Significance of Nursing Care in Palliation, Benefits, and Challenges of Different Australian Palliative Care Settings - Essay Example

Australia’s Palliative Care Student’s Name Institutional Affiliation Australia’s Palliative Care Patients presenting with life-threatening diseases often experience psychological, physical and emotional strain associated with their illnesses. Palliative care encompasses both the pharmacological and non-pharmacological aspects of care that indulges palliative care providers (PCP) or specialists (SPCP) to better the patient’s quality of life including that of the patient’s family members in order to preclude and lessen their suffering through prompt identification and precise assessment and management of pain and any other spiritual, psychological or physical problem associated with the life-threatening illness (World Health Organization, 2015). In Australia, palliative care is provided in four settings that include the community, acute hospitals, designated palliative care beds and in remote and rural Australia. In this essay, the significance of nursing care as part of palliative care, and a comparison of the acute hospital setting and the rural and remote Australia setting in providing palliative care shall be discussed. Significance of Nursing Care in Palliation Nursing care in palliation is part of what is envisaged in the WHO’s exposition of palliative care. Palliative care is meant to relieve the patient from the pain associated with the illness and other distressing or debilitating symptoms (WHO, 2015). The physical, psychological and the religious aspects that the patients associate with are usually incorporated during palliative care without the intention of postponing or speeding up the occurrence of death (WHO, 2015). Since the patient’s family members may be affected psychologically, physically or spiritually, palliation enables the family members cope with the chronic illness and the aftermath of the loss that might befall them if the patient eventually dies (WHO, 2015). Palliation, therefore, bolsters the quality of life in addition to positively influencing the prognosis of the disease. Nursing care plays a significant function in implementing the highlighted roles of palliative care and enhance the patient's quality of life (Haley & Daley, 2014). The importance of nursing in palliation care stems from the profession’s innate art of been closest to patients fortified by carrying out interventions that are evidence-based (Lynch, Dahlin, Hultman & Coakley, 2011). This guides and enables the assessment, diagnosis and management of patients requiring palliative care. Palliative nurses familiarize themselves with the patients and their families sharing their beliefs, values, and previous experiences. The nurse develops a caring, culturally reverent and ethically appropriate patient-nurse relationship that enhances patient management through mutual respect, empathy and compassion (Lynch et al., 2011). Identifying with and regarding the patients and family members' culture is salient especially in remote and rural Australia where patients are more attached to their cultures. It is at this point that goals for both the nurse and the patients together with their families are identified to shape the implementation of symptomatic management, choices of treatment, development of advanced directives and care and bereavement plans after death (Lynch et al., 2011). Nursing care allows the relief of suffering experienced by patients with life-threatening diseases or chronic illnesses. This is met via the strengthening and promotion of the functionality, intactness, strength, comfort, wholeness and the integrity of the patient and the family (Lynch et al., 2011). Patients’ suffering may be expressed in various ways that include grief, helplessness, discomfort, pain, isolation, coping inability, hopelessness and loss of meaning (Lynch et al., 2011). Nurses assess and identify the presentation of suffering and through nursing care, reduce or eliminate the manifestation of suffering during palliative care. Interventions targeting alleviation of suffering include been present and close to the patients and their relatives and efforts to remove the origin of suffering. Presence entails the nurses been emotionally and physically available, actively listening and acknowledging the patients and their families’ concerns (Lynch et al., 2011; Haley & Daley, 2014). Through the staff’s presence, the patient may feel comforted even without an effective suffering elimination strategy. Communication is paramount to a successful nursing in palliation care (Haley & Daley, 2014). It is through effective communication that the patients and their families can understand the holistic nature of palliative care including their involvement in care. Communicating with family members, for instance, enables them to handle caregiving demands appropriately and assist the patient in making decisions regarding possible changes in medical demands and to augment the nursing care towards coping with an imminent death. Constant communication with the family is part of what allows the family to feel supported, and encourage and maintain their participation in caring for the patient receiving palliative care. Palliative Nurses, in particular, are equipped with expert intuition based on their empathetic fathoming of what the patient is undergoing that confers them the ability to create a psychologically secure space that would allow a discussion of emotional matters with the relevant parties (Lynch et al., 2011). Ultimately, nursing care is instrumental in enhancing or keeping alive realistic hope for both the patients and their families. A palliative nurse, even though may not be regularly available at all setting of palliative care in Australia, have the knowledge in addition to the experience to facilitate and support the provision of palliative care nursing services. Nevertheless, other non-specialized