Conceptualization of palliative care in the USA
1. End stage cancer has been reported to have a deleterious and disengaging impact of the living conditions and the will to live among the patients with terminal disease. The impact of impending death and the perceived distress of the family members of patients after the death is known to give rise a varied number of challenges and restrictions in success of the palliative care that has been planned for the patient (Harvey, 2016). The will to live among the patients for these terminal diseases is often very less, hence, the nature of the palliative care can have a significant impact on the last few days or months for a terminally ill patient. The palliative care practice in USA has changed drastically in the last couple of decades, it has evolved significantly from the singular focus on the end of life care which is based entirely on the comfort of the patients to a completely broad and multifaceted interdisciplinary specialty approach which can potentially address the each and every holistic care needs of the terminally patient and their family members as well (Littlewood, 2014).
The practice scenario of the palliative care in the USA is now conceptualized as patient centered and family oriented care. The present western medicine technique of palliative care especially in the USA attempts to optimize the quality of life of the terminally ill patients by the means of anticipating, managing and preventing sufferings encountered. The primary focus of the palliative care practice is on pain management and the related distressing symptoms through pharmacological and non-pharmacological treatment methods. Along with the traditional means of medical aid, complementary or alternative medication (CAM) technique is also increasingly being used for terminally ill patients, especially for pain management. The beneficial impact of CAM has been very successful in improving the living experience of the patients along with providing much needed relief from the exhaustive pharmacological treatment procedure (Morrison, 2013). On a more elaborative note, for the young adults that are suffering from cancer or similar terminal illness, providing quality comprehensive care is often very difficult. In such cases, the implementation of CAM in conjunction with traditional therapies have been reported to be more effective in enhancing the quality of life and experience of the patients. For the elderly populations as well, the impact of the using both conventional westernized treatment methods in conjecture with the holistic alternative treatment methods is expected to yield better results in both patient satisfaction levels and in care outcome (Wilson et al., 2014).
Use of complementary and alternative medicine (CAM) in palliative care
2. Culturally diverse communities often experience various cultural and traditional restrictions when receiving curative care delivery with respect to palliative care given to the patients. There are various struggles such as communication around death and dying, anger regarding the impending death, family conflict, family centered care giving during the end of life stage, cultural differences, the concept of informed consent, and time flexibility. While the traditional treatment measures are exhaustive and pain inducing, the complementary or alternative medication techniques are also often associated with extensive activities such as acupuncture, yoga, and meditation, which might lead to cultural complications (Corin, 2017).
In this case, if Ella decided to continue with CAM mode of treatment, the reaction in her family is expected to be content and supportive of the decisions taken as the CAM treatment modes are more acquainted with the traditional healing techniques. However, if Ella is coerced into the mainstream medicine techniques, the family members might feel extremely agitated and angry for their cultural safety being violated and their loved family member being forced into a particular treatment method. Next, If Ella’s husband insisted his family traditions to be followed, it might interfere with the caring approach that is needed for the patient under consideration. Ella is a cancer patient and she might need a curative and individualized care plan involving the aid of both mainstream medication and CAM medication as well in order to be able to address each of the care needs that she is exhibiting. Hence, her family will have mixed reaction to this, whereas the elderly might feel content with Ella being treated with only traditional treatment methods; and on the other hand, the young generation of the family might disagree, concerned about her safety and wellbeing (Muriel & Brent, 2017).
The biological basis of care illustrates the impact of the illness along with the treatment procedure on the overall living experience of the patient and the family members as well. In this case, the care approach taken for Ella will have a significant impact on her state which will indirectly impact her son, daughter, grandson, granddaughter and daughter-in-law. Her son is alcoholic which can contribute to challenging behavior, hence in case the care approach is not optimal and effective for Ella, her son might be angered and agitated. Similarly her daughter is also diabetic which might lead accelerate the anxiety with underlying cardiac problems. Both her grandchildren are drug addict and the condition of their grandmother might affect them dearly and aggravate any psychotic issue. Lastly, her daughter in law is suffering from stress and anxiety, and the trouble, pain or struggles during the last few months of Ella’s life might enhance the stress on her daughter in law as well (Burke et al., 2015).
