Introduction
Palliative is a concept of care that provides coordinated medical service to patients with progressive incurable diseases.The allied health service is proactive and seeks to improve the lives of individuals that are faced with life threatening diseases and their families. Dying and death are part of life and as such palliative care offers the patients a holistic care service that includes social, psychological and spiritual care (1, p.33). Therefore palliative care aims at ensuring that the patients and their families lead the best quality of life without having to be stressed about their condition. This essay takes a critical look at the philosophy and principles of palliative care and how they apply in nursing care.
Discussion on the Statement
The philosophical statement given by the World Health Organisation on palliative care is directed at ensuring that the patients have the best quality of life even when they have terminal illnesses. Palliative care is extended to the family of the patients to ensure that they continue to lead normal lives despite the challenges caused by the terminal diseases. In the past, patients with terminal illnesses were seen as sufferers and with the continual advancement of the disease, care was focused was on lessening the pain for the dying patients. However, with the development of palliative care, the dying patients are no longer seen as sufferers but as other normal patients and are given specialised care from designated professionals (5, p. 23). These professionals maintain humaneness as a core value and must respect the law with regards to the patients and their families and include them in all key decisions.
The care is comprehensively provided to manage physical, psychological, social and spiritual needs of the patients and their families. Palliative care is governed by principles that govern its practice. In the nursing profession, the nurses affirm life and regard dying as a normal process. This is a message that is communicated to both the patients and their families to help them accept the harsh reality of life. Communication is an important part of the process and as such the nurses are required to communicate with the patients and their families in the best possible manner. The nurses are required not to hasten or postpone the death of the ailing patients. They are instead required to relieve the patients from pain and distress to ensure that they improve the patient’s quality of life.
Principles of Palliative Care in Nursing
Palliative care is governed by some core principles that the professionals like nurses, doctors, counsellors and social workers are supposed to adhere to. This section takes a critical look at the principles of palliative care as they apply to the palliative care of patients and families in nursing care. Successful incorporation of palliative care in nursing practice is not a function of complex specialist environments, medical interventions or availability of drugs and disciplines (3, p54). The principles highlighted here apply to nurses working in any environment where they encounter the dying. The principles are discussed under the following themes:
Emphasis on the quality of life
Palliative care should be centred on the quality of life of the patients and their families. The nurses are required to encourage the patients and their families and help them focus on the quality of the life of the patient and not the number of days left to live. Quality of life is defined differently depending on the patient and the disease. The nurses improve the quality of life of the patient by managing the distressing symptoms in order to positively impact the course of the illness. The nursing palliative care team should help the patients and their families enjoy their lives to the maximum while facing the complex medical conditions (10, p. 74). Communication plays an integral part in the nursing palliative care and as such the nurses are required to continually speak with the patients and their families about their wishes, desires and what quality of life means to them (6, p. 63). The communication on quality of life should start early in the course of the illness when the older members of the family are able to contribute before they get stressed and start making immediate decisions. The emphasis on quality of life improves management of symptoms and communication between the nurses and the family.
Patient and family are the focus of care
This is a core principle that cuts across all settings because the patients and their families are the unit of care, not the disease (2, p. 77). Palliative care addresses the meaning of suffering, life, death and disease within the context of each family unit. It recognises the fact that all family members will be part of the disease process and as such their views and individual care plans must be taken into account in the palliative care.
Symptom Management
The nurses are required to assess and treat symptoms using the least invasive ways that will not cause more distress than the original symptom (7, p. 80). Interdisciplinary collaboration, frequent assessment, communication and appropriate management are important concepts of symptom management in palliative care. Symptom management should always be the start of diagnosis in patients with life threatening diseases or those that are potentially life threatening. This should be continued throughout the treatment process in order to improve the patient’s quality of life (3, p. 87).
Communication and Decision Making
Communication with the patients and family should be done clearly, collaboratively and compassionately in order to improve the patient’s quality of life (8, p. 81). Communication with the patients and family is important as it ensures that the family and patients are consistently updated on the course of the disease and treatment. The patients and their families depend on frequent, consistent communication on sensitive and difficult information and may at times need repetition of facts. The communication should be both ways as the nurses should listen to the views of the patients and their families in order to be able to provide care that suits their needs in all ways including culturally and spiritually (11, p. 101). It also allows the family members to reveal more about the patient as this information may be useful in the treatment process depending on the disease.
Recommendations for Palliative Nursing Care
As already indicated earlier in the discussion, it is not easy to fully implement the principles of palliative nursing care. However, nurses should try hard to ensure that these principles are fully implemented in nursing care. Palliative care can be further incorporated through good hospital practice with nurses spending more time with the patients and their families to discuss and plan care within a multidisciplinary team framework (4, p. 15). The nurses should pursue a partnership approach and make good use of open and honest communication with the patients, relatives and the health team. Such ideology is important in nursing philosophy of individualised care that embraces a holistic approach and active patient participation in care (9, p. 71). The nurses should reintegrate palliative care into the culture of the hospitals. This reintegration into the hospital culture will be helpful to the patients particularly those with terminal illnesses. This is very critical because nurses are often at the forefront of general delivery of palliative care within the hospital. They are very well placed and should use their position to help uncover better ways of improving the quality of care to the patients and their families. Lastly, the nurses should receive palliative care education to ensure that they are equipped with the knowledge and management skills necessary for dealing with patients and their relatives as they have diverse personalities, cultures and beliefs.
Conclusion
Palliative care is very important to the patients and their families particularly those with terminal illnesses. This essay has explored the philosophy and principles of palliative care in nursing and has concluded by making recommendations on how hospitals can incorporate it within their cultures. For effective implementation of palliative care in nursing, the nurses need to be well educated on palliative care and how to conduct it in order to minimise misunderstands between them and the patients and their relatives. Proper implementation and execution of palliative care is important in improving the quality of lives of the patients and their families, especially those with terminal or potentially terminal illnesses. Therefore nurses should engage the patients and their relatives in all key decisions to ensure that they get as much information from them in time before the levels of stress get high. Such information is important and can be used in providing individualised care to the patients.
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