A Palliative Care an Approach in the Community Setting and Acute Hospitals - Term Paper Example

Palliative Care Introduction Palliative care is an approach that focuses on improving the quality of life for both patients and their families facing serious illnesses. This is achieved by preventing and relieving suffering through early identification, and flawless assessment and treatment of pain as well as other problems, and also caters for physical, psychosocial and spiritual needs (Gott et al, 2013). In Australia, palliative care is offered in almost all healthcare setting and this includes neonatal units, padiatric service, acute hospitals, general practices, residential and community aged care services, as well as generalist community services (Tillmann, 2013). The focus of this essay will be discussion of palliative care approach in community setting and acute hospitals. Additionally, the essay will compare and contrast the challenges and benefits of community and acute hospital setting when providing palliative care for the patient and their family. Community setting consists of the patient’s home or a community living setting for instance residential home for the aged or supported care facility. In Australia, home is the most common setting where about 70-80 percent of patients get palliative care. According to Department of Social Services (2014) a community setting such as an individual’s home provides familiarity, comfort, privacy as well as normal routines that settings like hospitals cannot offer. Home even represents resident aged care facility where many people would prefer to die as they consider it their home. Provision of palliative care in a community setting involves supporting the carers who in most cases are friends and family. Provision of end-of-life care in a community setting is especially intense for families and friend carers (Shahid et al, 2013). This is because while carers are managing their own grief and others’ grief, they also have the responsibility of providing high level of physical and emotional support that the patient requires at the end-of-life. Therefore, carers at community setting are supposed to liaise with various service providers, make clinical and other care decisions in addition to making the required preparations for the time after death (Gott et al, 2013). Accordingly, adequate and effective support of the carers throughout this experience enable them to have more control over the end-of-life care for the patient and higher satisfaction from fulfilling the wish of the patient to die at home. Basically, if more carers are supported to offer end-of-life care within the community setting, there will be reduced dependence on hospitals and institutions (Luxford, 2010). Gott et al (2013) explain that in Australia, most individuals spend time within acute hospitals within the last period of their lives and a considerable percentage die in acute hospital setting. Acute hospitals offer end-of-life care to most individuals who die within Australia. ACSQHC (2013) shows that even though most individuals indicate that they would wish to die at home, 52% normally die within a hospital setting. The most common course of decline toward death entails constant loss of function or decrease in function after experiences of acute deterioration (Lavack, 2014). During the end-of-life, individuals are regularly hospitalized and hence come across many health care providers and the regular encounters in hospital setting provide chances to discuss regarding the patient’s choices and preferences for treatment options towards end-of-life and hence the need for palliative care. The quality and safety of end-of-life care is vital for the patients, their families as well as individuals that provide care for the patient. This therefore provides an opportunity to provide physical, emotional and spiritual care to both the patient and their families during this period and their stay in a hospital (Lavack, 2014). Challenges and Benefits of Palliative Care in Community and Acute Hospital Settings The main benefit of palliative care in a community setting is that the setting provides comfort, privacy and normal routines that a hospital setting cannot provide (Department of Social Services, 2014). Additionally, most people prefer to spend their last moments at home and hence their wishes are provided when palliative care is provided at home. The families also get to spend more time with their loved during the person’s last moments when compared to a hospital setting (Department of Social Services, 2014) A major challenge in palliative care in a community setting is the inability to effectively manage medications which a major issue since the medications are used in treating symptoms that the patient experiences such as pain. Ineffective medication management is due to poor health literacy and can result to non-concordance with medication regiments and eventually cause significant treatment issues for the patient and this significantly affects their quality of life and for their families as well (Hussainy et al, 2011). Hussainy et al (2011) indicates that palliative care in community setting poses the highest risk of medication misadventure and adverse events, and as a result, hospital admissions. Another challenge with provision palliative care in a community setting is that there are may be rapid and unanticipated deterioration in patient’s condition and the limited availability of carer and health-care services within community setting. Such deteriorations can be life-threatening and can only be handled in a hospital setting (Luxford, 2010). Another challenge in a community setting is that there may be lack of understanding between the carers ad the healthcare providers and this may in turn impact palliative care negatively. For instance, carers and families may feel that GPs do not understand their needs and similarly GPs and district nurses may feel that they do not have the required time, resources and