Palliative Nursing and Spirituality - Essay Example

?Palliative Nursing and Spirituality in Greater Western Sydney 0. Introduction Palliative care is caring for one who has terminal illness (Taylor and Box, 1999, p. 6). It involves supporting people “who are suffering from an illness from which no cure can be anticipated” (Taylor and Box 1999, p. 6). The aim of palliative care is “to maximize the quality of a person’s life” (Taylor and Box, 1999, p. 6). It is a multi-disciplinary effort. The aim is sought to be realized through the coordination and delivery of a range of services to individuals who are the subject of palliative care (Taylor and Box, 1999, p. 6). According to Taylor and Box (1999, p. 6), “it is recognized that a range of problems, including physical, emotional, social and spiritual may need attention” in palliative care. A multi-disciplinary team delivers palliative health care where the person wants it to be (Taylor and Box, 1999, p. 6). Thus, palliative care can be delivered in the person’s home, hospice, hospital, and a nursing home (Taylor and Box, 1999, p. 6). However, according to Taylor and Box (1999, p. 6), the primary caregivers in palliative care are actually the family, relatives, and friends of the object of care although a palliative care team provides the professional help. Perhaps, one of the most important concerns in palliative care is to reduce the pain associated with the illness or even the dying. Relief and alleviation of pain can be achieved through a range of “painkillers and other drugs, massage, meditation, aromatherapy, acupuncture, radiotherapy” as well as morphine tablets and skin patches (Taylor and Box, p. 6) Palliative nursing is practised in the context of significant human suffering in which the nurse is both a witness and a participant (Aranda, 2008, p. 573). This implies that the nurse is subject to stress and anguish just as the patient. Yet, improving the quality of life even in dying is a central goal of health care (Aranda, 2008, p. 574). 2.0. Greater Western Sydney and Demographics The demographics of Greater Western Sydney imply a multi-cultural setting and a multicultural spirituality. Greater Western Sydney covers 8,000 square kilometres composed of the fourteen local governments of Auburn, Bankstown, Baulkham Hills, Blacktown, Blue Mountains, Camden, Campbelltown, Fairfield, Hawkesbury, Holroyd, Liverpool, Parramatta, Penrith and Wollondilly (Greater Western Sydney Economic Development Board, 2004, p. 1). The Greater Western Sydney Economic Development Board (2004, pp. 1 and 3) considers Greater Western Sydney to have a “culturally diverse population” of 1.8 million in 2003 that is projected to be at 2.2 million people in 2026, with an estimated population growth rate of +0.9% per annum. Greater Western Sydney’s estimated annual population growth rate of 0.9 % is higher than the population growth rate for Sydney and New South Wales of only 0.8 (Greater Western Sydney Economic Development Board, 2004, p. 4). Greater Western Sydney is the traditional home of the following aboriginal peoples: Eora/Dhawal, Dharug, Gandangara, Eora, Tharawal (Two Ways Together Regional Report, 2006, p. 7). The presence of Aboriginal groups in Greater Western Sydney is highlighted further by the existence of four Aboriginal Land Councils: the Deerubbin Local Aboriginal Land Council, the Gandangara Local Aboriginal Land Council, the Metropolitan Local Aboriginal Land Council, and the Tharawal Local Aboriginal Land Council (Two Ways Together Regional Report, 2006, p. 8). According to the Two Ways Together Regional Report (2006, p. 8), aboriginal men compose 20% of the manufacturing male workforce, 13% of the construction male workforce, 10% of the retail male workforce, 9% of the transport and storage male workforce, 7% of property and business services male workforce, and 7% of the wholesale trade male workforce. Further, according to the same report (p. 10), aboriginal women compose 15.6% of the retail female workforce, 12% of the education female workforce, 10% of the property and business services female workforce, 10% of the health and community services female workforce, and 17% of the manufacturing female workforce. . In 2001, the Aboriginal population of Greater Western Sydney was estimated at 23,282 and was believe to constitute almost a fifth of Australia’s Aboriginal population (Two Ways Together Regional Report, 2006, p.11). In all of the 14 local governments, it is clear the aborigines compose a significant part of the population. In 2001, the breakdown of Aborigines per local government area is as follows (Two Ways Together Regional Report, 2006, p. 11): 6,093 in Blacktown; 3,602 in Campbelltown; 4,117 in Penrith; 2,038 in Liverpool; 1,303 in Bankstown; 1,147 in Parramatta; 1,118 in Fairfield; 384 in Hawkesbury; 863 in Blue Mountains; 680 in Holroyd; 576 in Wollondily; 525 in Camden; 464 in Auburn; and 372 in Baulkham Hills. Based on these demographics, it is easy to see that from the Aboriginals alone, we see a diversity of faith and spiritual beliefs. Other than this, we expect that the Greater Western Sydney population is composed of various Protestant Christians, Islamics or Muslims, Catholics, Buddhists, and people of various faiths and spirituality. These imply a plurality of belief systems and forms of spirituality. Thus, the concept of diversity is useful “when thinking about and caring for people” (Boogaerts and Merritt, 2008, p. 53). 