Abstract This paper deals with a presentation of the benefits to the hospital and the patient in the development of a palliativecare program within a hospital setting. The implications for nursing and nursing leadership are primary focuses. This paper is presented as the beginnings of a research project, inclusive of survey and interview questions attached in the appendix.
From the Paper ""Establishing a palliative care service can improve patient care and ease family concerns for patients who are hopelessly ill. For the hospital such services can improve utilization outcomes" (Meier, 2001). In hospitals that offer palliative care programs, emphasizing dignity and comfort over disease emphasis and medical treatment (Burton, 1998) substantial improvements in symptoms of pain, nausea, digestive upset, diarrhea, constipation and shortness of breath were demonstrated, as well as increased ratings of level of medical and supportive services (Meier, 2001). The World Health Organization defines palliative care as "the active, total care of patients whose disease is not responsive to curative treatment" (World Health Organization, 1990 as cited in Chrystal-Frances, 2003)."
Abstract This paper takes a look at palliativecare, the union of medical, spiritual, and cultural considerations into a holistic, compassionate approach geared toward reducing the severity of symptoms. According to the paper, palliativecare focuses on comfort and pain management rather than on curative measures and emphasizes care for terminal patients and their families. The paper reviews the video 'On Our Own Term: Moyer on Dying', part of a series called "A Different Kind of Care".
Outline:
On Our Own Terms
Hospice and PalliativeCare Spirituality, an Aspect of PalliativeCare Reflection
From the Paper "In most cases, death brings the terminally-ill patient toward spirituality; indeed, this is the essence of existence for the majority of people. Whether or not we have strayed from our religious backgrounds, most people when close to death seek to understand the big questions of life. As a nursing student from a Catholic university, I have studied a curriculum that encompasses many aspects of life, including spirituality. However, most student nurses at the developmental age of college students focus on careers and relationships which can distance them from spirituality, probably the most important issue for a terminally-ill patient. How can we, as nursing students, discuss spirituality with patients at the end of life when some of us are either too young for spiritual awareness or too old and cynical? More importantly, how can we use spirituality in our nursing practice if our training has concentrated on oxygenation, safety, nutrition, and other health issues?"
Abstract This paper discusses palliativecare, care that involves an active approach related to comfort and support for patients who are either living with or dying of a life threatening condition. The paper further discusses how according to the World Health Organization, palliativecare enhances quality of life through prevention and relief of suffering while employing a holistic approach so that physical psychosocial and spiritual issues are addressed. This paper then elucidates the goals of palliativecare in terms of a particular patient and addresses the issues of spirituality, coping and the role of the nurse.
Abstract This paper discusses palliativecare, focusing on the ethical and practical considerations that must be taken into account. The paper also explores the ways in which individuals living with life limiting conditions, receive and experience palliativecare services.
Outline:
Introduction
Statement of Problem
Background of Problem
Literature Review
Medicare Hospice Benefit
Barriers Associated With Receiving PalliativeCare
From the Paper "According to Foley (2005) the terms palliative care and hospice care are often used interchangeably. In the United States palliative care was once known only as hospice care and it started at the grassroots level to enhance the quality of care for patients that were dying in their homes. Today hospices are often referred to as palliative care and it is a fully funded entitlement program that provides care for half of the people in America that die of cancer and 30% of those that die of a myriad of other chronic diseases (Foley, 2005). The new palliative care movement has been created in an effort to improve the care of those that are dying of a terminal illness. The philosophy of this new palliative care movement aims to improve the quality of life for the terminally ill and their families (Foley, 2005). "
This paper researches palliativecare nursing preparation for the psychological factors of patient, family and caregivers during the end-of-life period.
Abstract The paper discusses the competencies necessary for nurses in providing high-quality care to patients and families of patients during the transition at the end-of-life stage of care. The paper reveals that a critical aspect of palliativecare is support on the psychological level and preparing the patient and family members to cope with the factors associated with impending death. The paper emphasizes that only the nurse who possesses the stated competencies and whom has prepared the family in anticipation of the progressive stages of the disease, is capable of minimizing the experienced psychological stress for both the patient and their family members.
