Database of Systematic Reviews, (11).CD008970. https://doi.org/10.1002/14651858.CD008970.pub3

Donald, E.E. and Stajduhar, K.I., 2019. A scoping review of palliative care for persons with severe persistent mental illness. Palliative & Supportive Care, 17(4), pp.479-487. https://doi.org/10.1017/S1478951519000087

Ghaljeh, M., Iranmanesh, S., Nayeri, N.D., Tirgari, B. and Kalantarri, B. 2016. Compassion and care at the end of life: Oncology nurses' experiences in South-East Iran. International Journal of Palliative Nursing, 22(12), pp.588-597. https://doi.org/10.12968/ijpn.2016.22.12.588

Meneses, K., Landier, W. and Dionne-Odom, J.N., 2016, May. Vulnerable population challenges in the transformation of cancer care. In Seminars in Oncology Nursing (Vol. 32, No. 2, pp. 144-153). WB Saunders. https://doi.org/10.1016/j.soncn.2016.02.008

Quill, C.M., Sussman, B.L. and Quill, T.E., 2015. Palliative care, ethics, and the law in the intensive care unit. Critical Care Nursing Clinics, 27(3), pp.383-394.https://doi.org/10.1016/j.cnc.2015.05.007

Sawin, K.J., Montgomery, K.E., Dupree, C.Y., Haase, J.E., Phillips, C.R. and Hendricks-Ferguson, V.L. 2019. Oncology nurse managers’ perceptions of palliative care and end-of-life communication. Journal of Pediatric Oncology Nursing, 36(3), pp.178-190. https://doi.org/10.1177/1043454219835448

Schroeder, K. and Lorenz, K., 2018. Nursing and the future of palliative care. Asia-Pacific Journal of Oncology Nursing, 5(1), p.4. https://doi.org/10.4103/apjon.apjon_43_17

Sekse, R.J.T., Hunskår, I. and Ellingsen, S., 2018. The nurse's role in palliative care: A qualitative meta‐synthesis. Journal of clinical nursing, 27(1-2), pp.e21-e38. https://doi.org/10.1111/jocn.13912

Wiegand, D.L., MacMillan, J., dos Santos, M.R. and Bousso, R.S. 2015. Palliative and end-of-life ethical dilemmas in the intensive care unit. AACN advanced critical care, 26(2), pp.142-150.https://doi.org/10.1097/NCI.0000000000000085

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