Palliative Care: Members Of Team, Client Needs, Advance Care Planning, Patient Care, Signs Of Deterioration, Symptom Control, Loss And Grief, Resource Suggestions, Policy, Protocol, Procedure, Ethical And Legal Issues

Members of a Palliative Care Team

1.1 List 8 (eight) members of a palliative care team.

1.    The patient
2.    Nurse
3.    Dietician
4.    Physical therapist
5.    Chaplain
6.    A palliative doctor
7.    A social worker
8.    The patients’ loved ones

1.2 Mention 4 (four) responsibilities of the palliative care team

1.    They help in guiding the client in making a decision plan for better living based on their concerns, care, and goals for their care.
2.    Provide the client and their loved ones spiritual and emotional support as well as guidance
3.    Prescribing treatments to regulate discomfort and other painful symptoms.
4.    Help with complex medical decisions, assisting the client to assess the pros and cons of several treatments.

2.1Lifestyle

1.    Exercise
2.    Diet

2.2 Social

1.    Talking to health specialists
2.    Cultural differences

2.3 Emotional

How to deal with:

1.    Anger
2.    Depression

2.4 Spiritual

1.    Making peace with other people
2.    Spiritual pain

3.1 Legal terms
•Advance Care Directive (ACD)

An Advance Care Directive is a way of recording ones’ wishes so that if they are very ill to comprehend or convey their therapeutic treatment preferences, their desires can

still be appreciated. This saves the family stress in case of emergency.

3.2 Enduring Power of Attorney (Medical Treatment)

This is a legal document that permits a different person to make choices regarding their therapeutic care on their behalf. It allows the agent to make the same choices they believe the appointee would have made regarding their health.

3.3 Refusal of Treatment Certificate

This is a voluntarily signed medical document that can only be signed by a person above 18 years and who is of sound mind. It permits them to generally decline therapeutic treatment or any other kind of treatment.

3.4 Ethical issues

In palliative care, ethical issues occur as a result of concerns about what type of care is appropriate for the individual with a limited life expectancy. The conflict also occurs among patients, family members, nurses and other palliative team members regarding what institutes proper care.

4.1 Hydration

Conducting fluid assessment is crucial. It should include an evaluation of vomiting, urine output, an estimation of insensible fluid losses and loss in feces. A thorough evaluation should also include a treatment history that will provide beneficial information on any predisposing factors resulting to hydration.

4.2 Nutrition

Steroids used during chemotherapy may cause nausea thus Brian needs to eat foods that have less odor and low-fat foods as they take longer to digest, protein and calorie-rich foods to help grow and repair body cells and gain weight respectively and fluids to prevent dehydration.

4.3 Respiratory difficulty

Positioning Brian in an upright position to allow him to breathe easily, ensuring that there are dietary modifications to avoid choking, making the room cool, conducting breathing exercises as well as exploring any constant fears like suffocation or choking.

4.4 Swallowing difficulty

Making sure that Brian frequently eats small quantities of room-temperature foods that are easy to sallow particularly soft and smooth foods like puddings and avoid coarse foods that need a lot of chewing like nuts, sits upright when eating or drinking.

4.5 Non pharmaceutical and complementary care for managing pain

Client Needs

Radiations from chemotherapy tend to cause emotional burden and stress conducting yoga will help Brian generate a sense of wellbeing. Additionally, massage will reduce stress contributing to pain control. Acupuncture, on the other hand, will reduce vomiting and nausea during chemotherapy.

4.6 Social and emotional wellbeing

Conducting exercise with Brian to help him relax his muscles and provide a distraction from any negative worries, give him beneficial information to help him comprehend about his cancer better and ensuring he is involved in normal activities like family functions.

5). 

1.    Reduced oral intake
2.    Change in the skin color
3.    A decline in blood pressure
4.    Breathing difficulties

6). 

