Addressing Spirituality in Palliative Care - Essay Example

Case Study on Addressing Spirituality in Palliative Care Introduction Certain incurable conditions like advanced malignancy and end-stage organ diseases are a challenge to health professionals like nurses for several reasons. Besides instituting treatments to manage their symptoms like pain, the nurses also need to take care of other aspects like emotional support, spiritual care and psychosocial interventions. The end-stage of life, when the patient and his/her family members know about the proximity to death, evokes certain feelings and emotions like rage, denial, bargaining, envy, depression and acceptance (Aranda, 2008). These emotions are a part of adjustment and grieving to the loss. Patients who are in terminal stages of life need to be managed in a holistic manner keeping in mind the emotional distress they are going through. Such a care is known as palliative care. According to the World Health Organization (2009), palliative care is “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." In this essay, one of the important components of palliative care, the spiritual care, will be discussed with reference to a case scenario in the context of holistic care. Case scenario 55 year old Marina, a known patient of hypertension and diabetes, was diagnosed to have breast cancer in December 2008. She had consulted her gynecologist because she felt a mass in the left breast. Mammography and biopsy results established the diagnosis of stage-2 breast cancer of the left breast. The very diagnosis of breast cancer upset Marina and her family members. She underwent left mastectomy with removal of left axillary lymph nodes. Since testing for hormone receptors revealed suitability for hormone therapy, Marina was started on tamoxifen therapy. Despite aggressive anti-cancer management, the woman developed metastases over few months and became terminally ill within a year. She developed metastases in the liver and bone subsequent to which she became very ill, pale and sick looking. Having enjoyed a contentful life with full of love, happiness and luxury, Marina pleaded the treating oncologist to provide care which allowed her to live in peace for the few remaining days in her life. The team of doctors, after consultation with the her husband and other family members initiated palliative care. The main issue that was dealt with in this stage was pain relief. However, the head of the palliative team insisted that Marina also get proper spiritual care in view the emotional turmoil she and her family members were going through. Marina is a loving mother of 3 girls. She is an excellent home maker, a great support to her husband even during the days he had unemployment, a role model to her daughters, a good caretaker to her grand child and her pregnant daughter. As an obedient and caring daughter-in-law, a supportive wife, an able and intelligent mother, and a loving grandmother, she is an indispensable member of the family. Following diagnosis of breast cancer which progressed rapidly, the woman became less active with her family because of frequent admissions to the hospital, surgery, chemotherapy and complications of the disease and treatments. Spiritual care Illness which causes the person to live for less than 6 months is known as life-limiting illness (OToole, 2008). It is very important to address spirituality in the treatment of life-limiting illneses like cancer because spirituality is the basic needed of each and every individual through whom the individual looks for meaning of his or her life (Taylor, 2006). Pain in cancer affects the spiritual aspect of the individual (National Health Service, 2006) and increases fear of death, loneliness and discomfort. When Marina came to know of her diagnosis, her first response was disbelief. Marina thought that there was some mistake in the report. The gynecologist had to counsel and educate about the importance of undergoing treatment. Then over a period of few weeks, she adjusted emotionally to the disease she had. Frequent hospital admissions, surgery, chemotherapy, side effects to treatment made her realize and acknowledge her disease state. She then adopted the spiritual way to console herself. Marina believes in Jesus and she keeps thinking about him. Maria is now in a palliative care center. The primary care givers are nursing staff in conjunction with her daughters and husband who coordinate with other members of the palliative care team. The activities of the team are coordinated by primary care physician. Other members of the team include clergy, trained volunteers, social workers and nurses and other therapists (NHPCO, 2008). In the process of delivering palliative care, the work environments threaten the nurses ability to provide care that is desired by persons who are dying. In order to count as to what is stressful in palliative care, nurses must understand the relationship between palliative care values which are inherent and the ability of the nurses to make a difference in the lives of the terminally ill patients and their families. Infact, the goal of every palliative care nurse must be to reduce the gap between values and practical application of values (Aranda, 2008). Addressing spirituality in the context of holistic care The aim of palliative care is to enhance the quality of life of the patient and influence the course of the disease in the most positive sense. The care must be initiated as early as possible in the course of the disease in conjunction with other supportive therapies like chemotherapeutic, medical and surgical interventions. Palliative care adapts the philosophy of hospice care and the interdisciplinary practice. It applies to all terminally ill patients irrespective of their diagnosis, race, religion, age, gender and culture (National Cancer Control Programme, 2005). Marina must be provided spiritual care as a part of palliative care. Spiritual care delivery can be enhanced by respecting and supporting the decisions of Marina and her family members, by gauging the depth of her anger, distress and despair, by offering her to discuss about her concerns and problems openly without any inhibitions and by showing concern to her interests like making wills and