3.0. Palliative Care According to the Palliative Care Australia (2009), palliative care includes comprehensive care for the needs of patients, caregivers, and families with complex needs. Further, in all the upper three levels of palliative care as well in the primary care level of palliative care, nurses including clinical nurses play a role. At the level of primary care of palliative care, the following types of nurses play a role in palliative care: registered nurses, generalist community nurses, and nurse practitioners (Palliative Care Australia, 2009). At levels 1 to 3 of “specialist palliative care”, clinical nurses play a role, usually as part of the health personnel in a multi-disciplinary team (Palliative Care Australia, 2009). Cure, alleviation, or prevention may be possible for cardiovascular, diabetes and other diseases. However, with the onset of aging, having the said diseases can be part of palliative health care. There is a case for greater attention for palliative health care for Greater Western Sydney. From 2002 to 2005, the rates of hospital separation among Aboriginal people in Greater Western Sydney for cardiovascular diseases is the third lowest in Australia and around 30% lower for Aborigines in Australia (Two Ways Together Regional Report, 2006, p. 14). Data from the 2001 health survey of Australia revealed that the prevalence for cardiovascular diseases and diabetes are higher among the Aboriginal population that is a significant population of Greater Western Sydney (Two Ways Together Regional Report, 2006, p. 11). Further, according to the Two Ways Together Regional Report (2006, p. 11), “the rate of diabetes amongst the Aboriginal people in Greater Western Sydney region rose dramatically from 1993-96 (65 per 100,000) to 2002-05 (352 per 100,000).” Based on the data, the Two Ways Together Regional Report (2006, p. 11) concluded that the rate for diabetes “in the period from 2002 to 2005 was therefore almost six times higher than the rate for 1993 to 1996.” The Two Ways Together Regional Report (2006, p. 11) also concluded that “higher rate of patients in the region identifying as Aboriginal may have contributed to the six-fold increase in diabetes rates”. More importantly, the Two Ways Together Regional Report (2006, p. 11) emphasized that the diabetes situation among Aborigines of Greater Western Sydney indicate “a major health crisis for Aboriginal people in relation to diabetes.” Palliative care can be complicated among aborigines. One reason is employment. Latest immediately available data indicate that only around 52% of Aboriginal males and 39% of Aboriginal females are employed in Greater Western Sydney (Two Ways Together Regional Report, 2006, p. 19). Another factor is income. Latest immediately available data indicate that in 2001, “the median Aboriginal family income was $200-$399 per week as compared to the non-Aboriginal median weekly income of $400-$499 per week” (Two Ways Together Regional Report, 2006, p. 19). Worst, according to the Two Ways Together Regional Report (2006, p. 14), in some areas of Greater Western Sydney, there is a high proportion of Aboriginal residents who earned zero or negative income (7.6%) 4.0. Nursing Ethics, Spirituality, and Palliative Care Based on the work of Folkman in 1997, Aranda (2008, pp. 576-577) pointed out that spirituality can play a role in the “resolution of a stressful event, such as a diagnosis of a terminal disease.” Thus, as the professional nurse is committed to the improvement of the quality of life of patients even in dying, assisting them in their spiritual needs regardless of their spiritual beliefs can be one of the functions of a nurse. The nurse need not share the spiritual belief of the patient but so long as the spiritual belief promotes the alleviation of pain or coping with the stress of pain, the nurse can include in her or his role the task of assisting the patient in executing the patient’s spiritual rituals or practice. The 2008 Code of Ethics for Nurses in Australia is an important guide on how nurses practising their profession in Australia should handle the dimension of spirituality in palliative care. The 2008 Code of Ethics emphasises that the nursing profession respect the human rights of Australia’s Aboriginal and Torres Strait Island peoples as the traditional owners of Australia (Australian Nursing and Midwifery Council, 2008, p. 3). Consistent with this categorical recognition of the rights of Aborigines, the nursing profession must therefore recognize the patient’s right to spirituality especially because that spirituality can alleviate the suffering and pain of the Aboriginal patient even if only psychologically. Point 2 of Value Statement 4 of the Australian Code of Ethics for Australian Nurses require nurses to provide health care without discriminatory or prejudicial attitudes concerning characteristics such as ethnicity, culture, religion, spirituality, and other demographic variables (Australian Nursing and Midwifery Council, 2008, p. 7). Consistent with this, nursing and the other health care profession must allow the patients of palliative care to practice their religion or spirituality consistent with