Palliative Care in Nursing and Healthcare

Michelle Brown, Michelle Brown, Author

• Publisher: SAGE Publications Ltd
• Year: 2015
• Print ISBN: 9781446295694, 9781446295687
• eBook ISBN: 9781473969353
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

This book helps nursing and healthcare students to prepare for the challenges of working with the increasing number of patients requiring palliative care, so that they can work in partnership with patients and their carers, providing care that is compassionate, practical and backed up by the latest evidence. Delivering palliative care can be emotionally challenging and the book focuses on supporting healthcare staff, allowing them to provide the care that is needed.

Key features include:

* case studies in every chapter, helping students to practically work through difficult scenarios

* reflective activities that assist readers in thinking critically about their care and how to improve it

* a holistic approach to palliative care that includes family, carers and interprofessional work

* up to date theory and policy.

Palliative Care in Nursing and Healthcare is suitable for undergraduate nursing students and allied health students and practitioners.

 Michelle Brown is Senior Lecturer at the University of Derby.

1 Palliative care past, present and the future

Michelle Brown

This chapter will explore:

• the philosophy underpinning palliative care
• the journey that palliative care provision has taken and where we are now
• the tools available to help care for those with a life-limiting condition
• the palliative care needs of patients with a life-limiting illness including those with a non-cancer diagnosis.

Reflection points

Start by thinking about these reflection points:

• What is palliative care?
• Who can access palliative care services?
• Who delivers palliative care?

Palliative care and its goals

You matter because you are you. You matter to the last moment of your life, and we will do all we can not only to help you die peacefully, but to live until you die. (Saunders 1976: 1003–4)

As nurses, we work with patients in order to promote and achieve individualised care. This is because we recognise that a patient is not just a set of physical symptoms or a diagnosis, they are also a physical being with psychological, social, spiritual and emotional needs. Identifying what is important to each individual patient helps us to prioritise their care needs and helps to ensure that we support them and create the optimum quality of life for that individual right up until their death. The concept of a ‘good death’ is what we all strive for as professionals, and therefore assisting a patient in achieving that should be our ultimate goal and indeed our responsibility.

Palliative care from the beginning

The hospice movement developed its impetus in the 1960s and 1970s. One of the key drivers in initiating this dynamic change was Cicely Saunders (later to become Dame). She generated a new vision surrounding caring for those at the end of life. It was one which incorporated a holistic view of the patient rather than seeing them as a set of physical symptoms. She achieved this vision by engaging and listening to the individuals in her care and noted that they were experiencing more than just physical symptoms, believing that these physical symptoms had psychological, emotional, social and spiritual components.

The goal of palliative care is to achieve the best possible quality of life for patients and their families (World Health Organization (WHO) 1990). ‘Palliatus’ is a Latin term meaning ‘to cloak or conceal’, therefore palliative care involves utilising comprehensive holistic assessments and adopting appropriate treatment strategies in order to improve quality of life for those with a life-limiting illness (Claxton-Oldfield et al. 2004). There are a number of ways that we can treat a patient with a life-limiting illness; for example, medical palliation is the active relief of a symptom or a problem which does not necessarily affect lifespan. Palliative care does not simply involve the administration of a cocktail of drugs (pharmacotherapy), but also involves a multitude of interventions in order to help, support and care for those patients and their carer and/or relative. Symptoms may be multidimensional, meaning they do not only derive from a physical problem. An example could be a patient who has heart failure and feels that she is dying. She may have other psychological issues as her husband died in a distressed state from heart failure five years before. In addition, she may have severed contact with friends because she may not want to burden them or feel like socialising due to her current state of health. This would mean that she has emotional, psychological and social issues which may be exacerbating her condition, so dealing with only physical symptoms would not address the whole problem. Holistic assessment is the key to addressing any issues or aspects that may be contributing to the patient’s diminished quality of life.

