The Hospice Approach to Terminal Care - Research Paper Example

The Hospice Approach to Terminal Care Abstract The hospice is a multidisciplinary, physician directed program of care that is designed to meet the emotional, spiritual, and physical needs of terminally ill patients. The goal of the hospice care is to maintain the provision to the patient the highest quality of life. Efforts made must be directed to relieve the enervating symptoms related to their disease, most specially in administering dosage adequate in controlling pain. Hospice care had chosen purposely not to integrate and therefore, established themselves independently with other medical facilities. The approach of hospice in caring their terminally ill patients is on: (1) Symptom relief as their primary concern; (2) Interdisciplinary team and plan of care; (3) Autonomy and Community towards the patients; and (4) Home care emphasis. In conclusion, the approach of hospice care in terminally ill patient is a holistic approach helping the patient and the family live a comfortable and quality life and its priority of care is to preserve the dignity of a dying patient. Introduction The hospice is a multidisciplinary, physician directed program of care that is designed to meet the emotional, spiritual, and physical needs of terminally ill patients. This include provision of services to the patient at home and if necessary, at the hospital (Dupee, 1982). The goal of the hospice care is to maintain the provision to the patient the highest quality of life. Efforts made must be directed to relieve the enervating symptoms related to their disease, most specially in administering dosage adequate in controlling pain (Dupee, 1982). In hospice care, it is encouraged that the family and friends of the patient are to participate in his care. Patients are provided with whatever necessary assistance to help them cope with their ordeal of terminal illness (Dupee, 1982). The term hospice care is used synonymously to palliative or comfort care in some areas and by other health care providers. Others refer this as an alternative to traditional medicine instead of the acceptable component of taking care terminally ill patients (Lieberson, 1999). The Principles of Hospice Care In America, the first hospice was opened in Connecticut Hospice with Dr. Sylvia Lack and was funded partly by the National Cancer Institute. Originally, hospice care was a home – care based and expanded later to include a free – standing in patient facility (Lieberson, 1999). Hospice care had chosen purposely not to integrate and therefore, established themselves independently with other medical facilities. They positioned themselves to rebuke directly the conventional settings in managing pain (Lieberson, 1999). Hospice was viewed to have saved the potential cost of the patient as a home based care service. This has led the authorization of the government for hospice care national study evaluating patients of more than 1,700 who underwent terminal care (Lieberson, 1999). As a result, the Congress authorized reimbursement of hospices by the Medicare who were able to meet the specific criteria after the aforementioned study showed satisfaction at lower costs with hospice care compared to that from the conventional care (Lieberson, 1999). The use of hospice care has increased steadily despite of the hindrances. In 1994, it was shown in the studies that hospice care had increasingly served around 300,000 patients and families compared to the figure obtained in 1990 which were only 200,000. Around seventy five to eighty percent of these patients were diagnosed with cancer, and the rest were mostly patients who suffered from other debilitating diseases such as AIDS or from failing kidney, heart or lung (Lieberson, 1999). The philosophy of hospice care is based on the three basic principles, namely; “openness of mind, friendship of the heart, and freedom of spirit to listen to patients.” The last principle which was the freedom of spirit to listen to patients notes that regardless of the sex, race, lifestyle, religion, or disease, patients are taken care of by the hospice as human beings and their respective sufferings were also addressed (Lieberson, 1999). Lieberson (1999) noted that the aforementioned principles were based on the concept of: (1) As death is a natural part of life cycle, it is inevitable that it is not hastened or postponed by the hospice; (2) the clinical goals of the hospice is for the relief of pain and symptoms; (3) The psychological, spiritual, and physical pain are all significant and would require the interdisciplinary team skills and approach to address them; (4) Together with the team of the hospice care, the patients, families, and loved ones are also considered as part of the unit of care; (5) The critical part in supporting family members and friends is the bereavement care; and (6) Regardless of the ability to pay, care must be provided. Hence, it is evident that it is the goal of the hospice to promote an alert, dignified end of life of a patient that is pain free in a respectful manner that suits the needs of an individual (Lieberson, 1999). The Hospice Approach The approach of hospice in caring their terminally ill patients is on: (1) Symptom relief as their primary concern; (2) Interdisciplanary team and plan of care; (3) Autonomy and Community towards the patients; and (4) Home care emphasis. In symptom relief, the primary concern of hospice care is to address the patients’ need to be relieved from their suffering as well as to let them live a quality of life. In hospice care, although the efforts in extending the life of the patient are usually not pursued, pain is treated aggressively to help the patient possibly live a comfortable life. The physical and emotional symptoms of the family is said to be the focus of the hospice instead on the terminal disease itself (Lieberson, 1999). Additionally, the hospice also intends to help in confronting