Palliative Care Approach in Different Health Care Settings

Question: Discuss about thePalliative Care Approach in Different Health Care Settings. Answer: Introduction: Deaths at home has declined considerably in Australia, during the past few years. Most of the deaths occur in health care settings, such as Inpatient designated palliative care bed, Acute hospital, Community, and Rural and remote area. People want their symptoms controlled with personal, social, and psychological support in their final stage of living. So, an effective palliative nursing approach is more significant in providing the best care, without unnecessary prolonging their end of life. It is estimated that around 86% percent die in hospitals and residential care, while death at home has diminished to 14 percent. The changing trend poses new challenges for nursing in different palliative care settings. This essay identifies, compares, and contrasts the challenges and benefits of nursing care, with regard to the palliative approaches for a person, family, and the carers in different health care settings in Australia (Duckett Swerissen, 2015). The Palliative Care: The palliative care is a dedicated health care system, delivered simultaneously with the curative treatment to the people with incurable illnesses. It improves the quality of their life, as well as their family (DOH, 2016). Palliative care is a top quality medical care given by a multidisciplinary team, consisting of specialist physicians and nurses, general practitioners, psychologists, physiotherapists, bereavement counselors, and pastoral carers, for controlling pain and affiliated symptoms (AMA, 2015). Since chronic pain is experienced by persons who have chronic illnesses and disabilities, employing a biopsychosocial model will enable focusing on the persons, rather than the pain in them (Haley Daley, 2014). This must be done considering that most ageing people do not acknowledge that they are terminally ill (McVey et al., 2014). As an effective strategy for managing the pain problems, nurses need to educate the patients in self management, coping skills, and use of analgesia. Timely referral to the pain management system and collaboration is the best practice of improving care of the people (Haley Daley, 2014). Defining Palliative Care: According to DOH (2016), the World Health Organization has defined palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual (DOH, 2016). The palliative care services involve hospitals with/ without palliative care beds, community based care, general practice, palliative care beds, and a combination of these (Mitchell, 2011). In Australia, palliative care is provided at health care centers, including Acute Hospitals and Residential and Aged Care Facilities (RACF) (DOH, 2016). The Palliative Care Approach and its Principles: The palliative care is helpingthe people to live well during the end of their life, strategically involving several health careprograms and services by the governmental bodies (URBIS, 2016). Therefore, it is imperative that such a palliative approach should enhance the life quality in terminally ill patients, by decreasing their agony and meeting their cultural, mental, social, physical, and religious requirements. The approach is continuous, honoring the individuals dignity in dying normally. It does not promote or postpone deaths, but improves the life quality in persons (DOH, 2016). TheNational Palliative Care Strategy 2010 embodies collective commitments of the governmental entities, palliative care service providers, and community oriented institutions in developing and executing palliative care strategies and services, uniformly in Australia. It focuses on: (i) Awareness and understanding of dying as a common part of life, while enhancing scope, benefits, and access to the available palliative care services (ii) Appropriateness and effectiveness in keeping palliative care accessible to all (iii) Leadership and governance in collaborative, positive, and effective implementation of the palliative care strategies, and (iv) Capability in constructing, improving, and supporting the appropriate segments in health care and human services (DOH, 2016).. Importance of Palliative Nursing Approach in Different Settings in Australia: Patients suffering from life limiting illnesses are seen in all settings of health care, such that the situations may require the nurses working in specialty areas add palliative approach to the care they give. Palliative care nurses engage at different levels within an interdisciplinary team of health care (Palliative Care Nurses Australia, 2015). They act supportive of the patient, patients family, and the carer, always respecting their cultural identities (Caresearch, 2015). Palliative care is delivered in several ways, considering the varying geographies. Though patients suffering from cancer have the lions share of palliative care services, most of the people with life limiting illnesses die not from cancer, but from organ failure or infirmity. The importance of palliative nursing approach is crucial in such cases, as it is difficult to take decisions as to when and