Outline:
Introduction
Palliativecare Nursing Competencies
Correlation of End-Of-Life Factors and Psychological Stress
Summary and Conclusion
From the Paper "There was little in earlier centuries that the health care professional could actually do to help patients during the end-of life period except to attempt to ease the pain and suffering experienced by the individual however, recent research has identified specific competencies and best practices for the individual who acts as a nurse to patients during this transition period. Since people live longer in today's world and the elderly population only continues to grow, there are more people with chronic illness in need of care."
Abstract This paper attempts to affirm the hypothesis that spirituality plays a major role in contemporary palliativecare. The paper attempts to affirm the hypothesis via a topical survey of recent nursing, medical and sociology journals. A conclusion is reached which suggests that spirituality is a valuable part of palliativecare.
From the Paper "When speaking of the end of life, quantitative research is relatively easy to obtain. It is easy to find out how many people die, when, and from what causes. What is less accessible, however, is information regarding the nature of that death, whether it was a so-called 'good death,' or not. Recently, there has been increasing interest, according to Christina M. Puchalski, MD, an associate at the Center to Improve Care of the Dying, "in the spiritual aspects of palliative care" Puchalski designed a course in spirituality in end-of-life care in 1992, amid predictions by her superiors that it would not attracted students or attention."
Tags: health, need, distress, culturally, sensitive, interactions, spiritual, growth, chaplains
Abstract The paper examines three programs that dominate EOL care in the current healthcare sector in the US. These include the inpatient/ICU or hospital-based palliativecare program, nursing homes and hospice EOL programs. The paper analyzes their efficiencies, explains the advantages and disadvantages of ICU palliativecare programs and finally posits that among the three, both hospice and nursing home programs are determined as better options than the ICU program. The paper explains that this is primarily because these two programs provide the care, efficiency and satisfaction that the elderly need as they go through the end of life phase in their lives.
From the Paper "The argument for the ICU palliative programs is put forth by Imhof (2005), who recommended utilizing the ICU palliative programs provided in hospitals (hospital-based programs). EOL care services, as argued by the author, provide numerous benefits to the facility of the patient's care, that is, hospital-based programs "require limited organizational effort, pose minimal risk, and cause little disruption to the ongoing operations of the organization" (161). Apart from these advantages of the hospital's palliative programs, patients enjoy other services that come with the program, such as the provision of informational literature for the patient and his/her family, consultation services, palliative care rooms, and additional linkages with the community through collaboration with local hospice, home health agencies, and long-term care facilities and integration into the community (of the patient) (162)."
Tags: inpatient, ICU, hospital, palliative, care, nursing, homes, hospice
Abstract This paper proposes a study to compare nurses' and patients' attitudes and beliefs about palliativecare nursing and decision-making processes. The paper relates that the study will also explore contradictory beliefs about palliativecare held between nurses' and primary care providers. The paper further relates that the researcher intends to explore whether there are prominent differences between nurses' and patients' perceptions of palliativecare and which factors influence perceptions about palliativecare among nurses, patients' and doctors. In addition, the research will also analyze what role doctors' preferences have in palliativecare treatments offered to patients and which criteria are used to determine patients' choices and involvement in palliativecare decision-making in a hospital or other long-term care environment.
Outline:
Abstract
Introduction
Background to Study
Significance of the Study
Literature Review
Overview of PalliativeCare Studies
Method
Theoretical Framework
Participants
Design, Setting, Instruments
Ethical Implications
Dissemination of Results
Work Plan
Budget
From the Paper "Carmel, Werner & Ziedenberg (2004) note that often decisions about palliative care are deferred to doctor's and nurses, and relate to their preferences more so than that of the patient, especially in cases of elderly patients or patients with poor health prognosis. Solomon et. al (1993) conducted a study involving over 600 physicians and 700 nurses working in five hospitals, finding that significant differences existed between the needs for palliative care and preferences between doctors, nurses and even patients (Carmel, Werner & Ziedenberg, 2004). Most notably, there is evidence suggesting more attention need be paid on "prognoses or patients' preferences" instead of the attitudes and beliefs of the healthcare providers involved in care (Carmel, Werner & Ziedenberg, 2004, p. 27)."
