The Liverpool Care Pathway was a programme developed in the late 1990’s by the Royal Liverpool University Hospital and Liverpool’s Marie Curie Hospice, for delivering palliative care to people with terminal illnesses in the United Kingdom. The fundamentals of the pathway were to help doctors and nurses provide quality end-of-life care, ensuring a peaceful and comfortable death for patients. It aimed to guide health staff looking after a terminally ill patient on matters such as the suitable time to remove tubes providing food and fluid, as well as on when to stop admitting medication. However, the pathway was abolished after a review that took place in 2013 due to several controversial issues: reports found that many people complained that …show more content…
Despite this framework, to support health care staff, being phased out of the United Kingdom it is continued to be used in 21 countries globally including: Australia, New Zealand and India.
During the nineteenth century it became more apparent that end-of-life care standards in the United Kingdom were variable. Specifically, there was a large amount of concern around patients being subjected to treatment methods and testing that did not prolong their lives, and the pain that came with the ongoing treatment methods in place. Serval hospitals were not keeping up with standards that were being produced in hospice care settings, which promoted the idea of taking elements of the hospice setting and putting them into use in hospitals and home care. This idea emerged into an integrated pathway titled, The Liverpool Care Pathway, to provide a structured record and guidance for health care professions to use in palliative care. The pathway itself had three sections: initial assessment, on-going daily assessment and care after death. It took into consideration all four elements of
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The evidence submitted to the panel through members of the public and health care professionals, who had experience with the use of the LCP, were published under a document titled “More Care, Less Pathway”. The review team identified several issues surrounding end-of-life care and the pathway. The first confusion being of the term “end-of-life”, which covers prognosis from many months down to several days. In the case of applying the LCP to a patient the term caused confusion, as health care staff were likely to misinterpret the statement and lead to the pathway being initiated inappropriately. It acknowledged how hard it is to diagnose when a patient is going to die, but in some circumstances placing patients on the LCP caused distress to family members when the patient then recovered. For example, one patient named Kathleen Vine was under the LCP and after four months of treatment she was allowed back home describing her experience under the pathway as “distressing” and felt like she was “being left to die”. The ninety-year old patient was taken into hospital for a shoulder injury, but her family were told by health care professions that she only had 48 hours to live and was being put onto the LCP. Family members were confused as they did not understand how a dislocated shoulder spiralled into a situation in
Many people are unaware of what Hospice does and where they can find one, but Hospices have actually been around since the Middle Ages. People living during the time made shelters where they took in weary people who had no place to go. They called these places “Hospices” (History of Hospice). Later on, Dame Cicely Saunders had an idea to expand these places. Dame Cicely Saunders served as a nurse during World War II (The National Hospice Foundation). After watching all of the soldiers suffering during the war, Saunders was devastated to see all of those men die painful deaths. This sparked the idea for Saunders to create a place where people could peacefully die. She would call this place “Hospice”. The first Hospice was established in London in 1967 (The National Hospice Foundation). After opening the London Hospice, Saunders decided she wa...
Terminally ill patients deserve the right to have a dignified death. These patients should not be forced to suffer and be in agony their lasting days. The terminally ill should have this choice, because it is the only way to end their excruciating pain. These patients don’t have
Gawande’s book is very pertinent to the present day and has by many accounts sparked a national discussion on end-of-life care and how we treat our elderly. With elderly people accounting for a greater proportion of the American populace and as people start living even longer than they do now, end-of-life care will become and remain a major issue faced by doctors, patients, their families, and the healthcare system. Additionally, with our greater focus on improving patient outcomes while getting the most value for our healthcare dollars, end-of-life care is a major area that healthcare systems and hospitals will focus on, as it accounts for a large portion of their budget. As a response to the need to take care of our aging population, hospice care and palliative medicine are some of the newer specialties in the medical field that have been increasing in popularity and more research needs to be focused in these areas to better understand how to improve patient outcomes.
However, the framework in practice is very complex, and has various inconsistencies, such as the legality of refusing treatment, the sovereignty of a living will and the issue of prosecuting those who assist someone to end their lives. There is evidence that shows doctors using palliative sedation as a means to facilitate death in patients that are in extreme pain and the use of limiting or even stopping treatment at the patient’s request is not uncommon. The difficulties of putting the law into practice make it extremely difficult for courts, legislators and doctors to reach clear decisions on individual cases. Therefore, the inconsistencies in the legal framework need to be addressed, as with these present the argument against legalising the right to die is weakened. Legalising assisted dying would simplify the framework and ensure that set barriers and safeguards could be created in order to protect the patient and his/her
Thanks in part to the scientific and technological advances of todays’ society, enhanced medicinal treatment options are helping people battle illnesses and diseases and live longer than ever before. Despite these advances, however, many people with life threatening illnesses have needs and concerns that are unidentified and therefore unmet at the end of life, notes Arnold, Artin, Griffith, Person and Graham (2006, p. 62). They further noted that when these needs and concerns remain unmet, due in part to the failure of providers to correctly evaluate these needs, as well as the patients’ reluctance to discuss them (p. 63, as originally noted by Heaven & Maguire, 1997), a patient’s quality of life may be adversely affected. According to Bosma et al. (2010, p. 84), “Many generalist social work skills regarding counseling, family systems, community resources, and psychosocial assessments are relevant to working with patients and families with terminal illness”, thereby placing social workers in the distinctive position of being able to support and assist clients with end of life decisions and care planning needs. In fact, they further noted that at some point, “most social work practitioners will encounter adults, children, and families who are facing progressive life limiting illness, dying, death, or bereavement” (p. 79).
