¶ … Palliative Care on the Caregiver Palliative care has several positive effects on the caregiver. These can be divided into emotional, social, psychological, and physical effects. First is the positive psychological effect that the caregiver such as the nurse, personal care worker, or family member to deal with the tough job. One study found that when patients died with unrelieved suffering, as nurses, they would also endure enormous suffering on their part Bailey, 2008.

The impact to the nurses is majorly because they had perceptions of suffering where they felt the patient was undergoing a difficult situation and they had feelings towards the patient since they feel they were unable to help the patient during the time of the patient's distress. They also have to endure feelings of failure since they bear the burden of the patient's unrelieved pain Barclay and Maher, 2010.

Some nurses also mentioned the impact of the unrelieved pain on the relationship between the patient and their family and stated that palliative care helped them to build a strong relationship between the patient and their family thus allowing them to benefit largely.

Research that has been published in the New England Journal of Medicine found positive emotional, social and psychological effects of palliative care on the caregiver. The study shows that proper palliative care when provided alongside other standard medical treatments helps to improve the quality of life of the patient and their family Temel et al., 2010.

It prevents depression of the family members and the patient as well and enables the patient to live longer thus allowing the family to build a strong relationship with the patient. The study found that the reason why palliative care is associated with such improvements in patient and family quality of life is because palliative care is aimed at making patients feel a lot better. It includes the standard treatments since they begin by making the patients feel better compared to standard medical treatment alone, which majorly makes patients feel worse at the start.

The social status of the family members of the patients receiving palliative care is also improved. The family member as a caregiver faces challenges of the illness of the patient and must manage the caregiving expectations of the patient, changes they have to make to their daily lives to provide support for the patient and responsibilities they have to take on. Families also benefit emotionally and psychologically from palliative care since the family members believe their patient is comfortable and well taken care of during their time of sickness and even when the patient dies, the family members accept that the patient died a peaceful death while receiving the optimal medical, nursing, spiritual, and psychological care. Meier (2011)

posits that a family's perceptions of the care that is provided to their patient affect their health and how the family functions as a whole. Therefore, providing palliative care to patients also benefits the family members greatly.

Family members also indirectly benefit from palliative care since when the patient has a reduced level of physical, psychological, and social distress, the family communication is no longer strained and thus they are able to build a strong relationship with the patient. Family members also feel enabled to sustain a relationship with the patient when they can see the patient is not experiencing suffering and they are well taken care of physically, mentally, medically, and psychologically.

Palliative care also has positive effects on the nurse and the family as a result of the learning component of the care provided. Palliative care is often intended at educating the family on the situation of the patient, the disease progression, the care that is being provided (medical, psychological, physical, mental, etc.) and thus gives the family members and the nurse and opportunity to discuss their concerns and fears relating to the patient's condition. The family members benefit from an in depth understanding of the situation of the patient and they experience increased confidence in the range of care being provided to their patient.

The nurse also benefits from this learning component since the nurse is able to share the patient's situation with the family members and explain to them the care that is being provided thus receive support from the family members Downar et al., 2010.

When the family members support the actions of the nurse, it is easier for the nurse to administer the treatment since the nurse feels empowered and confident to provide the necessary psychological, spiritual, physical, and mental care to the patient.

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Therefore, when they see the patient is receiving the appropriate care, they feel that even though they are unable to provide the care themselves, they made the right decision and their patient is receiving the best care possible.
Negative/adverse effects of palliative care on the caregiver

Palliative care is often associated with the double effect principle. The principle of double effect is used to define situations whereby the medication or procedure that is administered to the patient has good intentions of relieving pain and suffering but at the same time it may lead to unintended, either foreseen or unforeseen, negative consequences such as hastening death of the patient or increasing their suffering in another way Reese, 2013()

In the discussion of palliative care, the double effect of the medication administered for pain is often evident. According to many experts on palliative care, the medication that is provided to palliative patients is meant to treat pain and other symptoms that are associated with the patient's terminal illness. The pain medication, however, can also hasten death, potentially hasten death, actually speed up death, or indirectly contribute to the patient's death. Other scholars state that this is the unavoidable, known, but accepted consequence of pain medication Saunders, 2009()

Looking at the principle of double effect, it provides that the action provided should itself be morally ethical and good or at least indifferent in all ways. The principle also provides that the person providing care must only intend for the good effect even though the negative or secondary effects may be unavoidable, foreseen, and accepted. The third rule of the principle is that the good effect must not be achieved by using the negative effect while the last rule is that the positive effect must outweigh the negative result Cavanaugh, 2008()

In assessing the administration of pain medication in end-of-life or terminal illnesses, when the caregiver uses medication to treat the pain, they often intend on the positive effect of controlling or treating the pain even though they may foresee the negative or secondary effect of the medication. However, this negative effect is not their intention. Pain management using opioids, which have respiratory depression that is potentially life threatening as a side effect is the core of the debate on the double effect of pain medication.

This double effect of pain medication may give the caregiver (nurse or family member) a tough choice to make in choosing the type of pain medication for the patient. When the nurse is faced with such a difficult situation, and with the patient's pain situation not improving on its own, the nurse may make the decision to administer the pain medication because this is the positive effect and it outweighs the negative effect. However, should anything happen to the patient such as a respiratory arrest, the nurse would often have a hard time facing the patient's family since they know at the back of their minds that the arrest was caused by the pain medication.

Similarly, the patient's family is faced with a tough decision as a result of this double effect of pain medication. The patient's family would also have a tough choice in approving the use of opioids on the patient once they are made aware of its potential side effect. The patient's family in most cases would resist the pain treatment since they are aware it has the potential to hasten the death of their patient. This situation may cause a disagreement to arise between the healthcare professional and the family in the situation where the family is opposed to the treatment and the patient is open to it. Therefore, the patient would receive less than the optimal care that may even have the effect to hastening death on its own or increasing patient suffering.

In some situations, healthcare professionals avoid suggesting strong opioids for terminally ill patients because by proposing this treatment, they would seem to be suggesting to hasten the death of the patient. The dilemma that arises from the double effect of pain management in palliative care is stressing for both the family members and the healthcare professional that have to make tough choices to support the care provided to the patient.

Strategies to reduce or prevent the negative effects of palliative care

Pain management is an important…