In this article, Palliative Care: Continued Progress But Gaps Remain,( Morrison, R. 2015) discussing briefly about the different challenges in palliative care, such as, disparities in access, the shortage of trained staff and the need for the government to focus more on palliative care side to improve overall quality of this specialty of care. Over the years, the United States ability in handling serious and end-of-life care is improving, but more services are needed to meet patient demands. In US, large hospital network offers palliative care, but taking into consideration the number of people require palliative care, the service is insufficient in most of the hospitals.
Palliative care is a new team-based medical specialty that focuses
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In the mid 1990’s, palliative care was developed in recognition of the need to enhance the quality of life of seriously ill patients in order to achieve the best possible quality of life for patients. The Center to Advance Palliative Care and the National Palliative Care Research Center have been tracking growth in the prevalence of hospital palliative care services in the U.S. As per the research, even though the largest hospitals in the nation have palliative care services, still disparities in access to palliative care services have persisting. Where one lives matters, it highly depends on the geographical location of the patient. Therefore, the hospitals in the East South Central and West South Central parts of the U.S. are markedly less percentage of palliative care programs. Moreover, the not-for-profit and public hospitals are having the palliative care programs more than for-profit hospitals. Hurdles to receipt of palliative care by high-risk hospitalized patients include late or non-referral by primary treating physicians; clinician misunderstanding of the role and contributions of concurrent
Palliative care is medical or comfort care that reduces the severity of a disease or slows its progress, but does not provide a cure (Dreeben, 2007). Different people have different needs when life is ending. Working with the incurable may sound depressing but death is a certainty and what we do each day for these patients as physical therapist assistants, matters. Providing care effectively and appropriately has a huge impact on the patient, therefore acquiring the ability to comfort and care for a patient at such a critical stage in life, is an amazin...
...red theory to show the relationship of theory to the practice of palliative care in the clinical setting, it is uncertain if this shared theory will improve palliative care practices and nursing competence in caring for the palliative and chronically ill patient. By writing objectively, this article provides valuable information and brings attention to the need for developing indicators to test the shared theory and brings a call to action for education and nursing competence to enhance the quality of life for both nurses and palliative care patients.
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.
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
Dealing with death on a regular basis can take a toll on a person. Being a hospice nurse will never be easy and is certainly not for the faint of heart. A hospice nurse watches patient’s health decline, often times very rapidly, and many times sit by the patient’s side as they pass away. It can be exhausting both emotionally and physically. You need to have a big heart and a strong will to help those in need for the occupation. Sara Schmidt certainly never saw herself in the profession, but discovered that she has a true love for helping people.
End of life care in the Intensive Care Unit (ICU) can be very stressful for ICU nurses due their need to rapidly transition from curative care to end of life care, therefore the interventions they choose are very important. The qualitative study “A Study of the Lived Experiences of Registered Nurses who have Provided End-of-Life Care Within an Intensive Care Unit,” by Holms (2014), explores the experiences of ICU nurses who have provided end of life care to dying patients and their families in the ICU. End of life care according to Radbruch and Payne, is “synonymous with palliative care yet it is more specific to acutely unwell patients who require palliative care in the last few hours, days or weeks of their lives” (As cited in Homs, 2014, p. 549). Sadly, patients in the ICU are critically or terminally ill, and most are unable to plan their own end of life care. Therefore, nurses in the ICU are needed to help guide patients and family members through this process. According to Wright, “95% of patients within the ICU may not have the ability to make informed decisions” (As cited in Holms, 2014, p. 549). The discussion of end of life care in the ICU continues to be a very controversial because care is highly inconsistent due to conflicting opinions on what to base the care for the patient.
This is further corroborated by Ingleton et al (2011), who believed that the need for community-based palliative and end of life care will increase rapidly over the course of the next 20 years because of increasing emphasis on shifting the delivery of care out of the hospital and into primary care which invariably leads to changes in the role of Community Nurses and in the demands on their time. Consequently, the above mentioned changes will place tremendous pressure on community nursing services and family carers (Department of Health, 2006a and Department of Health, 2006b)..
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.
The care of patients at the end of their live should be as humane and respectful to help them cope with the accompanying prognosis of the end of their lives. The reality of this situation is that all too often, the care a patient receives at the end of their life is quite different and generally not performed well. The healthcare system of the United States does not perform well within the scope of providing the patient with by all means a distress and pain free palliative or hospice care plan. To often patients do not have a specific plan implemented on how they wish to have their end of life care carried out for them. End of life decisions are frequently left to the decision of family member's or physicians who may not know what the patient needs are beforehand or is not acting in the patient's best wishes. This places the unenviable task of choosing care for the patient instead of the patient having a carefully written out plan on how to carry out their final days. A strategy that can improve the rate of care that patients receive and improve the healthcare system in general would be to have the patient create a end of life care plan with their primary care physician one to two years prior to when the physician feels that the patient is near the end of their life. This would put the decision making power on the patient and it would improve the quality of care the patient receives when they are at the end of their life. By developing a specific care plan, the patient would be in control of their wishes on how they would like their care to be handled when the time of death nears. We can identify strengths and weakness with this strategy and implement changes to the strategy to improve the overall system of care with...
Death is a universal truth. Hospice reduces the suffering associated with death. Hospice is considered the philosophy and model for quality, compassionate care to terminally ill patients. Patients accepted into a hospice program usually have a prognosis of less than six months to live (Potter, Perry, Stockert & Hall, 2017, p. 761). Hospice provides skilled medical care, pain management, emotional, and spiritual support tailored to the patient’s needs and wishes. The goal of hospice is to focus on the quality of life during the end of life. It gives patients a sense of dignity, provides patients and families with support, and it is cost effective. Today, seven out of ten Americans die from chronic disease. By 2020, the number of people living with a chronic illness will increase to 157 million (Hogan 2012). As the elderly population in the U.S. continues to increase, the importance of hospice will only continue to grow.
Even though many dispute over the value and usefulness of treatment and care of terminally ill patients, the debate for the most useful care and pain reliever for these patients is the question that most patients, and their families, have to ask themselves daily. Wesley J. Smith suggests that Hospice care for patients with such a horrible illness is a beneficial program and that many patients need to utilize it. Smith also recommends that a valuable care option would be to “allow the terminally ill to enter hospice care without having to give up life-extending or curative treatments”. (Smith 3) With this statement, Smith demonstrates a way that these ill patients can be provided with treatment and also care for the patient’s quality of life.
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
Palliative care “focuses more broadly on improving life and providing comfort to people of all ages with serious, chronic, and life-threatening illnesses” (http://www.WebMD.com). Palliative care is not the same as hospice, since it is not only for the dying. According ...
The subject of death and dying can cause many controversies for health care providers. Not only can it cause legal issues for them, but it also brings about many ethical issues as well. Nearly every health care professional has experienced a situation dealing with death or dying. This tends to be a tough topic for many people, so health care professionals should take caution when handling these matters. Healthcare professionals not only deal with patient issues but also those of the family. Some of the controversies of death and dying many include; stages of death and dying, quality of life issues, use of medications and advanced directives.
Palliative care, and the medical sub-specialty of palliative medicine, is specialized medical care for people living with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. The design and implementation of successful inpatient acute palliative care programs primarily serve all patients with complex or serious illnesses (including cancer), yet they also can reduce non-beneficial utilization of acute care hospital services when costs from such admissions typically exceed revenues, in the case of long or high-cost stays. The increase in the numbers and costs of caring for chronically ill Medicare patients has become a