The first journal article is about advance care planning (ACP) in palliative care. This is of interest due to several clinical experiences and the realization that many families either ignore the patient’s request for end of life (EOL) care or who have no idea of how to plan for EOL care. By reading the research and understanding the methods used, this will allow for insight into how to implement palliative care into clinical practice across different sites. The authors of this original research are Jeanine Blackford PhD, RN, senior lecturer at La Trobe University in Australia, and Annette Street PhD, associate dean of research and professor of cancer and palliative care studies. According to Blackford & Street (2011), this research is important as there are many countries that “report a low percentage of people who have completed an advance care plan” (p. 2022), and ACP is needed upon admission to facilities that offer palliative care. In addition, the purpose of the study is to try and obtain guidance to integrate an ACP model into routine clinical practice in the community. The research question chosen for the analysis of this article is: Is it feasible to implement ACP into routine practice and documentation at multi-site locations in...
Hospice focuses on end of life care. When patients are facing terminal illness and have an expected life sentence of days to six months or less of life. Care can take place in different milieu including at home, hospice care center, hospital, and skilled nursing facility. Hospice provides patients and family the tool and resources of how to come to the acceptance of death. The goal of care is to help people who are dying have peace, comfort, and dignity. A team of health care providers and volunteers are responsible for providing care. A primary care doctor and a hospice doctor or medical director will patients care. The patient is allowed to decide who their primary doctor will be while receiving hospice care. It may be a primary care physician or a hospice physician. Nurses provide care at home by vising patient at home or in a hospital setting facility. Nurses are responsible for coordination of the hospice care team. Home health aides provide support for daily and routine care ( dressing, bathing, eating and etc). Spiritual counselors, Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family. Social workers provide counseling and support. They can also provide referrals to other support systems. Pharmacists provide medication oversight and suggestions regarding the most effective
Death comes to all in the end, shrouded in mystery, occasionally bringing with it pain, and while some may welcome its finality, others may fight it with every ounce of their strength. Humans have throughout the centuries created death rituals to bring them peace and healing after the death of a loved one.
One of the greatest dangers facing chronic and terminally ill patients is the grey area regarding PAS. In the Netherlands, there are strict criteria for the practice of PAS. Despite such stringencies, the Council on Ethical and Judicial Affairs (1992) found 28% of the PAS cases in the Netherlands did not meet the criteria. The evidence suggests some of the patient’s lives may have ended prematurely or involuntarily. This problem can be addressed via advance directives. These directives would be written by competent individuals explaining their decision to be aided in dying when they are no longer capable of making medical decisions. These interpretations are largely defined by ones morals, understanding of ethics, individual attitudes, religious and cultural values.
The change which is outlined in this paper relates to how early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management. PICO format question will be used , along with a supportive body of evidence regarding the fact that early onset into a hospice program is helpful with providing end of life pain control. Hospice programs available, and options associated with them will be discussed as well as common concerns associated with early admission to hospice. The methods used for payment of hospice, and how one qualifies for entrance into a hospice program will be explored. A literature search will be performed and its results detailed within the body of this paper. Recent publications on the subject matter and associated issues such as moral and ethical questions as well as the change question will be discussed. Planning, implementing and evaluation of the change proposed will be explored within this paper.
Overall the need for a better based end of life care strategy is warranted globally. More of a focus should be given on care and high quality service for patients. As of now too much decision lies with the healthcare professionals and this can lead to faulty decision making because the health care providers are doing what they believe is in our best interest. In reality the patient or ourselves only have the true idea how we would like our final days to be carried out. By developing and carrying out an end of care plan we can take the decision making out of the family and doctors and place it on the patient. By all counts the need for change is apparent within the healthcare industry in regards to end of life care. By considering this unique change a great deal of improvement can be derived from this decision making process.
THOMAS, K. and LOBO, B., 2011. Advance care planning in end of life care. Oxford: Oxford University Press.
Palliative care involves the holistic care to maintain and improve the quality of life of the patient and family during hospitalisation until the terminal stage. Palliation of care refers to the multidisciplinary approach of providing comfort and support for the terminally ill patient and family, thus has an important role in maintaining and improving the quality of life of the whole family. Chronic illness such as cancer gives a physiologic and emotional burden for the patient and family. Education and counselling of the possible options as well as treatments for pain and other symptoms that could help alleviate anxiety, suffering and discomfort. Palliative care provides assistance for the family as a channel for communication between the
The end-of-life nurse’s primary objective is to provide comfort and compassion to patients and their families during an extremely difficult time. They must satisfy all “physical, psychological, social, cultural and spiritual needs” of the patient and their family. (Wu & Volker, 2012) The nurse involves their patient in care planning, as well as educating them about the options available. They must follow the wishes of the patient and their family, as provided in the patient’s advance directive if there is one available. It is i...
The primary reason why I’ve come to this view. Each patient diagnosed with a prolonged terminal illness has a unique response to their medical situation based on many factors such as; support