nurses can also be supported by palliative nurses in providing the best nursing care to patients and families that need such kind of care. Comparing and Contrasting Benefits and Challenges of Different Settings Rural and Remote Australia Almost 25% of Australians reside in rural areas where they have established their homes in remote communities or small towns (National Rural Health Alliance [NRHA], 2012). Australians requiring palliative care who have been accustomed to the rural lifestyle would prefer to receive their care from their rural settings because of various reasons. Palliation in remote Australia saves the patient the inconvenience associated with traveling to specialized care centers for such services. They can receive their care from the comfort of their home or in familiar surroundings with the support of friends and local health professionals. Social workers in the community can also contribute towards improving the psychological or emotional suffering experienced by a patient in this setting. Occupational therapy is readily applicable in such setting as the patients can easily be supported to maintain their daily living activities that include grooming, dressing and washing without a change in the environment. In a rural setting, patients, and their families can maintain or sustain their cultural practices while receiving palliative care (NRHA, 2012). Cares working with the patients in such settings are often familiar with the setting's culture and are bound to respect it and streamline care in line with the cultural practices. This is, especially important for the indigenous Australians such as the "Aboriginal and Torres Strait Islander people" (NRHA, 2012). Palliative care services necessitating the input of SPCP can be facilitated by local health professionals through telehealth or by physical consultation (NRHA, 2012). Palliative care in the rural settings has its challenges. Since the services of SPCP are only sought on demand, it may be difficult to provide specialist palliative care services as a matter of urgency (NRHA, 2012). In addition, supplies of medical supportive equipment and medicines useful in palliative care may take longer than expected. This may end up delaying the provision of care and aggravate some patients’ suffering. Another challenge is also attributed to the prolonged absence of specialised staffs such as pharmacists to assist in medicine management, SPCP, and PCP (NRHA, 2012). Lack of these professionals may derail the provision of efficient and comprehensive palliative care services. Acute Care Setting Some patients in need of palliative care get admitted to acute hospitals because of an acute medical condition or when their life-threatening diseases worsens. For some, the realization that they have a life-threatening condition that deserves special palliative care occurs while in acute hospital setting. For such reason, most patients would receive their initial, most of their palliative care or whole palliative care from the acute hospital. Such hospitals have the benefits of having SPCP most of the time who facilitate provision of timely palliative care services that include assessment and management of symptoms, and planning for patient discharges (Trankle, 2014). In addition complications of the illness can also be managed in an intensive care setting something not possible in remote Australia and most community settings (Trankle, 2014). A common challenge in acute settings is an overemphasis on interventions that are not aimed at palliation especially when the patient's symptoms deteriorate rapidly (Trankle, 2014). In such a critical care case, care is more leaned towards saving the patient's life rather than end-of-life care. Treatment attempts are occasionally done in futility instead of patient-directed palliative care. On certain occasions, patient’s family members are reluctant to embrace palliation and insist on critical care believing that their patient can be healed rather than undergo palliative care (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2013). Moreover, it is also difficult to maintain cultural aspects of care in acute settings especially for patient form a minority cultural group (NRHA, 2012). Staffs who are familiar with a patient's culture are better placed in achieving the cultural goals of palliative care, even though they may not be available in acute hospital setting. Conclusion Palliative care to the relevant Australian population is salient towards enhancing the quality of life of patients with life-threatening illnesses. Palliative nursing should be patient-centered addressing specific patients and their families' needs. In Australia, the different settings which such services are offered have their benefits and challenges. Depending on the predominant needs of the patient, the right choice of palliation setting should be made by health professional in conjunction with the patient's family members to achieve optimum end-of-life care. References Australian Commission on Safety and Quality in Health Care. (2013). Safety and quality of end-of-life care in acute hospitals: A background paper. Sydney: ACSQHC. Haley, C. & Daley, J. (2014). Palliation in chronic illness. In E. Chang & A. Johnson (Eds.), Chronic illness and disability. Principles for nursing practice (2nd ed., pp. 232-248). Chatswood: Australia. Lynch, M., Dahlin, C., Hultman, T. & Coakley, E. (2011). Palliative care nursing: Defining the discipline. Journal of Hospice and Palliation Nursing, 13(2), 106-111. National Rural Health Alliance. (2012). Palliative care in rural and remote areas. Deakin West, ACT.: National Rural Health Alliance. Trankle, S.A. (2014). Is a good death possible in Australian critical and acute settings?: Physician experiences with end of life care. BMC Palliative Care, 13(41), 1-14. World Health Organization. (2015). WHO definition of palliative care. Retrieved from http://www.who.int/cancer/palliative/definition/en/ Read More