Aim of Assessment
The aim of this assessment is to provide students with an opportunity to (1) gain a deeper understanding of age appropriate nursing care for a patient receiving palliation, their family and carers and the nurse’s role surrounding death and dying; (2) further develop research and written communication skills.
Essay Question:
Australia’s population is becoming increasingly diverse. Therefore, meeting the palliative care needs in a range of settings poses many challenges. To demonstrate your understanding of a palliative care approach in a diverse environment, select a patient from one of the following lifespan categories:
� Child
� Young Adult
� Older adult (65+)
Write an essay that:
a) Discusses the importance of providing age appropriate care reflecting a palliative
approach for a person and their family.
b) Illustrate your understanding of nursing care using a palliative approach when applied to your chosen life span category.
� Use current and relevant literature to adequately support your discussion throughout the essay.
Getting started with the literature
To commence this process the following reading may initiate further understanding in relation to age appropriate in nursing care for a patient receiving palliation and their family and carers.
Haley, C., & Daley, J. (2014). Palliation in chronic illness. In E. Chang & A. Johnson (Eds.), Chronic illness and disability. Principles for nursing practice (2nd ed.). (pp. 232-248). Chatswood: Elsevier.
Monterosso, L., Kristjanson, L., Aoun, S., & Phillips, M. (2007). Support and palliative care needs of families of children with life-threatening illnesses in Western Australia: evidence to guide the development of a palliative care service. Palliative Medicine 21 (8), 689-696 DOI: 10.1177/0269216307083032
Bhatnagar, S,. & Joshi, S. (2011). Palliative care in young adults: an issue which needs higher and better awareness. Indian Journal of Palliative Care, 13(3), 173-174. doi:10.4103/0973-1075.92332
Brererton, L., Gardiner, C., Gott, M., Ingleton, C., Barnes, S., & Carroll, C. (2011). The hospital environment for end of life care of older adults and their families: an integrative review. Journal of Advanced Nursing, 68(5), 981-993.
Palliative Care
The population in Australia is very diverse. The diversity can either be linguistic or cultural in nature. This diversity affects the way different professionals operate in the country. Care givers are expected to acquaint themselves with the expectations of the different linguistic and cultural groups. Cultural diversity plays a very important role in determining how the various groups in Australia receive the care afforded them by the care givers. Culturally appropriate care is very important as this ensures that the care recipients needs, cultural beliefs and expectations are factored in the care being provided. The paper that follows will discuss age appropriate palliative care in Australia and the role of a nurse surrounding death and dying.
Palliative care denotes the specialized medical care given to people with serious or terminal diseases. This kind of care focuses on affording patients with relief from the pain, symptoms, and stress associated with the terminal disease. The primary goal of palliative care is to improve the quality of life for the patients and their families. Palliative care is offered by a team of nurses, doctors, and other specialists, who work together to offer the patient with an extra layer of support. Palliative care can be offered to patients of any age and the care can be started at any stage of the terminal or serious disease. It can also be provided in concert with curative treatment (Payne et al, 2008).
Previous discussions on palliative care largely focused on patients suffering from cancer. However, research had found out that over 300,000 deaths result annually from non-malignant conditions (Ferrell & Coyle, 2010). For instance, in the year 2004, the Coronary Heart Disease Collaborative conceded that that prognoses from heart failures produced greater sufferings compared to the prognoses of many cancers (Matzo & Sherman, 2010). Whilst some studies, such as that conducted by Payne et al (2008) concluded there was shortage of evidence as touching the palliative needs of patient suffering from neurological conditions.
As stated earlier, the primary goal of palliative care is to treat people who are suffering from terminal or chronic illnesses that include kidney failure, Parkinson’s disease, congestive heart failure, Alzheimer’s disease, among others. The care regime focuses on the alleviation of the pain, fatigue, nausea, insomnia, loss of appetite, and depression that is associated with the serious illness. These symptoms are accentuated among the older adults. Therefore, the care giver must pay close attention when it comes to dealing with an older adult who is suffering from any chronic or serious illness (Payne et al, 2008).