training to take a more proactive role during palliation (Shahid, 2013). Carers and families require time to ask questions, discuss decisions and assist in relieving their anxiety and creating a better understanding of the situation. Unlike in a hospital setting where specialist health care providers are readily available to for instance handle uncontrolled symptoms or advice what to do after the patient’s death, this is not the case in a community setting. Additionally, in a community setting there may be no available specialist to provide bereavement services to the family after the patient’s death and also communication of the death to the family members may be a complex issue since various communities receive the death news differently and hence require specialized handling of the issue because as Shahid (2013) indicates, death and dying’ is a sensitive topic for many communities. The key benefit of palliative care in an acute hospital setting is that there is timely access to specialized treatments and investigation and hence if a patient is receiving palliation in a hospital setting he/she is likely to receive appropriate care when compared to palliation within a community setting. Additionally, in a hospital setting there is a multidisciplinary team and hence both the patient and the family as well are likely to receive an additional layer of support from a team of physicians, nurses, counselors and other specialists (Levack, 2014). Another benefit of receiving palliative care in a hospital setting is that there is long-term relationship with patients in certain specialties such as renal, diabetes and many types of cancers (Tillmann, 2013). One of the significant challenges to providing palliation in a hospital setting is that healthcare providers mostly focus in treatment rather than providing palliation care (Levack, 2014). According to Levack (2014) in a hospital setting, treatment concerns always overshadow other palliation concerns. Most physicians and nurses working within hospitals focus on cure and normally feel they are not adequately equipped to look after patients who might be dying. This is particularly hard when they also have the responsibility of providing care for those receiving active treatment for acute diseases (Gott et al, 2013). Additionally, cure and care may seem not compatible particularly in an acute hospital setting where healthcare providers are under daily pressure of meeting treatment goals. As a result, there is failure to openly acknowledge that a patient is dying and hence requires palliative care for the patient and their families (Tillmann, 2013). In a hospital setting, the most common complaint from patients and their families is poor pain control as well as late analgesia. This is due to the lack of confidence among healthcare providers and deeply embedded concern regarding the over-use of opioids (Levack, 2014). Another challenge in a hospital setting is that hospitals are big and complex specialized units with progressively specialized personnel who normally lack other skills outside their specialty (Gott et al, 2013). This therefore means that the families and the patients are not likely to receive the required palliation such as counseling and bereavement services from specialists. Healthcare providers in various specialties can find certain features of offering palliation services hard in the context of their precise area of proficiency (Lavack, 2014). Basically, management of pain and symptoms which forms the basis of palliative care is extremely complex and requires significant proficiency. Normally, symptoms intensify very fast and require confident and proficient diagnosis and management. Discussing emotive matters such as life and death also need significant proficiency and skills. Healthcare providers in hospitals lack this expertise since many hours of practice are needed to attain a level of mastery on palliative care for them yet they do not have the opportunity due to their professional practice (Gott et al, 2013). Emotional burden is a key challenge that nurses face during provision of palliative care (Kirby et al, 2014). According to the study, nurses empathize with not only the patient but also the family and the various emotions which nurses display during provision of palliative nursing care sadness, grief, frustration as well as fatigue (Kirby et al, 2014). Actually, nurses spend a lot of energy emotionally supporting patients and families as well maintaining their own psychosocial wellbeing. Nurses face challenges of managing their emotions and demeanor around patient and balancing hope and futility is a big burden to nurses (Kirby et al, 2014). More importantly, studies show that nurses lack the required skills to deliver palliative nursing care since they only have specialty of delivering nursing care (Gott et al, 2013). Additionally, Campbell & Amin (2014) explain that during provision of palliative care nurses are worried about legal aspects. For instance, euthanasia may come up with legal complaints from the family and thus legal feature is one of the main challenges nurses face during provision of palliative care. Conclusion This essay has discussed the benefits and challenges of providing palliative care in community and acute hospital setting. The key benefit of palliative care in a community setting is that one gets to spend more time with their families and that patient spend their last moments at the comfort of their homes. However, there are various challenges in community setting such as poor control of symptoms, especially pain management. On the other hand, the main benefit of palliation on acute hospital setting is that there is timely access to specialized treatments and investigation. Challenges include healthcare providers focusing on treatment rather than palliation of the patients and their families. References Australian Commission on Safety and Quality in Health Care (ACSQHC). (2013). 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