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Palliative, Rehabilitation and Continuing Care

Introduction to Palliative, Rehabilitation and Continuing Care

Dignity is a crucial aspect of palliative care and focuses on the beneficence of the patient by ensuring respectful relationships, adequate clinical support, personal, and emotional assistance for the care (Henselmans et al. 2017). Patients in the palliative care require additional support and therefore dignified and compassionate care for them becomes essential (Franco et al. 2019). 

A literature review provides a synthesis of knowledge from various sources and provides analysis and evaluates the finding of the researcher (Kleijn et al. 2018). This literature review aims to synthesise information about the importance of dignity and its influence on patients in palliative care. This review will be focused on providing an engaging discussion by reviewing the primary research done to assess the impact and influence of dignity in palliative care settings. This review will summarise the findings of the researchers and draw the existing overlaps in findings and contrast them for a complete evaluation. 

Literature Review of Palliative, Rehabilitation and Continuing Care

Theme 1: Dignity as a therapy in palliative care 

Vuksanovic et al. (2017) performed a comprehensive randomized controlled trial to assess the significance of dignity in palliative care patients. The study was focused on 70 patients that were terminally ill and were provided dignity therapy. The results from the trial revealed that individuals who underwent dignity therapy have higher generativity and ego-integrity. This implied, that the therapy was useful as the individuals that received it had greater confidence and satisfaction. Similar results for the efficacy of dignity therapy were also obtained by the controlled study of Juliaio et al. (2017) that conducted dignity therapy on 80 patients. The study indicated that the therapy was significantly helpful for the patients to alleviate the psychological distress in the patients receiving palliative care. These studies concluded that dignity therapy is an effective way to counter stress in palliative care settings. 

Theme 2: Models of dignity and their application 

Ostlund et al. (2019) conducted a qualitative study with 20 patients and assessed the impact of Chochinov model of dignity in palliative care nursing. The study revealed that the care actions and application of dignity in palliative care helps in promoting patient health, boosts their confidence, and helps them feel more comfortable in the care setting where they feel respected. The application of dignified frameworks in palliative care setting was also studied by de Luca et al. (2017) through an examination of the palliative care rights of the patient and the significance of treating the patients with dignified and respect mannerism. 

Theme 3: Measurement of dignity in palliative care and feedbacks from patients 

Patient feedback through interaction and questionnaires can be seen as a tool the measure the application of dignified practices in the care setting. A scoping review was developed by Johnston et al. (2017). The study asserted that the feedbacks reported from the patients using “Patient-reported outcome measures” indicated a significant overlap in patient interaction with healthcare professionals and develops the idea of dignity and mutual respect through enhanced communication. According to an observational qualitative analysis conducted by Hanselmans et al. (2017), practices like shared decision making, effective communication, and mutual respect also assist in the process of rapport building and help patients feel dignified. 

Table

Table: Themes summarised from literature

 

Authors Names and Date of Publication

 

Common Theme

1. Vuksanovic et al. (2017)

2. Juliaio et al. (2017)

3. Ostlund et al. (2019)

4. de Luca et al. (2017)

5. Johnston et al. (2017)

6. Hanselmans et al. (2017),

Shared

Decision-Making

 

*

*

   

*

Person-centred care

*

*

*

*

*

*

Application of dignity frameworks

 

*

*

*

*

 

Rapport building

*

   

*

 

*

Dignity therapy

 

*

*

     

Discussion on Palliative, Rehabilitation and Continuing Care

The authors in the study provide an argument for the high application of dignified processes in palliative care settings are extremely beneficial for the patients as it helps them to boost their confidence and are essential for their psychological well-being (Vuksanovic et al. 2017). The concept of dignity is often schooled to the healthcare professionals including nursing along with compassion, empathy, and significance of person-centred practice is to be followed. This helps in the development of trust and rapport between the patient and the healthcare professional and helps in providing the best quality care through competence (Henselmans et al. 2017). 