Moreover, a well thought out palliative care that attends to the needs of the older adults contributes towards relieving emotional and physical complications that accompany old age. Therefore, regardless of the final result of the disease, palliative care must be integrated as part and parcel of the care afforded to the older adults. Moreover, care givers should consider incorporating physiotherapy services in the palliative care plan to help in managing the symptoms presented by different medical conditions (Ferrell & Coyle, 2010). The role of physiotherapy is likely to increase as more and more people join the older adult category. Care givers must contract the services of physiotherapists to care for the older adults patients because as this group continues to age and move closer to the end of their lives, the symptoms are predicted to worsen as the older adults develop more chronic and debilitating diseases.
The rapidly changing demographics suggest that more physiotherapists will be required to take care of the older adults patients, the current status records that there is a shortfall in the number of physiotherapists working in the palliative care unit. Worse still, older adults cannot afford the services of the few available private physiotherapists owing to the high demand. The few private physiotherapists are overstretched and their services are highly priced (Mitchell et al, 2010). Another drawback that contributes to the shortfall in the number of physiotherapists is the fact that before a physiotherapist is admitted to offer his or her services in palliative care, he or she must have many years of experience.
Specialized palliative care requires that the care be founded in the context of a multidisciplinary approach, providing a variety of services needed by the older adults that are facing the end of life, either a consequence of old age or terminal illness. There is compelling evidence which shows that specialist teams have gained proficiency and that they are able to offer satisfactory services that fully address the needs of the older adults as well as the needs of their family members (Matzo & Sherman, 2010). These specialist teams are desired because of their ability to reduce the costs associated with palliative care by cutting down on the duration that a patient must be confined in an acute hospital setting. Specialist teams are also hailed for their ability to design care programs that are tailored to address the individual needs of the older adults and their families. These teams understand that the patients and families coming to their practices are all unique and that there is no uniform treatment plan that can be applied across the board.
Aside from the provision of a culturally relevant palliative care, the care must be designed for a specific age group. This discussion will now focus on palliative care for the older adults in Australia. The older adults defined as persons who are past 65 years old. This group of people possesses many challenges in life. Most of their normal bodily functions are in a decline. The cells in their bodies are quickly dying off and their immune system is also not as vibrant as it used to be during their youthful days. The diminishing power of the immune system means that any disease condition facing them will be accentuated (Crozier & Hancock, 2012). Worse still, this group of patients takes a serious hit whenever they are faced with chronic or terminal disease. Although the major goal of palliative care is to improve care, two equally important goals include addressing the needs of people approaching their death and offering bereavement support to the family of the deceased person. The care giver must therefore devise ways by which they can administer culture and age appropriate palliative care to the older adults patients.
Most of the older adults in Australia are found residing in communities. These communities might either be in the homes owned by the older adult or in retirement homes, or some may be found living with their relatives and friends. Palliative care is very important for the older adults living in communities in Australia. The important forms of care include a palliative approach, end-of-life care, and specialist palliative care. These approaches are applied in an integrated fashion. The end-of-life care is resorted to when the care givers are sure that an older adult is nearing his or her death (Watson, 2009).
Gott & Ingleton (2011) asserts that the number of older adults suffering from life-long medical conditions towards the end of their lives is scheduled to increase. This forecast necessitates the inclusion of non-cancer related prognoses within the palliative care bracket. By so doing, palliative care will be in conformity with the WHO (2011) guideline which requires that the palliative care needs of older adults be expanded so as to accommodate a greater range of conditions. Such a move will necessitate the creation of a framework that promotes understanding among the healthcare staff at all levels.
Previous discussions of palliative care and ageism were distorted in a number of ways. Firstly, these discussions assumed that ageism was a limiting factor, which limited the older adult’s access to palliative care. Essentially, this assertion assumed that older people failed to access palliative care because of their advanced age. This assertion was and still is misguided because palliative care is a life-long care plan. Second, palliative care is viewed to be synonymous to hospice care, meaning that palliative care is considered as a terminal event. This view is misguided because palliative care is not a terminal event but a longitudinal process. Such a distorted view has the potential of placing unnecessary distress on the older adults suffering from chronic or terminal conditions. Importance of providing age appropriate palliative care
Palliative care need to be designed in such a way that it is age appropriate. Patients at different stages of their lifespan require different kind of care. It would be erroneous to try offering the same type of palliative care to an older adults and a child. These two groups of people are both in different phases of their lives. Age related palliative care appreciates the fact that the older adult’s immune system is weak and should therefore be strengthened. Older adults approaching their end of life require that their spiritual, psychological, and physical needs be met. These needs can only be addressed of care givers divide the patients into their age categories and then devise a program that will address the needs and issues of the specific age group. End of life or hospice care is very important for the older adults. This care ensures that the spiritual, medical, and psychological needs of the patients are catered for (Emanuel, & Librach, 2011).
