Palliative Care

 

Simrat Kaur, Bhivu Atwal

Assistant Professor, Department of Medical Surgical Nursing, School of Nursing, Galgotias University,

 Greater Noida

*Corresponding Author E-mail: simrat.kaur@galgotiasuniversity.edu.in

 

ABSTRACT:

Palliative care is the active holistic care of patients with advanced progressive illness and includes areas other than oncology. Apart from, managing pain and other symptoms, palliative care is aimed at delivering psychological, social and spiritual support to patients and their family to achieve the best quality of life. Development of cancer palliative care and hospices has gained momentum in the UK since the opening of the World’s first hospice in London in 1967 by Cicely Saunders and colleagues. Today, palliative care and end-of life care are growing areas of research worldwide.

 

KEYWORDS: Hospice, holistic.

 

 


INTRODUCTION:

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. Palliative care is an interdisciplinary approach to specialized medical and nursing care for people with chronic conditions. It focuses on providing relief from the symptoms, painphysical stress, and mental stress at any stage of illness. The goal is to improve quality of life for both the person and their family. Evidence as of 2016 supports palliative care's efficacy in the improvement of a patient's quality of life.

 

Aims:

·       Provides relief from pain and other distressing symptoms;

·       Affirms life and regards dying as a normal process;

·       Intends neither to hasten or postpone death;

·       Integrates the psychological and spiritual aspects of patient care;

·       Offers a support system to help patients live as actively as possible until death;

·       Offers a support system to help the family cope during the patients illness and in their own bereavement;

·       Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;

·       Will enhance quality of life, and may also positively influence the course of illness;

·       Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

 

Origin:

In 1974, Dr. Balfour Mount, a surgical oncologist at The Royal Victoria Hospital of McGill University in Montreal, Canada, coined the term palliative care to avoid the negative connotations of the word hospice in French culture, and introduced Dr. Saunders’ innovations into academic teaching hospitals. He first demonstrated what it meant to provide holistic care for people with chronic or life-limiting diseases and their families who were experiencing physical, psychological, social, or spiritual distress.

 

Description:

Palliative care can seem like a scary process, but essentially it’s a support system to help a patient and their loved ones cope.

 

The Principles of Palliative Care:

Palliative care is not simply a process that a patient undergoes in hospital by themselves. It’s a philosophy that is integrated into their overall care and the care their family receives.

 

Pain Management:

Physical pain is an unfortunate part of many health conditions at the end of life stage. Although it is a common symptom, not everyone receiving palliative care support will experience pain. Pain relief should therefore be something that includes the physical, psychological, social, and spiritual aspects of suffering. As pain is layered and multidimensional, there is no one way of treating it. Physical pain cannot be treated separately from the psychology and anxieties of pain. And vice versa, the mental suffering cannot be addressed independently from the physical experience.The first principle of managing pain is an adequate and full assessment of where the underlying pain is coming from. Keep in mind that patients may have more than one area of pain and different pains have different causes.

 

The World Health Organisation have developed three-step “ladder” for pain relief in adults, which can essentially be used in palliative care.

 

They recommend that pain medication should be given “by the clock” – which is approximately every 3-6 hours, rather than “on demand”.

 

If pain occurs, there should be prompt oral administration of drugs in the following order:

1.    Non-opioids (aspirin and paracetamol);

2.    Then, as necessary, mild opioids (codeine);

3.    Then strong opioids such as morphine, until the patient is free of pain.

 

To calm fears and anxiety, additional drugs – “adjuvants” – should be used.

 

A comprehensive knowledge of the underlying pathophysiology of pain is essential for effective management.  The three-step approach of administering the right drug in the right dose at the right time is supposed to be inexpensive and 80-90% effective.

 

There must always be a considerations given to treating the underlying cause of the pain – this could be by surgery, radiotherapy, chemotherapy, or other appropriate measures.

 

Palliative care is provided where the person and their family wants, where possible. It is not exclusively locked into a clinical or hospital setting.

 

This may include:

·       At home

·       In hospital

·       In a hospice

·       In a residential aged care facility

 

Many people indicate a preference to die at home and making this possible often depends on several factors, such as the nature of the illness, the amount of care the person needs, how much support is available from the person’s family and whether the person has someone at home who can provide physical care and support for them.

 

CONCLUSION:

Palliative medicine is the continuation of the long struggle to accept life on its own terms, honestly and openly. Taking its place in academic medicine, this new subspecialty will enable future generations of physicians to gain generalist-level palliative medicine skills while advancing knowledge in the field and fulfilling our promise to patients and their families that we will not abandon them when our treatments fail and that, at all times, we will do all we can to relieve their suffering.

 

REFERENCES:

1.      https://www.sciencedirect.com/sdfe/pdf/download/eid/3-s2.0-B9780723434580000129/first-page-pdf

2.      https://en.wikipedia.org/wiki/Palliative_care

3.      http://asheducationbook.hematologylibrary.org/content/2008/1/465.full

4.      https://hellocaremail.com.au/principles-palliative-care-need-know/

 

 

 

 

 

Received on 27.09.2019          Modified on 21.10.2019

Accepted on 30.11.2019     © A&V Publications all right reserved

Int. J. Nur. Edu. and Research. 2020; 8(1): 121-122.

DOI: 10.5958/2454-2660.2020.00026.5