their beliefs, even if it has no relation at all to the alleviation of the suffering or difficulties of patients of palliative care. However, spirituality and alleviation of suffering are related: spirituality can ease both the suffering and pain of dying or near dying. As Tollefson et al. (2008, p. 117) has pointed out, pain has a cultural determinant. The role of the nurse is to support the primary health professionals in managing a person’s condition (Johnson and Chang, 2008, p. 10). Usually, the work of palliative care is undertaken by a team especially if palliative care is within the context of a hospital or a hospice (Johnson and Chang, 2008, p. 11). However, among other health professionals, nurses have more frequent contact and continuous presence with patients and, thus, have the greater responsibility to assist the patients in their spiritual needs upon the latter’s request. 5.0. Palliative Care and Spiritual Care: Clinical Nursing and Clinical Example Clinical nursing pertains to involvement in the care of patients, nursing diagnosis and preventable action (Australian Institute of Health Welfare, 1999). In palliative health care, a role that clinical nursing can assume is to discover ways how a dying or believed to be a dying person’s patient’s room, for example, can be improved so the room can be conducive for patients to engage themselves in spiritual activity. Consistent with full respect that the patients deserve for their beliefs, a clinical nurse must simply create the means for patients with the help of his or her relatives conduct spiritual activity that can improve the quality of life of a dying person as he is about to die. This can mean talking with both the patients and his or relatives in how the patient’s surroundings can be improved in a manner that it can promote spiritual activity between the patient and his or her relatives. Those who will conduct the spiritual activity should be the patients and his or her relatives and friends and assisted only by the clinical nurse. For example, I recall that I once expressed to a Roman Catholic family that if they want the room to be arranged so they can properly or effectively pray the rosary, all they have to do is to make a verbal request. In a way, my suggestion had also served as my “support on the journey of grief” being experienced by the family (Schultz and Bruce, 2005, p. 138). The assistance of relatives and friends is important especially because a dying may have decreased cognitive functions (Toole, 2009, p. 286) 6.0. Conclusion Based on the demographics and characteristics of Greater Western Sydney, there is a strong basis to argue that attending to spirituality concerns will be an important part of palliative health care in the area. The duty of the nurse in advancing the quality of patient lives in palliative health care is to support in a non-discriminatory manner the spiritual concerns of his or her patient, regardless of the nursing professional’s spiritual beliefs. In providing spiritual care in palliative nursing care, a nurse need not have the same spiritual beliefs as the patient. What is more important is that the nurse is able to encourage or lead the patient and his/her friends and relative to conduct spiritual practices consistent with their beliefs. I believe that this practice will enable me to provide spiritual care to a culturally diverse population and this has been my guiding principle or point of view in nursing. References Aranda, S. (2008). The cost of caring: Surviving the culture of niceness, occupational stress and coping strategies. In S. Payne, J. Seymour, & C. Ingleton, Palliative care nursing: Principles and evidence for practice (pp. 573-590). 2nd ed. Maidenhead, England: Open University Press. Australian Institute of Health and Welfare. 1999. Area of clinical Nursing. Available from: www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458212 (Accessed 8 May 2011). Australian Nursing & Midwifery Council. (August, 2008). Code of ethics for nurses in Australia. Australian Nursing & Midwifery Council. Boogaerts, M. and Merritt, A. (2008). Psychosocial care. In E. M. L. Chang & A. Johnson (Eds.), Chronic illness and disability: Principles for nursing practice (pp. 50-65). Chatswood, NSW: Elsevier Australia. Toole, G. (2009). People with particular condition. In: Communication: Core interpersonal skills for health professionals (pp. 284-305). Chatswood, NSW: Churchill Livingstone. Greater Western Sydney Economic Development Board. (2004). Greater Western Sydney Regional Economic Summary. Department of State and Regional Development: Greater Western Sydney Economic Development Board. Johnson, A., & Chang, E. M. L. (2008). Chronic illness and disability: An overview. In E. M. L. Chang & A. Johnson (Eds.), Chronic illness and disability: Principles for nursing practice (pp. 1-13). Chatswood, NSW: Elsevier Australia.   Palliative Care Australia. (2009). Role and delineation in palliative care in Australia. Available from: http://www.standards.palliativecare.org.au/Portals/20/NSAP/Public%20Access/Role%20Delineation%20in%20PC%20in%20Au%20-%20PCA%20Qual%20Resource%20Guide.pdf (accessed 8 May 2011). Schultz, C. and Bruce, E. (2005). Living with loss and grief. In: K. Martin-McDonald, A. McCarthy, & C. 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