Abstract This paper seeks to better understand what hospice care entails in Canada. It reviews some of the barriers faced by patients, families and palliative nurses with end of life issues. It discusses how quality of care at the end of life has many significant issues. The writer notes that countless citizens who could benefit from palliativecare do not receive it or obtain it during the last few days or weeks of their illness. The author touches on strategies for overcoming the existing barriers in community based hospice care as well as how nurses can be leaders in ensuring that appropriate palliativecare is received.
From the Paper "Hospice care is not only for the patient; but for their family and friends as well. Emotional, spiritual, physical and social needs are addressed by the palliative team. Hospice provides tailored services in a caring community where patients and families attain the required groundwork for a death that is satisfactory to them. The nature of dying is one of a kind so that the goal of the hospice team is to be responsive and receptive to the special needs of each individual and family."
"Although hospice-palliative nurses bring expert knowledge and skills to the delivery of comprehensive and empathetic care to persons and families living with advanced illness, studies reveal that due to enormous barriers in end-of-life care in nursing homes and patients' residences, unnecessary suffering occurs at the bedside."
Abstract This paper discusses how the end-of-life phase is the most important and testing time for all the people involved, from the patient to the relatives and the care providers, and how understanding the needs and the mental state of the patient is of utmost importance in delivering palliativecare. It looks at how good, palliativecare is all about reducing the distress of the patient as much as possible and helping them attain a peaceful end. It also examines how, in order to make the end of life a smooth and relatively trouble-free experience for the patient, it is necessary that nurses, relatives, and all other volunteers are properly educated and prepared for the eventuality.
From the Paper "In palliative care the role of the nurse is most significant as we are more concerned with treatment of symptoms rather than perception or diagnosis. Fatigue and depression in end stage is not homogenous in nature making it difficult to understand the underlying psychopathology. Furthermore most people fall into "dysphoria" (demoralizing syndrome) in which case clinical evaluation is inappropriate, as the condition might have resulted from problems of an entirely different nature. This is more complicated by the prevalence of other mental disorders like dementia and drug induced mood swings. Nurses need to be well trained in pattern recognition and logical assessment of the condition and take suitable action to solve these problems."
Abstract The paper overviews ethical concerns and the nursing practice standards in palliativecare settings. The paper focuses on the ethical implications of the DNR (do not resuscitate) order from the nursing perspective. The paper maintains that good palliativecare is all about reducing the distress of the patient as much as possible and helping him attain a peaceful end. The paper asserts that this can sometimes demand a sense of moral detachment.
Outline:
Introduction
The DNR (Nursing Implications)
Conclusion
From the Paper "The DNR (do not resuscitate) order is a request which advices against the use of Cardiopulmonary resuscitation for revival of the heart function of the patient who has a cardiac or pulmonary arrest. Typically, the request for DNR is given as an advance directive by the patient, but in cases where the patient is in comatose state the physician discusses it with the family before recording the DNR order. [Hanna Mari Hilden et.al, 2004] The DNR order in effect takes away the obligation on the part of the attending nurse or the physician to revive the failed heart using CPR. Nurses in palliative care have to face cases where the DNR is applied consistent with the patient's autonomy."
Tags: moral, detachment, palliative, care, illness, pulmonary, arrest
Abstract This paper is a discussion of palliativecare in the elderly patient. The topics discussed include pain management, pain assessment and palliation, sensory loss/balance, and falls, poly-pharmacy and others. The writer points out that not every older patient is a good candidate for aggressive treatment, nor should every older patient be treated with the expectation of recovery. Further, the writer notes that at times there are issues that affect elderly patients who are frail, for whom palliative treatment is the only recourse.