ceremonies after death (National Cancer Control Programme, 2005). Pain relief is the corner stone of palliative care and enhances the spiritual value of care. Along with pain relief, other symptoms like nausea and vomiting, regional swelling, sleeplessness, gastritis and constipation must be addressed (Johnson et al, 2006). Quality of life of Marina may be enhanced by encouraging her and allowing her to indulge in activities which are a source of enjoyment and relaxation for her like watching movies and listening to music, by making her feel that she is yet a much wanted member in the family and by providing her time and space to spend family with her husband, children and grand children (National Cancer Control Programme, 2005). Education and training must also be delivered to caregivers and family members to increase the psychological and social dysfunctioning of Lora (Keefe et al, 2005). One of the important aspects of providing palliative care is involvement of the family members and friends in taking decisions pertaining to the patient (National Cancer Control Programme, 2005). Even the patient must be involved and this increases the sense of dignity and self-esteem of the patient. Proper communication and provision of appropriate information to both the patient and her family members before any decision is taken like starting a new intravenous line, changing pain medication or referring to a new consultant increases trust between the patient and the nurses. As Mok and Chiu (2004) rightly put it , "Trust, the achievement of the goals of patients and nurses, caring and reciprocity are important elements of nurse–patient relationships in palliative care." It is very important for nurses to develop a trustworthy relationship with Marina and her family members because they stay with the patient until her death, through the journey of illness and the trustful relationship offers some comfort to the patient. Nurses will be able to deliver the best possible care to the patient only by establishing such a relationship. Also, through such a relationship, nurses will be able to prepare Marina and her family members to death. Caring actions, right attitude and trustworthiness establish connectedness to the patient and help her and her family members go through the journey of death with some solace and peace. The family members must be prepared for death and must be asked to come to terms with the fact. If necessary, they must be provided counseling and appropriate therapies. They must be allowed to see Marina as much as possible. However, the family members must not be allowed to see some distressing aspects of care like changing of dressing, securing intravenous lines, change in the color of the area, etc (National Cancer Control Programme, 2005). Addressing dignity in spiritual care Part of spiritual care is maintaining the dignity of the patient before and even after death. This is because, reliance of the patient on the nurses and other caregivers erodes the sense of dignity. Once day-to-day deterioration has begun in Marina and when the situation has come that death can occur any time, she must be provided holistic comfort, her symptoms must be managed properly, she must be given minimal drugs, her wishes must be upheld, anxiety levels must be alleviated and her fear, religious needs and spiritual needs must be addressed by telling her that her family is around (National Cancer Control Programme, 2005). There are 3 main themes in maintaining dignity and they are "the unrecognizable body, fragility and dependence and inner strength and a sense of coherence" (Hall, Longhurst and Higginson, 2009). Dignity in Marina can be upheld by allowing her to do as many activities as possible and by treating her with respect. Conclusion It is very important to address spiritual care in palliative care of terminally ill patients. Spiritual care in the context of holistic care and maintenance of sense of dignity allows the patient go through the journey of death in peace and solace and helps the family members come to terms with death and loss of their beloved ones. Nurses providing palliative care for terminally ill patient must address issues of spiritual care along with other aspects of palliative care with appropriate attitude and understanding the importance and benefits of holistic care. References Aranda, S. (2008). The cost of caring. Surviving the culture of niceness, occupational stress and coping strategies. Payne, S., Seymour, J., and isigleton, C. (Eds.). palliative care nurisng: Principles and practice for evidence (2nd ed.) (pp.573- 590). Berkshire: Opne University Press. Keefe, F.J, Abernethy, A.P., Campbell, L.C. (2005). Psych.ological approaches to understanding and treating disease-related pain. Ann Rev Psychol., 56, 601 –630 Hall, S., Longhurst, S., and Higginson, I. (2009). Living and Dying with Dignity: A Qualitative Study of the Views of Older People in Nursing Homes. Medscape Today. Retrieved on 20th April, 2010 from http://www.medscape.com/viewarticle/710065 Johnson, A., Harrison, K., Corrow, D., Taylor, M., and Johnson, R. (2006). Chapter 17: Palliative care and health breakdown. In E.Chang, J. daily and D. Elliott (Eds.). Pathophysiology applied to nurisng practice (pp 448- 471). Sydney: Elsevier. Mok, E. and Chiu, P.C. (2004). Nurse–patient relationships in palliative care. Journal of Advanced Nursing 48(5), 475–483 National Cancer Control Programme. (2005). Manual for Palliative Care. Retrieved on 20th April, 2010 from http://www.whoindia.org/LinkFiles/Cancer_resource_Manual_5_Palliative_Care.pdf National Hospice and Palliative Care Organization (NHPCO). (2008). Caring Connections. Retrieved on 20th April, 2010 from http://www.caringinfo.org. NHS Best Practice Statement. (2006). Management of chronic pain in adults. Retrieved on Retrieved on 20th April, 2010 from www.nhshealthquality.org OToole, G. (2008). Communication: Core Interpersonal Skills for Health Professionals. Sydney: Elsevier (pp.290- 293). Taylor, E. (2006). Spiritual assessment. In Ferrell, B., & Coyle, N. Textbook of palliative nursing (pp. 581-582). New York: Oxford. WHO. (2009). WHO Definition of Palliative Care. Retrieved on 20th April, 2010 from http://www.who.int/cancer/palliative/definition/en/ Read More