how the desired supportive care is to be given to them (Mitchell, 2011). The majority of patients who die of predictable illness do not get any palliative care, and their number is increasing with the ageing population. The situation is critical, wanting a systematic change (Mitchell et al., 2010), as they get the care, not according to the prognosis, but on the basis of the complexity of the situation. The smaller services often have connections with larger services that receive patient referrals of a complex nature. Moreover, palliative care improvements are not uniform across the communities (Mitchell, 2011). A recent survey has revealed that at least one family member dies in more than 20% of the families, and that the bereaved members suffer from depression and anxiety, making them incapacitated in engaging normal life. Therefore, it is necessary to identify these people for extending support to them, through enhanced palliative care approach. All people need quality end of life care, in the way they wanted to live till they die. To facilitate this, the way of delivering care at the life end should be changed (Palliative Care Australia, 2016). Challenges and Benefits of Palliative Care Approach in Australia: Challenges in Rural and Remote Settings In Australia, one third of its people live in rural areas, with a significant number located in its remote regions. Rural and remote communities lack enough support services and are prone to higher levels of disease. The scarcity of specialist symptom management, insufficient communication facilities, and the low levels of employment, education and earnings are making them vulnerable. Most of the rural patients, together with their families, fail to get any access to the palliative care services, illness information, and support. The number of GPs are less, causing low medical input. In addition, the lack of transport, isolation, and loneliness are disadvantageous in palliative care in rural and remote settings (Caresearch, 2016). The Aboriginal peoples culture provides resistance in accessing health services, due to their way of life, and the system of beliefs. Spiritually, they are bound to stay within their own regions (Obrien et al., 2013), as the relocation will create psychological problems, because of their strong bond to their family and land (McGrath et al., 2006). Their estrangement from the mainstream health care causes non-availability of their data admissions to palliative care centers (Obrien et al., 2013). Securing medical advice and supplies for palliative care is difficult for people residing in remote regions of Australia (National Rural Health Alliance, 2012). The inadequate administrative support and knowledge about the available resources and barriers, and the limited training in pain management and communication techniques pose severe challenges in providing palliative care in rural settings (Fink et al., 2012). People developing cancer will experience increased distress due to the distance from treatment center and support services (Watts et al., 2016). Challenges in Acute Hospital Settings In spite of the several opportunities for intervention, health care standards, guidelines, and training, the palliative care in acute hospitals reflects negative outcomes for patients, their families, carers, and the nurse professionals. Most often, there develops disagreement about the given treatment and safety measures adopted in the case of the people dying in acute hospitals. The evaluation of quality and safety is calculated with respect of unexpectedness and prevention, causing a diversion from the actualities (ACSQHC, 2013). Talking about death or dying brings discomfort, leading to non delivery of quality of life in a timely manner. The decreased shared understanding between the patients and their families, and the nurses, physicians, and the other health clinicians can aggravate the situation. As a result, there will arise lack of clarity and constancy in addressing the issues, during a patients availing palliative care. Such a flaw will bring confusion in fixing the responsibility for the issues that harm the efficacy of the palliative care approach (ACSQHC, 2013). In order to give suitable care to persons who have life terminating illnesses, it is necessary to acknowledge that dying is important for them. Therefore, the nurses approach to care will become critical in all acute hospital settings (Bloomer et al., 2013). The benefits of palliative care approach in acute hospitals and rural-remote settings: A palliative care approach gives relief from pain and other problems for the patients, while ensuring quality of life and right to dying, normally. Palliative care neither accelerates nor delays death of the people, who are suffering from predictable illness. It incorporates the psychosomatic, religious, and spiritual elements of the patients, and helps them to live actively, as far as possible, till death comes (DOH, 2016). The palliative care approach helps the families and carers to manage the illness of the patients, and supports them in the bereavement. The needs of the patients and their families are given utmost