the issue of approaching death that accompanies with the ailment. The concept of total care of the patient is exemplified and its emphasis is placed on the total control of pain that includes the physical, mental, social, and spiritual area, which are based on the need of the patient (Lieberson, 1999). Even if these would require heavy sedation and shortens the survival rate of the patient, hospice still puts an emphasis on the aggressive use of narcotics in controlling pain and does not advocate on cardio-pulmonary resuscitation and other unwanted medical interventions. It is also the belief of hospice care to treat the patient from anorexia only when it improves significantly the life of the patient since it does not significantly produce weight gain nor enhance the quality of life or prolong the survival (Lieberson, 1999). The approach of an interdisciplinary team and plan of care is often referred to as a continuing and supportive care and its goal is to provide pain relief and other symptoms that distress the patient. The patient and family’s psychological and personal support as well as the assistance to help the patient with his activities of daily living, independence and dignity are also provided by the hospice care (Lieberson, 1999). The supporters of the hospice care promote stress and autonomy on the right of the patient and family to make medical decisions, directives and refusal of unwanted therapy that prolongs life such as refusal to artificial nutrition and hydration. Hospice stresses on the importance of discussion of care planning that is honest and open with the patient and his family. Hospice is strongly antagonist of physician assisted suicide due to some issues of legality (Lieberson, 1999). The need of the family for support is also stressed in hospice care such as the need of a vacation from the responsibility from the patient. Hospice care educates the family to minimise the distress of the patient, and to cater other needs such as in organizing the house, administering pain and nausea medications and accompanying the patient during times of disease peculiarities. Among patients who preferred to stay at home, services can still be provided in the nursing home, facilities that assist care of the patients, and in some hospitals. Research An article by Pace (2006) talks that as the patient with terminal illness approaches the end life, they need a special care. Discomfort and pain secondary to his illness is managed by the doctors even though the chance of recovery is nil. Hospice care often works with palliative care where care is focused on providing comfort rather than prolonging life. Hence, along with other services, hospice care together with palliative care, are provided to make the process of dying a comfortable one to the patient. Pace (2006) noted that the goals of hospice care include pain, discomfort, or distress management, creating an environment comfortable enough for the patient, allowing the patient, family, and loved ones to be close to one another during the process of dying, providing the relief from the caregiver of the patient and offering counselling for the patient and their loved ones. Pace (2006) summarized that in hospice care, services of physicians include management of pain and provision of care, nursing care and services from other health care provider, psychological and spiritual counselling, social services and support, help in bathing, getting dressed, and with other everyday activities that include running errands and preparation of meals. Hospice care also provides respite care services that give patient relief, and counselling for grieving loved ones. Another study on Caring for Persons with Dementia: A Palliative Approach by Panke and Ladislav (2002) notes that the advance state of Alzheimer’s disease is considered as a terminal illness as well because of its irreversibility. Therefore, just like the terminal illness such as cancer, patients with Alzheimer’s disease deserve to receive a comfortable and quality life with preservation of dignity as its priority of care. The hospice approach of patient with dementia is thru patient and family education and support in making decision that are difficult. Conclusion In conclusion, the approach of hospice care in terminally ill patient is a holistic approach helping the patient and the family live a comfortable and quality life and its priority of care is to preserve the dignity of a dying patient. The philosophy of hospice care is based on three basic principles of mind openness, “friendship of the heart and freedom of spirit.” In hospice care, terminally ill patients who are in their last stage of life such as those with cancer, heart failure, and Alzheimer’s disease are provided with the necessary medical services, emotional support, and spiritual resources. The practical details and emotional challenges that accompanies the patient and the care of a dying loved ones by the family and love ones is also taken care by the services in the hospice care. At the end of life, what matters the most is to control pain, letting the patient die with dignity, and addressing the psychological and spiritual pain that was brought by death per se. Citation Dupee, R. (1982). Hospice--compassionate, comprehensive approach to terminal care. Post-Grad Med.72(3): 239-41. Lieberson, A. (1999). Treatment of Pain and Suffering in the Terminally Ill.Hospice. Retrieved from http://www.preciouslegacy.com/chap10.html Mayo Clinic. (2011). End of Life: Caring for a Dying Loved Ones. Retrieved from http://www.mayoclinic.com/print/cancer/CA00048/METHOD=print Pace, B. (2006). Hospice Care. The Journal of the American Medical Association, 295(6): 712 Pamke, J. and Ladislav, V. (2006). Caring for Persons with Dementia: A Palliative Approach. Journal of Hospice and Palliative Nursing: 4(3): 143-149. WebMD. (2010). Hospice Care. Retrieved from http://www.webmd.com/balance/tc/hospice-care-topic-overview Read More