Care for terminally ill patients

¶ … Nurse in the Provision of Quality Palliative Care for the Terminally Ill Patient

The objective of this work is to research palliative care for the terminally ill patient and to present findings of the nurse's role in the provision of quality palliative care in patients who are terminally ill.

The Nursing Matters: Palliative Care 'Face Sheet' defines palliative care as "the holistic care of patients with advanced progressive illness who are not responsive to curative treatment. Management of pain and other symptoms and provision of psychological, social and spiritual support are critical." (Palliative Care, 2007) the goals of palliative care include:

Providing relief from pain and other symptoms of distress;

Neither hastening nor postponing death;

Affirmation of life and regard toward dying as a normal process;

Integration of the psychological and spiritual aspects of patient care;

Offer a support system to help patients live as actively as possible until death;

6) Offer a support system to help the family cope during the patient's illness and in their own bereavement. (Palliative Care, 2007)

PURPOSE of STUDY

The purpose of this study is to examine palliative care for terminally ill patients and to discern the role of the nurse in providing quality palliative care to terminally ill patients.

METHODOLOGY of STUDY

The methodology of this study is qualitative in nature and will be conducted through an extensive review of literature that is academic, professional and peer-reviewed in nature in this area of study.

SIGNIFICANCE of STUDY

The significance of this study is the knowledge that it will add to this area of study.

LITERATURE REVIEW

The work of Cramer, et al. (2003) entitled: "Nurse's Attitudes and Practice Related to Hospice Care" states that an assessment was made of "hospice-related training, knowledge and attitudes, demographic and practice characteristics and personal experience..." By a self-administered questionnaire. Findings of the study state that "Characteristics associated with discussion of hospice with both patients and families was found to be related to satisfaction of patients and their families with hospice palliative care.

The work of Wright (2002) entitled: 'Caring for the Terminally Ill: The District Nurse's Perspective" reports a study focused on exploration of the role of the district nurse in the care of terminally ill patients in comprehending and bring clarity to the work of the district nurse in palliative care. The district nurses are stated to have been found in this study to view their role as centric to a relationship with the patient and their family. The focus of care was stated to have been determined by need which were identified within the interactions and discussion of the relationship between the nurse, patient and the patient's family and that the needs of care were complex in nature and great difficulty was experienced in distinguishing the specific needs but they can be divided into four categories: (1) emotional; (2) social; (3) physical; and (4) informational. (Wright, 2002)

The work of Dr. Keri Thomas entitled: "Caring for the Dying at Home: Companions on the Journey" (2003) states that predictors of family care satisfaction were found in studies to be: (1) family care perceptions; (2) family members age; (3) family functioning - greatest need of support in those with poor functioning; and (4) length of time patients receive care. (2003) Thomas relates that "Admission to a hospital does not necessarily imply improved care." (2003) Thomas additionally relates that main areas of concern in home palliative care for terminally ill patients includes: (1) communication; (2) symptom control; (3) staff support and (4) facilities-efforts. (2003) Providing palliative care at home for terminally ill patients includes considerations of: (1) adequate nursing care; (2) night sitters; (3) good symptom control; (4) confident and committed GPs; (5) access to specialist palliative care; (6) effective coordination of care; (7) Financial support; and (8) terminal care education. (Thomas, 2003) Thomas reports a randomized controlled trial, which shows positive effects of introducing the specialist palliative care teams in the care of the dying.

The work of the Open Society Institute - Project on Death in America entitled: "Economic Barriers to Palliative Care" states the fact that the United States "stands alone among industrialized countries in its lack of a tax-supported, universal health care system, its patchwork of assemblage of palliative care/hospice benefits, and its treatments of essential health services as 'entitlements'." (2007) Noted as problematic in this report is the tendency of physicians to wait until very late in the terminal illness of patients to refer this patients to hospice and other palliative care programs. It is related that "This patterns of delayed referral does more than deprive individuals of palliative care-it jeopardizes hospice programs themselves. To be financially viable, hospice programs, which receive per diem reimbursements, must be able to balance out the high initial costs of services to new patients with the lower costs of maintaining stabilized patients." (Open Society Institute - Project on Death in America, 2007) Finally, it is related that "high quality end-of-life care depends upon an integrated network of in-hospital, out-patient, home and nursing home services." (Open Society Institute - Project on Death in America, 2007) Issues requiring research which present barriers to the provision of comprehensive quality palliative care include the issues as follows: (1) How does the six-month eligibility requirement affect patient access to end-of-life care?; (2) What is the impact of delayed referrals on hospice services?; (3) Are there cost incentives within HMOs to rush patients receiving expensive curative treatments into less expensive hospice programs?; (4) How does "dehospitalization" impact the ability of medical centers to provide cost-effective palliative care services?; (5) Will capitated managed care, under which physician groups are paid a lump sum to care for each enrollee, undermine the viability of hospital and home palliative care services?; (6) Will capitation shift more patient care to family members? And (7) Where are the resources likely to come from to provide widespread, humane end-of-life care? (Open Society Institute - Project on Death in America, 2007