Palliative, Rehabilitation and Continuing Care

Introduction to Palliative, Rehabilitation and Continuing Care 

Palliative care is the end of life care delivered to the patients that is highly critical in nature. This type of care is delivered mainly to the patients with neurological disorders because the neurological disorder is progressive and the nerves degenerates with progressing time. There are core values that guides the delivery of palliative care standards by the nurses and assist in the provision of quality palliative care delivery. One of the selected core value is “to demonstrate respect for the person, their family and carers” (Australia, 2018). This is one of the most important core value because the respect of patient holds paramount importance in nursing and following this core value ensures delivery of quality palliative care.

The time around the end of patient’s life is precious and it needs to be respected thus it is important to approach in a safe and responsive manner.

Literature Review of Palliative, Rehabilitation and Continuing Care 

The common themes that are emerged from the journal articles searched from various databases are as follows:

  • Theme 1 - Shared Decision Making

The major respect of the patients and the family members can be showcased by involving them in decision making process. The shared decision making process is an important quality of patient centred care and it allows the palliative care receiving individuals to be able to “make optimal medical decisions” as per their preferences (Henselmans et al., 2017). This process of integration of both the patients preferences and best available evidences is important for the palliative care. The shared decision making is most important in the process of “advance care planning (ACP)” that includes the preferences of end- of- life of the patient (Huang et al., 2020).

  • Theme 2 – Patient centred care

The delivery of patient centred care enables the end of life treatment of the patients with dignity. The patients requiring palliative care might have sensitive needs in terms with their life expectancy and symptoms thus the provision of dignity enhancing is allowed to be given through patient centred care (Kennedy, 2016). The adequate resources and positive environment is required for the “delivery of dignified and person centred end- of- life care to the patients”. The requirements of the family members also demands consideration, particularly following bereavement (Soderman et al., 2020).

  • Theme 3 – Effective communication

The end of life care requires effective communication skills so that effective care can be provided to the patients and the family members (Montgomery et al., 2017). This creates a sense of trust and security and this assists the nurse in reducing the stress that the patient and family members experience daily due to the hospice patient. This allows in establishing effective connection with the patient that allows the respect of their priorities and wishes. This leads to making informed decision making about their care (Cain et al., 2018).

  • Theme 4 – Empathy as care

Empathy in the palliative care works in favour of the patient and the family members as it shows the respect of the pain that the patient is going through (Fernando, Rea & Malpas, 2018). Showing empathy refers to showing support and sharing the sadness of the patient and carer members receiving end of life care (Caro et al., 2017).

  • Theme 5 – Ethical responsibilities

The nurses needs to respect the ethical considerations because they most often come across the etical issues like issues related to autonomy and decision making (Marty & Cater, 2018). The respect of the patients and the family members can be done by complying with the ethical responsibilities and respecting autonomy of the patient (Prince- Paul & Daly, 2016).

Table (This template Table is example only and can be modified to suit your report. The layout below supports understanding of structured presentation)

Table: Themes in journal articles

 

Authors Names and Date of Publication

Common Theme

1. Henselmans et al., 2020

2. Prince- Paul & Daly, 2016

3. Kennedy, 2016

4. Huang et al., 2017

5. Caro et al., 2017

6. Marty & Cater, 2018

7. Cain et al., 2018

8. Soderman et al., 2020

9. Montgomery et al., 2017

10. Fernando et al., 2018

Shared

Decision-Making

*

   

*

           

Patient centred care

   

*

       

*

   

Effective communication

           

*

 

*

 

Empathy as care

       

*

       

*

Ethical responsibilities

 

*

     

*

       

Discussion on Palliative, Rehabilitation and Continuing Care 

The author identifies that the core value of respecting the patient and the family members in palliative care can be best followed by involving the patient in decision- making. The shared decision making allows the patient and family members to be a part of their care and this allows respecting their preferences and views. This also allows respecting their culture values because the nurse learns about the cultural values of the patient through involving them in the decision making process. This gives the patients a sense of security and the nurses are best able to respect the patient’s preferences and them.

The author identifies the two main themes that are responsible for providing the respect to patient and family members that are effective communication and showing empathy as care. The family members and the patient goes through a turmoil of emotions when the patient is in palliative care because of the fact that the patient is receiving end- of- life care. Showing empathy to the family members of the patient having MND would assist them in going through this journey and this has a positive impact on reducing the emotional pain of the family members.

The authors have agreed that the nurses face many ethical issues when they are caring for the patient in their end phase of life relating to autonomy and shared decision making. The nurses are required to act in their ethical responsibilities so as to respect the patient’s decisions and autonomy along with making all the provisions that the patient is not harmed. In MND, the patient is unable to actually convey the preferences because of slurred speech so the family members plays a very important role in this aspect. The ethical considerations are important in respect to the patient and family members especially when caring for the patient having MND.

Conclusion on Palliative, Rehabilitation and Continuing Care 

The conclusion drawn is that the palliative care given by the nurses is based on the core value that is respecting the patient and family members. This can be performed based on the identified five themes that are shared decision making, effective communication, providing patient- centred care, ethical responsibilities and showing empathy as care. The palliative care to MND patient can be best given when the respect of both the patient and family members is involved because the family members also goes through emotional drain that requires the care from the nurses.

Reference List for Palliative, Rehabilitation and Continuing Care 

Australia, P. C. (2018). National palliative care standards. Canberra: Palliative Care Australia.

Cain, C. L., Surbone, A., Elk, R., & Kagawa-Singer, M. (2018). Culture and palliative care: preferences, communication, meaning, and mutual decision making. Journal of Pain and Symptom Management55(5), 1408-1419.

Caro, M. M., San-Martín, M., Delgado-Bolton, R., & Vivanco, L. (2017). Empathy, loneliness, burnout, and life satisfaction in Chilean nurses of palliative care and homecare services. Enfermería Clínica (English Edition)27(6), 379-386.

Fernando, A., Rea, C., & Malpas, P. (2018). Compassion from a palliative care perspective. New Zealand Medicine Journal131(1468), 25-32.

Henselmans, I., Van Laarhoven, H. W., Van der Vloodt, J., De Haes, H. C., & Smets, E. M. (2017). Shared decision making about palliative chemotherapy: A qualitative observation of talk about patients’ preferences. Palliative Medicine31(7), 625-633.

Huang, H. L., Tsai, J. S., Yao, C. A., Cheng, S. Y., Hu, W. Y., & Chiu, T. Y. (2020). Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study. BMC Palliative Care19(1), 1-9.

Kennedy, G. (2016). The importance of patient dignity in care at the end of life. The Ulster Medical Journal85(1), 45.

Marty, C. M., & Carter, B. S. (2018). Ethics and palliative care in the perinatal world. Seminars in Fetal and Neonatal Medicine, 23(1), 35-38.

Montgomery, K. E., Sawin, K. J., & Hendricks-Ferguson, V. (2017). Communication during palliative care and end of life: Perceptions of experienced pediatric oncology nurses. Cancer Nursing40(2), E47-E57.

Prince-Paul, M., & Daly, B. J. (2016). Ethical considerations in palliative care. Legal and Ethical Aspects of Care8.

Söderman, A., Östlund, U., Harstäde, C. W., & Blomberg, K. (2020). Dignity-conserving care for persons with palliative care needs—identifying outcomes studied in research: An integrative review. Palliative & Supportive Care, 1-19.

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