Different Aspects of Palliative Care

Question: Discuss about the Different Aspects of Palliative Care. Answer: Introduction The present essay strives to explore different aspects of palliative care which would include home-based palliative care, autonomy and choice in palliative care, collaborative process within a palliative care network, prevention and management of suicide among the service providers and service users in palliative care and so on. Palliative care is especially provided to the terminally ill patients and their family members by a certified health service. As the aim of such therapy is to develop patients and their family members quality of life, it necessitates a multidisciplinary approach. This involves specific medical care for the individuals suffering from life-limiting ailments. Medications administered for these patients are different from the standard ones that depends upon the established practices with diverse types of evidences. For instance anticonvulsants in order to treat pain, morphine for dyspnoea and so on. Palliative care can be offered in various settings like palliati ve care centres, at home and hospitals. Discussion Home-based palliative care (HBPC) It is seen that ill individuals prefer to be cared at home rather than in hospitals. Lustbader et al., (2017) in this regard have demonstrated that HBPC is associated with notable reduction in Medicare cost, less number of hospital admission and rise in hospice utilisation during the end months of life. Ventura et al., (2014) on the other hand, demonstrated a different context of HBPC. As per these researchers, nurses and patients face many challenges in HBPC system. For instance: palliative care nurses feel demoralised due to lower remuneration package compared to other nurses, which also give rise to their depression A health survey in Australia showed various impact of HBPC and various types of support, a care provider might find helpful. Majority of the care providers reported that the service users require assistance with household works, personal activities, medications administration and other organization related tasks. Majority of the care providers also stated about various effects on family and social relationships, limitations on participation in leisure activities and emotional reactions associated with caring situations. Many support care providers have mentioned about advice, access to more updated information, assistance with household activities, and in-home respite along with financial support. The potential range of palliative care is distinguished by the Medicare program, though the hospice-related benefits are narrowly defined and restricted to care, which is concentrated on comfort rather than cure. Home health agencies are accustomed with the needs and demands of the patients in palliative care. They also offer services for the patients, who are unable to afford hospice care. HBPC is preferred by many service users for providing better and satisfactory services, better use of resources along with cost saving (Labson et al., 2013). Demand is not a big challenge, however, workforce issue as it is time intensive that necessitates better care coordination. Some overcoming barriers could be educating the care providers, maintain constant communication among the partners involved in the system. Autonomy and choice in palliative care The patients under palliative care should be treated with respect and dignity or else the care quality could be compromised. Wilson et al., (2014) opined that the palliative care nurses need to be supported by the standards of patient-centred care. This includes providing patient care with respect, involving patients in their own care. This provides the patients with an opportunity to take part in decision-making in making their own choice regarding care interventions. Patients receiving palliative care and their decisions challenge the nurses to develop symptom management, patient advocacy, care quality and analyse the ethical issues. While such patients take responsibility of the end stages of their lives, they may challenge the nurses to re-analyse attitudes regarding autonomy, values of preserving life and application of lifesaving technology. Thenursing care professionals may become compassionate and believe that they have better understanding rather than the patients individual decisions. By declining the continuation of life prolonging strategies, the patients accelerate dying and fail to accept natural death. In such situations, thenursing professionals should examine the mental state of the patients, manage symptoms, decision making and application of advance directives. This is because spiritual distress, psychological and medical symptoms often elicit thoughts of accelerating death, though symptoms and pain have been managed. Walczak et al., (2015) opined that prognostication at the end of life is resisted and problematic. At times, shared decision making is deceptive, where the patients repel advance care planning and consider other values important than their autonomy. The characteristics of the system are more influential in end of life care than the patient preferences. The no common measure of medical knowledge, values, complex nature of patients and their family members do not match with the modern end of life approaches and thereby, the advanc e care planning. The alignment of bioethics towards individual choice and patient autonomy is a natural