Cultural and traditional restrictions when receiving curative and palliative care
3. Terminal illness diagnosis and the impending death is an event which can have a life altering impact on the family as well. The impending future where a family will have to bid adieu to their loved one devastates each of the family members, and the coping strategy of each of the members will differ along with their reactions to the prognosis of a terminal illness. These factors influence the patient and the family members considerably, these influences can be categorized into micro-, meso-, and macro- categories. First and foremost, discussing the micro-influence, the effect of her prognosis in the pertinent and likely family members will be affected by the prognosis and progress of Ella, and hence it might lead to certain conflicts and differences complicating the stay or experience Ella has. First and foremost, the type of care approach taken and whether or not it adheres to traditional beliefs of healing can be a major reason for conflict. Along with that who would be the direct point of contact or carer for Ella can also be a reason for conflict among her husband and children. The responsibility of funding Ella’s care can also be a major reason for conflict in her family so as who will be taking care of the funding and if all of them are going to fund alternately (Davis, Deane & Lyons, 2015).
The impact of a terminal such as cancer will also affect the extended family and even the neighborhood. Whereas going through the hardship of going through the terminal illness can strengthen relationships within the immediate family members, the impact of the pain and struggle of cancer can lead to impacting the psyche of the extended family and the neighborhood as well. Similarly, sympathy and acceptance from the meso-environment can help Ella and her family feel empowered and encouraged to go through the hard times and build resilience. Similarly, in case the extended family and neighborhood extends social isolation and withdrawal for Ella and herv family it will add to their woes (Israel, Baruiz & Solis, 2016).
Two local Australian institutes that can provide assistance to Ella and her family in her care includes Palliative Care Australia which is a person and family oriented care service providing assistance and support for the patients with a terminal illness with no prospect of care (Palliativecare.org.au, 2018). For this organization, the main focus of the organization is to enhance the quality of life of such patient and provide them a comfortable experience while living the last months of their life. Another considerable organization that can help Ella and her family is Palliative Care nurses Australia or PCNA that provides palliative care nursing service to the terminally ill and dying patients, providing care and assistance to the patients and the families to cope with the changes Ella’s life as well as her family members’ (Pcna.org.au, 2018).
Impact of the terminal illness and impending death on the family
4. A patient with a terminal disease is associated with various different complications and complexities and hence when the prospect of cure is also missing from the care scenario, the only care need that the terminally ill patient awaiting the time of death exhibit comfort and enhancement of the quality of life. In this case the hospice stay, whether it is in a hospital or if it is in the cozy environment of their own house, facilitates a huge difference in the outcome of the quality of life. On a more exploratory note, as mentioned by Lustbader et al. (2017), there are various comfort related issues and complexities associated with palliative stay in a hospital and as a result most of the terminally ill patients prefer to stay in their home and receive whatever care they can ion the home setting to be able to spend the last few days or months of time in the familiar and comfortable ambience of their own homes.
On a more elaborative note, most of the terminally ill patients that have no prospect of cure prefer the known, familiar ambience of their homes with which they have an emotional attachment; hence, before inevitable death, the patients often crave one last encounter with the home environment among their loved ones. As discussed by Ventura et al. (2014), in case of culturally diverse patients, the traditional beliefs and spiritual connections also drives the patients to want to live the last of their days and then die in their own house and among their family and loved ones. Considering the advantage of home stay for terminally ill patient, the comfort, peace and contentment of being surrounded by their loved ones in a house with emotional and spiritual attachments has to be discussed. However, there are considerable disadvantages of home based palliative care as well. First and foremost, terminally ill patient patients often require the aid of mechanical ventilation and monitoring in the severe stage which is difficult to provide in a home based setting (Hopp et al., 2016). Maintaining proper hygiene and sterile environment along with medication administration, most importantly IV medication of the hospital based setting is difficult to be replicated in the home setting as well. Managing any emergency deterioration in the patient condition which is a common occurrence such as cardiac deterioration, respiratory distress and even organ failure becomes difficult to manage in home setting (Hua et al., 2018).