From the Paper "The issue of palliation in care of the older patient is an important one to consider. Not every older patient is a good candidate for aggressive treatment, nor should every older patient be treated with the expectation of recovery. Palliation, then, meets the needs of these patients. At times there are issues that affect elderly patients who are frail, for whom palliative treatment is the only recourse. Although much of the elderly population enjoys good health, many individuals in that population have such illnesses as cancer. Such patients will not benefit from more toxic forms of treatment, but may benefit from treatments that focus on quality of life. Ultimately, as stated in Jerrard, "the goal of palliative care is to honor the patients' wishes"."
Abstract The paper looks at cancer and pain treatment, congestive heart failure, stroke treatment and the need for palliativecare. The paper discusses how geriatric nursing care requires more than ensuring the patient is kept comfortable. The paper also reveals that there are are significant differences in the morbidity, mortality and quality of life for patients suffering from the most common afflictions of the elderly, when proper staff attention is paid to both the symptoms and the treatments for these diseases.
From the Paper "The geriatric patient with cancer can be divided into two types: those who are suffering long-term, chronic cancers, such as prostate, liver and benign tumors. The other class is those who are at end-stage disease. Since many patients suffer from chronic cancers which can allow survival for a number of years, the healthcare professional must deal with both the symptoms of the disease, and be concerned about indications that need to be treated medically (Sarwal, 2003)."
Abstract The paper introduces the topic of palliativecare for geriatric patients by explaining that the purpose of bringing attention to common problems in elderly patients is to avoid or alleviate some of the difficulties encountered prior to the final transition from life. The paper looks at elderly patients' propensity for being undiagnosed, misdiagnosed or under-treated in the areas of pain, confusion, satiety and anorexia, and gastrointestinal distress. The paper addresses the psychosocial issues of fears and depression and notes the importance of support systems to ease transition from life to death.
Outline:
Introduction
Altered Presentation of Health Problems
Psychosocial Issues
From the Paper "The geriatric population is gradually becoming the largest single demographic group worldwide. Ironically, efforts to address their special health care needs, especially with regard to palliative care, continues to progress at a slow pace to such a point that the present crop of health care professionals will be unable to adapt quickly enough to meet geriatrics' specialized needs (Besdine, Boult, Brangman, Coleman, Fried, Gerety et al, 2005; Swiss Academy of Medicine, 2004). The National Institute of Health (NIH, 2004) has reiterated this and the assessment that end-of-life care is particularly incoherent regarding its development and establishment as a science and have yet to develop consistent use of validated measures and explore further new interventions. The primary objective of this acute care nurse practitioner content development manuscript is to concisely consolidate salient features and issues regarding common clinical presentations of geriatric patients for use in a clinical setting. While this may drastically contrast from the approaches to palliative care, it is the contention of this paper that, through bringing attention these common manifestations in elderly patients, some of the difficulties encountered prior to the final transition from life can be avoided or at least alleviated."
Abstract Everyone dies. Prior to that moment, there lies a need for comprehensive, compassionate care of the terminally ill patient. This paper examines three primary arenas for the provision of palliativecare. Firstly, the paper examines the hospital setting with 24 hour staff, pharmacy and equipment, acute care and ready access to care. It then looks at nursing homes which provide similar benefits, but in a more comfortable, private surrounding. Finally, the paper looks at inpatient hospice programs which accommodate terminally ill patients in their own homes with the broadest spectrum of palliativecare. Proper planning, through the establishment of advanced directives and communication between the patient, his or her family, and the attending physician, enables the implementation of the most desired and most appropriate level of care when needed.
From the Paper "For those individuals whose life expectancy and acuity level make the hospital setting impractical, another option exists in the form of terminal care in the nursing home. Approximately 20 percent of Americans will die in skilled nursing facilities. (Keay & Schonwetter 2). Grouping terminal patients in such a manner provides a unique opportunity to address their needs. With a more comfortable, private space for the patient, a staff present at all times, and ready access to medicines, the nursing home seems primed to provide a measure of care that could match or even surpass the hospital environment."