Authors in this study have also argued that dignity can be ensured in the palliative care settings by the implementation of the dignity frameworks like Chochinov model (Ostlund et al. 2019). These models assist in the establishment of primary practices and abide healthcare professionals to regulations to ensure dignified practices in the care setting and minimise complaints to ensure the best patient experience in a palliative care setting is delivered. It has also been discussed that the application of these frameworks help in processes like shared decision-making and improve the overall experience of the patient in palliative care centres (de Luca et al. 2017). 

Patients in palliative centres require more care and attention as they suffer from serious illnesses and require emotional as well as psychological support in conjunction with their ongoing treatment for the physical ailments (Juliaio et al. 2017). Therefore, dignified practices have been asserted by these studies not only as primary fundamental rights of these patients but also as a moral right for the care professionals to ensure quality care for the patients by providing support and dignified practices. 

Conclusion on Palliative, Rehabilitation and Continuing Care

This paper summarises a concise literature review on the themes that explore the importance of dignity in palliative care settings. Literature from various research journals has been collected and synthesised in this review to underline the importance of dignified practices in palliative nursing. The document also classifies the common themes and overlaps in these researches and provides a brief discussion about the essential factors discussed by the authors. In conclusion, the study asserts the importance of dignity and compassion in palliative nursing and how it improves the overall quality of care.

References for Palliative, Rehabilitation and Continuing Care

de Luca, G.B., Zopunyan, V., Burke-Shyne, N., Papikyan, A. and Amiryan, D. 2017. Palliative care and human rights in patient care: an Armenia case study. Public Health Reviews, 38(1), pp.1-11.

Franco, M. E., Salvetti, M. D. G., Donato, S. C. T., Carvalho, R. T. D., & Franck, E. M. 2019. Perception of dignity of patients in palliative care. Texto & Contexto-Enfermagem,28, pp. 65. https://www.scielo.br/scielo.php?pid=S0104-07072019000100379&script=sci_arttext

Henselmans, I., Van Laarhoven, H.W., Van der Vloodt, J., De Haes, H.C. and Smets, E.M. 2017. Shared decision making about palliative chemotherapy: A qualitative observation of talk about patients’ preferences. Palliative medicine, 31(7), pp.625-633. https://journals.sagepub.com/doi/abs/10.1177/0269216316676010

https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-017-0062-7

Johnston, B., Flemming, K., Narayanasamy, M.J., Coole, C. and Hardy, B. 2017. Patient reported outcome measures for measuring dignity in palliative and end of life care: a scoping review. BMC health services research, 17(1), p.574. https://link.springer.com/article/10.1186/s12913-017-2450-6

Julião, M., Oliveira, F., Nunes, B., Carneiro, A.V. and Barbosa, A. 2017. Effect of dignity therapy on end-of-life psychological distress in terminally ill Portuguese patients: a randomized controlled trial. Palliative & Supportive Care, 15(6), p.628. search.proquest.com/openview/73ba3701234f6141bdcbac664bbccb8a/1?pq-origsite=gscholar&cbl=39238

Kleijn, G., Lissenberg-Witte, B.I., Bohlmeijer, E.T., Steunenberg, B., Knipscheer-Kuijpers, K., Willemsen, V., Becker, A., Smit, E.F., Eeltink, C.M., Bruynzeel, A.M. and van der Vorst, M. 2018. The efficacy of Life Review Therapy combined with Memory Specificity Training (LRT-MST) targeting cancer patients in palliative care: A randomized controlled trial. PloS One, 13(5), p.0197277. https://www.narcis.nl/publication/RecordID/oai:research.vu.nl:publications%2F43c81590-4bbf-4165-bb24-2e20cab81b6c

Östlund, U., Blomberg, K., Söderman, A. and Harstäde, C.W. 2019. How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care. BMC Palliative Care, 18(1), p.10. https://link.springer.com/article/10.1186/s12904-019-0393-x

Vuksanovic, D., Green, H.J., Dyck, M. and Morrissey, S.A. 2017. Dignity therapy and life review for palliative care patients: a randomized controlled trial. Journal of Pain and Symptom Management, 53(2), pp.162-170. https://www.sciencedirect.com/science/article/pii/S088539241630759X

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