Local organizations that can provide assistance in palliative care
5. The terminal illness is intricately linked with pain, struggle and suffering, hence the concept of coping with these stressors develops significant impact on the psychological and social issues. First and foremost, a terminal illness and the impending death alters the perspectives and even the behavior of the patient suffering from the terminal illness is modified, and as a result the family members of the patients are also subjected to the stress as well. Considering the psychological issues that are prominent in this condition, the grief, anxiety and helplessness among the patient and the family. Most importantly, the inability of the family members to save Ella or even reduce her suffering along with the wish to prolong her inevitable death as far as possible will be a detrimental impact on the psyche of the patients and their family members (Doka, 2016). Considering the social issue, the financial burden of continuing the care for her might lead to considerable burden on the family. Along with that, unequal treatment from the community or extended family, cultural restrictions and discouragement from them can also affect their resilience and affect Ella and her experience as well. The chronic illness that has persisted or has been ongoing for a long period of time can result in many psychological issues on the family. The inability to cope with the stress of watching a loved one go through extreme hardship towards an inevitable death and the helplessness of not being able to help her could have led her son to alcohol addiction and aggravated the stress and anxiety of her daughter in law. The torture Ella had been going through and the stressful and depressing home ambience due to her ongoing illness could have propelled her grandchildren to substance abuse as well (Bowen, 2018).
6. Cultural diversity has a profound role in care delivery scenario, when providing care to a culturally diverse patient the care provider must ensure that the he care provided is culturally appropriate and adheres to cultural safety standards. Although diversity has a strong impact on how patients and the pertinent family reacts to illness as well, especially for chronic or palliative illness. It has to be acknowledged that Ella, the patient in the care scenario belonged to a family that was not just culturally diverse but had a diverse mindset and ways of coping with the stress of having to watch a member die due to terminal illness (Doka, 2016). The psychosocial struggle was evident in the family when the rest the family chose alternative medicine and her husband John insisted she continue with mainstream cancer treatment. Such conflict of interest can affect the care decision making and complicate the condition of the patient as well and in order to avoid it affecting the care for the patient, the care decision making should prioritize the choices of the patients. Considering the impact of the stress of her cancer prognosis, both financial and psychological has led her son to alcohol addiction and her grandchildren to substance abuse, and there is need for care planning that will focus on patient and family behavior modification and coping skills (Bowen, 2018).
7. Death is a catastrophic event for a family and it can never be easy for a family to cope with the loss of a loved one with whom they have shared a lifespan. Although, when faced with such a saddening prognosis it also helps to bring the whole family together and decide on optimally comforting and best solution for their loved one. In this case, different members of her family decided on different care approaches for her to be taken and the lifespan development for them has had a significant impact on their choices. John is a Native American who had lived in a city and was more acquainted with the westernized culture and ways of living. Hence, his insight and judgment were also influenced by the western culture which led him to choose mainstream medication for Ella. Although, Ella grew up in a farm where she was more acquainted with home remedies and traditional approaches to care which had been her and her extended family’s choice as well. The conflict of choices has resulted due to different upbringing, lifestyle, socio-demographic ambience and judgment of the both groups (Israel, Baruiz & Solis, 2016).
Although, considering the impact of intellect and cognitive ability, her son was an alcoholic with considerably altered judgment and cognitive abilities, which has a huge impact on his decision making for Ella. Her grandchildren were also dealing with drug addiction which alters cognitive thinking and judgment as well. In this case, these socio-cultural factors have undoubtedly given rise to care decision making issues. However, in this the family must prioritize the wishes and preferences of Ella as she transcends to her impending death and support her through this journey providing her comfort, love and care (Perkins, 2016).
References:
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