Another importance of providing age related palliative care lies in the fact that this type of care does not just cover the patient but also his family. Chronic illnesses are known to impart special stress on the families and having support can really mean a lot for these families. The support may range from trainings on how to care for their loved ones suffering from chronic conditions to helping the patient and his family plan for the future. It is important to note that properly executed palliative care makes the difference between a comfortable, painless existence and one that has much suffering.
There are different care plans that are tailored to ensure that all patients and their families receive the right kind of healthcare services and support, as well as the best holistic treatment. Holistic treatment plans have all aspects of palliative care factored into the plan. For instance, a plan is considered holistic if it addresses all the needs of the patients and their families. Failure to incorporate the services and attributes of any care provider would distort the functioning of the entire palliative care plan (Hudson et al, 2012).
Concerns have been raised as concerns the exclusion of the tenets of specialist physiotherapy from palliative care team. This move is advised against because it has the potential of inflicting detrimental effects to the patient under palliative care. It is advised that more research be done to ascertain the effectiveness and value that physiotherapy adds to palliative care. Additionally, it is proposed that the guidelines for palliative care should not just be binding on medical teams but also on physiotherapists and that these physiotherapists should be included among the core members of the specialized palliative care teams. Such an inclusion is important because it will allow for the development of a recognized clinical career structure for all physiotherapists working within the palliative care model. Additionally, this will help the specialized physiotherapists to keep pace with the ever-changing demographics of aging people.
It is worth noting that specialized care teams entail hospice care that includes services such as day care, inpatient services, community care, and a wide range of education, advise, support, and care. In Australia, decline in mobility on the part of the older adult inhibits them from accessing palliative care. It has therefore been proposed that palliative care be designed in such a way that will allow the care givers to attend to the older adult in his or her home.
References
Crozier, F., & Hancock, L. E. (2012). Pediatric palliative care: beyond the end of life. Pediatric nursing, 38(4), 198-203, 227; ISSN: 0097-9805
Emanuel, L. L., & Librach, S. L. (2011). Palliative care: Core skills and clinical competencies. Philadelphia: Saunders. ISBN 1437735975, 9781437735970
Ferrell, B., & Coyle, N. (2010). Oxford textbook of palliative nursing (3rd ed.). New York: Oxford University Press. ISBN 0199749701
Hudson, P., Remedios, C., Zordan, R., Thomas, K., Clifton, D., Crewdson, M., Hall, C., et al. (2012). Guidelines for the Psychosocial and Bereavement Support of Family Caregivers of Palliative Care Patients. Journal of Palliative Medicine. 10.1089/jpm.2011.0466
Matzo, M., & Sherman, D. W. (2010). Palliative care nursing: Quality care to the end of life. New York: Springer Pub. Co. ISBN=0826157920
Mitchell, G. K., Johnson, C. E., Thomas, K., & Murray, S. A. (2010). Palliative care beyond that for cancer in Australia. Medical Journal of Australia, 193(2), 124-126.
Mitchell, G., Nicholson, C., McDonald, K., & Bucetti, A. (2011). Enhancing palliative care in rural Australia: the residential aged care setting. Australian journal of primary health, 17(1), 95-101.
Payne, S., Seymour, J., & Ingleton, C. (2008). Palliative care nursing: Principles and evidence for practice. Maidenhead: Open University Press.
Watson, M. S. (2009). Oxford handbook of palliative care. Oxford: Oxford University Press.
World health statistics 2011. Geneva, Switzerland: World Health Organization, 2011. Print. ISBN 978 92 4 156419 9