I have been a registered nurse at UCLA for 18 months. One particular issue that has captured my attention is the utilization of palliative care in health care. Because nurses are generally at the bedside all the time, they have an important role to play in voicing the importance of its utilization and implementation in the patient’s care.
In 2003, the American Nurses’ Association published a position statement regarding “Pain Management and Control of Distressing Symptoms in Dying Patients.” The organization states:
In the context of the caring relationship, nurses perform a primary role in the assessment and management of pain and other
distressing symptoms in dying patients. Therefore, nurses must use effective doses of medications prescribed for symptom control
and nurses have a moral obligation to advocate on behalf of the patient when prescribed medication is insufficiently managing pain
and other distressing symptoms. The increasing titration of medication to achieve adequate symptom control is ethically justified.
I would like to expand this idea from what appears to be an end-of-life hospice position to the broader based idea of palliative care. My experience in both the medical-surgical and the intensive care settings have left me with the feeling that this specialty is often overlooked and underutilized in the acute care setting. It is generally believed that palliative care is the same thing as hospice or that a patient must stop aggressive treatment in order to receive it. Many of my colleagues, including physicians, have a preconceived notion that if palliative care is involved, it usually means the patient will be placed on an end-of-life protocol with a morphine drip. This co...
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...eeds of the adult/gerontology population, especially within the context of palliative care. As nursing continues to shift towards an evidence-based approach in health care, I am also interested in participating in the synthesis and dissemination of research-based guidelines in palliative care. UCLA’s advanced practice nursing degree program is nationally recognized and the medical center is known for its care on the adult/geriatric population. My brief tenure at UCLA has been a rewarding experience and an opportunity to continue contributing to this institution as an advanced practice nurse in palliative care would be an honor. My goal to maximize the use of this valuable, but currently underutilized resource within the acute care setting is ultimately about helping patients achieve and maintain a quality of life that is both acceptable to them and their families.
Terminally ill patients deserve the right to have a dignified death. These patients should not be forced to suffer and be in agony their lasting days. The terminally ill should have this choice, because it is the only way to end their excruciating pain. These patients don’t have
Support of our patients, our colleagues and of our own practice through evidence based practice techniques and scientific fact can be the most comforting evidence in this particular change proposal as it supports the PICO question, “In terminally ill patients, does early admission into a hospice program, versus those who are admitted later, result in more effective pain control at the end of life?” The answer, based in evidence is yes.
...rson cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable. Palliative care is a special form of disinterested charity. As such it should be encouraged. (Catechism)
The American Nurses Association (ANA) thinks that nurses should stay away from doing euthanasia, or assisting in doing euthanasia because it is against the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001; herein referred to as The Code). Overall, nurses are also advised to deliver a quality of care what include respect compassion and dignity to all their patients. For people in end-of-life, nursing care should also focus on the patient’s comfort, when possible the dying patient should be pain free. Nurses have also the obligation to support the patient but also the patient’s family members during these difficult moments. We must work to make sure that patients and family members are well informed about every option that is
The research also used a self-report questionnaire that contained 20 statements regarding palliative care. Each nursing professional had to indicate correct, incorrect, or unsure for each of the 20 items in the questionnaire. These items were classified in 5 sub-categories i.e. philos...
Hospice focuses on end of life care. When patients are facing terminal illness and have an expected life sentence of days to six months or less of life. Care can take place in different milieu including at home, hospice care center, hospital, and skilled nursing facility. Hospice provides patients and family the tool and resources of how to come to the acceptance of death. The goal of care is to help people who are dying have peace, comfort, and dignity. A team of health care providers and volunteers are responsible for providing care. A primary care doctor and a hospice doctor or medical director will patients care. The patient is allowed to decide who their primary doctor will be while receiving hospice care. It may be a primary care physician or a hospice physician. Nurses provide care at home by vising patient at home or in a hospital setting facility. Nurses are responsible for coordination of the hospice care team. Home health aides provide support for daily and routine care ( dressing, bathing, eating and etc). Spiritual counselors, Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family. Social workers provide counseling and support. They can also provide referrals to other support systems. Pharmacists provide medication oversight and suggestions regarding the most effective
Even though many dispute over the value and usefulness of treatment and care of terminally ill patients, the debate for the most useful care and pain reliever for these patients is the question that most patients, and their families, have to ask themselves daily. Wesley J. Smith suggests that Hospice care for patients with such a horrible illness is a beneficial program and that many patients need to utilize it. Smith also recommends that a valuable care option would be to “allow the terminally ill to enter hospice care without having to give up life-extending or curative treatments”. (Smith 3) With this statement, Smith demonstrates a way that these ill patients can be provided with treatment and also care for the patient’s quality of life.
I used to equate palliative care with these- defeat, failure and of course, death. Don’t all of the palliative care patients die? How else would a naive student define death? Had I not just spent years and years, learning how to save people’s life? ‘No, we are not going to offer curative treatment. No, we are not going to resuscitate. No, this patient will not live. It’s about time.’ Everything about it was negative.
Palliative care is medical or comfort care that reduces the severity of a disease or slows its progress, but does not provide a cure (Dreeben, 2007). Different people have different needs when life is ending. Working with the incurable may sound depressing but death is a certainty and what we do each day for these patients as physical therapist assistants, matters. Providing care effectively and appropriately has a huge impact on the patient, therefore acquiring the ability to comfort and care for a patient at such a critical stage in life, is an amazin...
According to World Health Organization (2002) “Palliative care is an approach which improves the quality of life of patients and their families facing life-threatening
Palliative care involves the holistic care to maintain and improve the quality of life of the patient and family during hospitalisation until the terminal stage. Palliation of care refers to the multidisciplinary approach of providing comfort and support for the terminally ill patient and family, thus has an important role in maintaining and improving the quality of life of the whole family. Chronic illness such as cancer gives a physiologic and emotional burden for the patient and family. Education and counselling of the possible options as well as treatments for pain and other symptoms that could help alleviate anxiety, suffering and discomfort. Palliative care provides assistance for the family as a channel for communication between the
... that the nurse or family can do. The goal for palliative care is to make the patient’s passing as comfortable and relaxing, as possible. Medication management should be provided for every patient that is having pain to allow for a more comforting, pain-free, and peaceful death.
The end-of-life nurse’s primary objective is to provide comfort and compassion to patients and their families during an extremely difficult time. They must satisfy all “physical, psychological, social, cultural and spiritual needs” of the patient and their family. (Wu & Volker, 2012) The nurse involves their patient in care planning, as well as educating them about the options available. They must follow the wishes of the patient and their family, as provided in the patient’s advance directive if there is one available. It is i...
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
After a thorough reading, the research questions focused on: Are the palliative care researchers needing innovations or creative approaches in the current generation of researches? Do the multi-dimensional scopes of the increasingly diverse and dispersed nature