6.1 Mention 4 (four) indications for use of syringe drivers in administration of pain medication.

1.    Poor oral medicine absorption.
2.    Persistent nausea and vomiting.
3.    Pain during oral medication administration.
4.    Abdominal obstruction

6.2 Specify 2 (two) contra indications for use of syringe drivers in administration of pain medication.

1.    Tubing sets should not be re-sterilized
2.    A pump that has been submerged in water should not be used again

6.3 List 2 (two) indications for intima sub-cut lines for pain relief, anti-nausea and steroid injections

1.    Difficulty in breathing; dysphagia.
2.    Fluctuating levels of consciousness

6.4 List 3 (three) commonly used medications administered using a syringe driver to relieve pain.

1.    Sedatives
2.    Analgesics
3.   Opioids

7.1 Emotional

1.    Varying emotions
2.    Depression

7.2 Cognitive

1.    Confusion
2.    Troubled concentration

7.3 Behavioural

1.    Feeling isolated from other people
2.    The need to isolate oneself from socializing

7.4 Physical

1.    Fatigue
2.    Sleep disturbance-sleeping too less or too much

8.1 Nurse

1.    Help patients create advance upkeep planning choices
2.    They educate the patients on their health condition
3.    Advocating for the patient’s treatment needs as well as those of their families.
4.    They are the principal upkeep givers to their patients

8.2 Social Worker

1.   They act as the patients advocate to assist them to express their final desires,         fears, and needs.
2.    Educate the patients’ relatives particularly on how to deal with the demise of their loved one.
3.    They are vital in assessment and evaluation of the patients’ condition.

8.3 Occupational Therapist

1.    Help the patients’ remain engaged in day-day life activities as well as prepare for a good demise.
2.    Provide education, training, and support to caregivers of palliative persons, from diagnosis to death.
3.    Offers proficient liaison within the upkeep team to promote best outcomes.

8.4 Speech Pathologist

1.    They communicate with the care team and offer input on the general upkeep of the patient.
2.    They assist in optimizing functions associated with swallowing problems so as to improve the patients’ comfort and satisfaction.
3.    They offer consultation to the caregivers, patients and their relatives with regard to dysphagia; swallowing.

8.5 Physiotherapist

1.    Help progress the quality of life for the patients
2.    They offer education to the patients about their condition
3.    They assist in the assessment of the patients
4.    They play a role in symptom management

9). 

1.    Bereavement Care Centre (Australia) – offers comprehensive and available counselling to the bereaved families.
2.    Crisis, Grief, and Healing (USA) – provides grief dialogue boards to talk over matters concerning grief and recovery.

10). 

10.1 Policy

1.    The Universal screening for palliative care requirements policy – patients are screened during dialysis and hospital admittances.
2.    The Expense Reforms for Palliative Care Services policy – to maintain the capacity building for palliative care facilities required.

10.2 Protocol

1.    Clinical Protocol – supports the exercise of administering one or more drugs through intravenous infusion.
2.    Palliative Care Assessment Protocol – offers direction for clinicians using the clinical evaluation tools.

10.3 Procedure

1.    Pain management procedures
2.    Procedures at time of death

11). Withdrawing therapeutic intervention – this involves ending medical treatment that has no positive value. It is not beneficial to combat the disease with forceful therapeutic interventions when the illness cannot be controlled

12). The holistic assessment guidelines assist professionals and supervisors to work together to create a unified approach to holistic mutual evaluation. The assessment should aim at the patients’ as well as relatives and caregivers needs by considering the physical, emotional, personal and social needs.

13). This legislation helps provide a way for able individuals who dread hostile end-of-life treatment to indicate the type of therapeutic care they would or would not like if they no longer had the ability to make their personal choices.

14). 

14.1 Cultural differences

Inpatient care cultural diversity is stated as the acceptance of personal characteristics, like, religion, gender, income, geographical location, skin color and facilitating equal access to culturally proficient healthcare. This is done by referring appropriate cultural resources to patients.

14.2 Role of Religion and Faith

During end-of-life care, religion and faith play two vital roles they include; establishing an ethical basis for clinical decision-making as well as providing a set of basic principles about life events.

15.1 Organ donation

Organ donation is an act of human solidarity. Organs should be obtained in a manner that honors the wishes of the deceased, human dignity and gives precedence to the potential donor’s family’s needs. The patient’s decision not to donate should be valued.

15.2 Request for autopsy

An autopsy can be performed only if the immediate family to the patient give their consent. The family can also limit the extent of the autopsy. They can also decide whether or not tissues obtained from the patients’ body can be preserved for advanced study.

15.3 Decisions regarding ACD

Advance care planning values a persons’ right to decide how choices are made regarding their care. Each individuals’ likings should not be assumed during decision-making. Individuals approach towards decision making cannot be employed if they are not able to make their own healthcare choices.

References:

DeWit, S.C. and O’Neill, P.A., 2013. Fundamental concepts and skills for nursing. Elsevier Health Sciences.

Hunter, C., 2016. Program Evaluation: Preferred Hospice.