care, along with the bereavement counselling for the needy. The palliative care approach increases quality of life in patients, while influencing the illness, positively. Palliative care can be delivered from the beginning stage of the illness, along with other life prolonging therapies. It also integrates the investigations to conclude and manage clinical complications in the patients (DOH, 2016). Conclusion: In Australia, deaths at home has declined recently, because of the innovations in the palliative care approach. Being a specialized health care provision, it gives relief to the patients from the stressful life threatening illnesses, by improving the quality of life for them. The act of honoring the rights of a patient to die a normal death, without having to suffer from the agonizing pain in the end days of life is a great achievement of the palliative approach. However, despite its positive impacts in the different palliative care settings, new challenges are brewing up, creating disparities in health care. References ACSQHC. (2013). Safety and Quality of End-of-life Care in Acute Hospitals: A Background Paper. Retrieved 15 Dec., 2016 from https://www.safetyandquality.gov.au/wp-content/uploads/2013/09/SAQ083_End_of_life_care_V15_FILM_REVISED_TAGGED.pdf AMA. (2015). Palliative Approach in Residential Aged Care 2015. Australian Medical Association. Retrieved 14 Dec., 2016 from https://ama.com.au/position-statement/palliative-approach-residential-aged-care-2015 Bloomer, M., Endacott, R., OConnor, M., Cross, W. (2013). The dis-ease of dying: Challenges in nursing care of the dying in the acute hospital setting. A qualitative observational study. Palliative Medicine 27(8), 757-764. doi:10.1177/0269216313477176. Caresearch. (2015). End-of-Life Care in Different Settings. Retrieved 15 Dec., 2016 from https://www.caresearch.com.au/caresearch/tabid/743/Default.aspx Caresearch (2016). Rural and Remote. Retrieved 15 Dec., 2016 from https://www.caresearch.com.au/caresearch/tabid/181/Default.aspx DOH. (2016). Palliative Care. Department of Health Government of Australia. Retrieved 14 Dec., 2016 from https://www.health.gov.au/palliativecare Fink, R. M., Kathleen S. Oman, K. S., Youngwerth, J., Bryant, L. L. (2013). A Palliative Care Needs Assessment of Rural Hospitals. Journal of Palliative Medicine, 16(6): 638-644. Retrieved 15 Dec., 2016 from https://www.ncbi.nlm.nih.gov/pubmed/23607812 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, Australia: Elsevier. Retrieved 17 Dec, 2016 from https://media.elsevierhealth.com.au/media/blfa_files/9780729541619.pdf McGrath, P., Patton, M., McGrath, Z., Olgivie, K., Rayner, R., Holewa, H. (2006). Its very difficult to get respite care here at the moment: Australian findings on end-of-life care for indigenous people. Health Social care in the Community 14 (2) 147-155. McVey, M., McKenzie, H., White, K. (2014). A community-of-care: the integration of a palliative approach within residential aged care facilities in Australia. Health Social Care in the Community, 22 (2), 197-209. doi: 10.1111/hsc.12077. Mitchell, G. K.,Johnson, C. E.,Thomas, K., Murray, S. A. (2010). Palliative care beyond that for cancer in Australia. Med J Aust.,193(2):124-6. Retrieved 15 Dec., 2016 from https://www.ncbi.nlm.nih.gov/pubmed/20642422 Mitchell, G. K. (2011). Palliative Care in Australia.The Ochsner Journal,11(4), 334337. Retrieved 15 Dec., 2016 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241066/#i1524-5012-11-4-334-Palliative1) National Rural Health Alliance. (2012). FACT SHEET 34 - OCTOBER 2012: Palliative care in rural and remote areas. Retrieved 15 Dec., 2016 from https://ruralhealth.org.au/sites/default/files/publications/fact-sheet-34-palliative-care-rural-and-remote-areas.pdf O'Brien, A. P., Bloomer, M. J., McGrath, P., Clark, K., Martin, T., Lock, M., Pidcock, T., van der Riet, P., O'Connor, M.(2013).Considering Aboriginal palliative care models: the challenges for mainstream services.Rural and Remote Health,13: 2339.Retrieved 15 Dec., 2016 from https://www.rrh.org.au/articles/subviewnew.asp?ArticleID=2339 Palliative Care Australia. (2016). Quality of Life: Important to the End. 2016 election STATEMENT. Retrieved 15 Dec., 2016 from https://palliativecare.org.au/wp-content/uploads/2016/05/PCA-Election-Statement-Final.pdf Palliative Care Nurses Australia. (2015). Palliative Care Nursing. Retrieved 14 Dec, 2016 from https://www.pcna.org.au/what-we-do/palliative-care-nursing Swerissen, H., Duckett, S. J. (2015). What can we do to help Australians die the way they want to? Med J Aust; 202 (1): 10-11. Retrieved 14 Dec, 2016 from https://www.mja.com.au/journal/2015/202/1/what-can-we-do-help-australians-die-way-they-want URBIS. (2016). Evaluating the National Palliative Care Strategy. Retrieved 15 Dec. 2016 from https://urbis.com.au/projects/evaluating-the-national-palliative-care-strategy Watts, K.J., Good, L.H., McKiernan, S.. Undressing distress among cancer patients living in urban, regional, and remote locations in Western Australia. Support Care Cancer, 24: 1963. Retrieved 15 Dec., 2016 from https://link.springer.com/article/10.1007/s00520-015-2982-4