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 (Froggatt and Hoult, 2002; Sidell, 2003; as cited in SCIE Research Briefing 10: Terminal Care in Care Homes, 2004)
Barriers identified to quality palliative care include "a lack of communication between decision makers including medical staff, care staff, the resident and their family...the failure to recognize that no curative or restorative treatment is longer possible, so that terminal care can then be provided...a lack of agreement on plan of care...a failure to implement the plan in a timely fashion." (SCIE Research Briefing 10: Terminal Care in Care Homes, 2004) Identified as "one of the potentially most important means of improving the quality of terminal care for the dying... is education and ...
SUMMARY and CONCLUSION
It has been related in the foregoing literature review that there are four basic components to the provision of quality palliative care by the nurse for patients who are terminally ill with those four components being identified as: (1) emotional; (2) social; (3) physical; and (4) informational. The role of the nurse in providing the patient and the family with communication and information is very critical in reducing the stress to both the patients and the family of the patient. Because there are structural barriers to the provision of quality palliative care to terminally ill patients, it is likely that while the nurse may fulfill all responsibilities for caring for these patients that without proper institutional and organizational changes that many patients will not receive palliative care of quality during the last period of their life due to terminal illness.
Thomas, Keri Dr. (2003) Caring for the Dying at Home: Companions on the Journey. Chapter Five Excerpts. Online available at http://www.goldstandardsframework.nhs.uk/content/guides_and_presentations/Evidence_base.doc
Cramer, LD et al. (2003) Nurse's Attitudes and Practice Related to Hospice Care. J Nurs Scholarsh. 2003;35:249-255
Wright, K. (2002) Caring for the Terminally Ill: The District Nurse's Perspective. Br J. Nurs. 2002;11:1180-1185
Palliative Care (2007) Nursing Matters - Fact Sheet. Online available at http://www.icn.ch/matters_palliative.htm
Nursing Matters (2007) Palliative Care Fact Sheet. Online available at http://www.icn.ch/matters_palliative.htm
Economic Barriers to Palliative Care (2007) Project on Death in America. Open Society Institute. Online available at http://www.soros.org/initiatives/pdia/articles_publications/publications/memo/economicbarriers
The Dying Person's Bill of Rights (nd) Wisconsin Hospice. Online available at http://www.wisconsinhospice.org/images/EOL%20Quality%20of%20Life%20Bill%20of%20Rights.pdf
World Health Organization Definition of Palliative Care (2007) CAPC Manual. Online available at http://126.96.36.199/educate/content/elements/whodefinition.html
Froggatt K.A.,.Hoult L. (2002). Developing palliative care practice in nursing and residential care homes: the role of the clinical nurse specialist. Journal of Clinical Nursing, 11 (6), 802-808
Sidell M. (2003). The training needs of carers. in: Katz J.S., Peace SM. (eds) End of Life in Care Homes: A Palliative Care Approach. Oxford, Oxford University Press. pp.115-130.
SCIE Research Briefing 10: Terminal Care in Care Homes (2004) Social Care Institute for Excellence Sept. 2005. Online available at http://www.scie.org.uk/publications/briefings/briefing10/index.asp
The Role of the Nurse in the Provision of Quality Palliative Care for the Terminally Ill…
(Froggatt and Hoult, 2002; Sidell, 2003; as cited in SCIE Research Briefing 10: Terminal Care in Care Homes, 2004)
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