development. The resolutions for end of life care is oriented towards individualistic remedies rather than the social remedies. Collaborative process within a palliative care network Collaborative palliative care practice clearly defines the role of the Department of Health and Human Services (DHHS), Palliative Primary Care Provider, Care Service and Primary Care Providers in supporting the delivery of need-based and high quality care to patients. The core objective is to confirm that all the health professionals providing care to the patients taking palliative care work together efficiently to deliver synchronised care consistently with high quality. Wittenberg-Lyles et al., (2010) mentioned that increases in palliative care services necessitates further analysis in interdisciplinary based approach in healthcare. The capability of a team to collaborate successfully has an impact on patient care quality, experience of the family members and staff time investment. However, Phillips et al., (2014) in this regard have mentioned about role ambiguity that can further give rise to a lack of collaboration within the interdisciplinary team members. Collaboration takes place by means of interdependence among the team members. In palliative care, this occurs as members deviate from discipline-specific limits. It is also observed that flexible nature of a job allows individuals to work independently in a team. This further gives rise to a newly generated professional activity, which would have been impossible without collaboration. This is also characterised by collective ownership of set of goals, while individuals share accountabilities fo r all the aspects associated with decision making and work together to incorporate their decisions. Collaboration is maintained though reflective process that allows a team to assess the results of the members effort. The caregivers involvement in palliative care showed an improvement in patient and family satisfaction compared to the traditional care (Smith et al., 2012). The collaborative process of communication is said to be a different type of interpersonal communication that is facilitated trough meetings within interdisciplinary teams. In this approach teams form comprehensive care plan and divide their responsibilities, which further help them to individually implement certain parts of the care plan, accordingly. Prevention and management of suicide among service providers and service users in palliative care According to OConnor et al., (2016) the patients receiving palliative care and the care providers are susceptible to various psychological challenges, which further leads to suicidal ideation. In such situation, the palliative care providers play a crucial role in supporting the morally deprived individuals and prevent them from committing suicide irrespective of the intensity of the challenging situations. Proper management requires identification of the core reason behind sufferers pain that decrease perturbation related with the situation. Effective therapy and counselling focuses majorly on approach, which treats individuals and not their behaviour. Behaviour changes require motivation. Crump et al., (2010) stated that because of significant intensity of situational stressors, the patients receiving palliative care are susceptible to high risk of suicide compare to general population. The care providers should distinguish between active suicidality and normal wish to die (active vs. passive ideation). Major treatment intervention includes engaging the suffering individuals in a conversation, which focuses on their feelings. Recognition if individuals thinking regarding suicide demonstrate unreceptive process of letting go. Agreeing to a common plan with the affected individuals may prevent immediate risk. Goroll, Mulley, (2012) in this regard have mentioned about operational suggestions to deal with suicide risk. This include initial intake of prior history of suicide attempt, development of high-risk assessment plan, implementation of emotional pain scale, maintaining daily discussions with interdisciplinary team members and so on. Conclusion From the above discussion, it could be concluded that majority of the palliative care seekers prefer to be cared at home rather than in hospitals. This necessitates maintenance of strong communication within the interdisciplinary team members. Patients and their family members need to be involved in decision making process that respects individuals autonomy. Palliative care increases overall quality of life of an individual by considering their emotional, social, spiritual and physical symptoms. As palliative care varies depend upon individuals needs, the offer services may differ from one case to another. This may include but not limited to providing support to family members to join to speak about their sensitive issues, support people to meet cultural responsibilities, referrals to the respite care services and so on. References Crump, S. K., Schaffer, M. A., Schulte, E. (2010). Critical care nurses' perceptions of obstacles, supports, and knowledge needed in providing quality end-of-life care.Dimensions of Critical Care Nursing,29(6), 297-306. Goroll, A. H., Mulley, A. G. (2012).Primary care medicine: office evaluation and management of the adult patient. Lippincott Williams Wilkins. Labson, M. C., SACCO, C. M. M., Weissman, D. E., Gornet, B., Stuart, F. B. (2013). 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