Palliative care: the present

There have been dynamic changes in palliative care provision within the UK to improve palliative and supportive care provision. These changes have been driven by research, recommendations, strategies and policy. The pivotal points include the introduction of the Department of Health’s End of Life Care Strategy (DH 2008) and the introduction of the Gold Standards Framework (Thomas 2003; National Health Service (NHS), Royal College of General Practitioners 2006). These frameworks alongside many other publications suggest standards of care that should be employed when caring for a patient and their family as they approach the end of life, including the opportunity to decide where and how they would like their care to be delivered (NHS 2014). The preferred place of care (PPC) allows a person to be cared for in an environment of their choice, which may be home, hospital nursing home or hospice (see Chapters 9 and 10 for further discussion). The National Institute for Health and Care Excellence (NICE) (2011b) stated that we should optimise the amount of time people spend in their PPC during the last year of life. To enable this to happen, coordinated, high-quality care is needed so that the individual feels confident that the care delivered is meeting their needs and that they are comfortable in the PPC. NICE have, in addition, produced standards to aid high quality end of life care which include: ‘improving supportive and palliative care for adults with cancer’ (2004); lung cancer guidance (2011a); standards for care at the end of life (2011b); and the use of opioids in end of life care (2012). Currently further guidance is being compiled including care of the dying adult (NICE 2015a, b, c), an update surrounding improving supportive and palliative care adults, due in 2018 and guidance for end of life care for infants, children and young people in 2016. In addition, organisations have been developed and work in collaboration with the National Health Service and Department of Health, such as the National Coalition for Hospice and Palliative Care (NCHPC), National End of Life Care Intelligence Network (NEoLCIN) and The Marie Curie Palliative Care Institute Liverpool (MCPCIL), to drive the quality of services in palliative and end of life care. The guidance available embraces common themes, which include the recognition that clear communication between all the members of the multidisciplinary team and the patient is paramount. In addition, education and support for staff caring for individuals with a life-limiting illness and the need to ensure that patients are central to all decision making using enhanced and effective communication skills are vital.

The issues are that worldwide, there is a lack of education and knowledge in those caring for people in the palliative phase of illness, yet the need for palliative and end of life care is significant and increasing (WHO 2014). Over 19 million people worldwide need palliative care, with 69 per cent of those being over the age of 65 (WHO 2014), so this sets an enormous task as health and social care professionals need to have some understanding about how to care for these individuals using the philosophies and standards suggested (see Figure 1.1).

Figure 1.1 Age of people requiring palliative care (WHO 2014)

This cannot be achieved without addressing people’s educational needs and supporting them in achieving the competence and confidence required to provide the high-quality palliative and end of life care everyone deserves. There are inherent difficulties in ensuring that patients receive high-quality palliative and end of life care, no matter where the patient is. In acute hospitals this may be challenging due to the environment itself (e.g. lack of privacy, lack of peace and quiet if they require it). There are challenges for staff regarding the need to spend time with those nearing end of life and to give them the care they need whilst at the same time attending to patients with acute ill health who need urgent attention. Trying to meet everyone’s needs is a dilemma in itself.

Palliative care models and tools

Tools have been designed and introduced to assist in the delivery of integrated high-quality end of life care no matter where it is delivered. The Liverpool Care Pathway introduced in the 1990s was adopted as best practice by NICE and the DH (Ellershaw et al. 199...

Table of contents

• Cover
• Half Title
• Publisher Note
• Title Page
• Copyright Page
• Contents
• About the editor and contributors
• About this book
• 1 Palliative care past, present and the future
• 2 Care and compassion in palliative care
• 3 Holistic assessment
• 4 Care planning and changing care needs
• 5 Supporting carers and families
• 6 Interprofessional working in palliative care
• 7 Communication in palliative care
• 8 Dealing with ethical dilemmas
• 9 End of life care
• 10 Death and dying
• 11 Support for the practitioner
• Index