Concept Analysis: Palliative Care

Introduction

Palliative care is a specialized care extended to patients with the aim of providing patients with relief from distressing symptoms. The main aim of palliative care is to improve the quality of life in a manner that promotes a person-centered care. This type of care is offered by a team that includes doctors, social workers, pharmacist, chaplain and other specialists collaborating. Palliative care focuses basically in predicting, preventing, diagnosing, and treating symptoms that patient experience in life-threating illness. It also involves assisting the patients, and their families make an important medical decision. The core reason for having palliative care is to improve the quality of life the patients, family, and caregivers (Rome, Luminaias, Bourgeois, & Blais, 2011).

The theory of Human Becoming Theory by Rosemarie’s Rizzo Parse will be used to inform more on the concept of palliative care. The theory guides the practice of nurses in their effort to focus on the quality of life. The theory of human becoming offers an alternative to the traditionally used bio-medical approach and the psycho-social-spiritual approach of most other theories and models of nursing. Through this theory, the quality of life from each person’s perspective thereby matching the goal of the practice of nursing.

Explanation of the Palliative Care

Palliative care near the end of life is important in helping patients and help families understand the nature of illness including prognosis. Palliative care specialists assist patients and their families in choosing the best medical care that matches with the patient’s care goals with those of the healthcare team. Palliative care is a broad spectrum that defines a continuum to serve the patients. Palliative care is offered by an interdisciplinary team with a primary goal of improving life.

The eligibility for patients to palliative care is not selective but allows for patients of all ages and ones who may have been diagnosed with any disease or a stage of illness. Patients may continue to receive treatment for all-life prolonging and disease-directed treatments.  The setting for this is mostly in hospital but may also be offered in hospital clinics, group practices, cancer centers, home care programs or nursing homes. It is important to note that the payment for the physician and nurse practitioner fees is catered for in the Medicare part for inpatient and outpatient care. The hospital’s teams are to be compensated under Medicare part A under the commercial insurance payments for the care episodes (Kelly & Morrison, 2015).

Literature Review

Various research has led to the common knowledge that people with serious illness and their families in most cases receiver below standard medical care. This is considered in the untreated symptoms, unmet psychosocial needs, huge caregiver burden, and low patient and family satisfaction. The introduction to palliative care deals with problems in a method that in well-coordinated, follows a team approach with the aim of achieving better health care results and better community support. The teams offering the palliative care assists in lowering the overall healthcare costs in the following way; reduction and prevention of clinical complications, facilitating discharge planning, lowering the instance of preventable hospitalizations, readmissions, and emergency room visits.

The World Health Organization (WHO) prescribes an adoption of a public health approach that includes the palliative care across all countries to help address the needs of all advanced cancer patients and their families and promoting universal access to the various required services at all levels of care within the healthcare system. Such a public health approach should have three main features. There should be a government policy to guide the integration the palliative care in the structure of the national healthcare system. There should also be an educational policy that offers support to train the healthcare professionals.  A drug policy would also be important to assure of the availability of the essential drug for pain management, symptoms and psychological distress. With the three measure in place coupled with a committed leadership an effective palliative care program can be created (Word Health Organization, 2007).

Palliative Care has been found to be very helpful to the patients at the end of life stages as well as their families. The goal of palliative care, in this case, will be to relieve the suffering of patients and their families. This is attained by comprehensive treatment and physical, psychosocial, and spiritual symptoms that the patients face. At a point when death approached, symptoms of the patient may point to the need of aggressive palliation. Palliative care defines the goals to relieve sufferings in all levels of disease and is not just confined to end-of-life care (Rome et al. 2011).

Attribute of palliative care

The four attributes of palliative care include; individualized patient care, support to the family, interdisciplinary teamwork, and effective communication. The individualized patient care emphasizes the physical, emotional, social and spiritual needs of any given patient. The focus is put on all aspects of the patient care as opposed to just focusing on controlling the symptoms. In this attribute, the patient’s family members are requested to give a contribution to specific goals of care. The care is pointed to the patient with the aim of improving life.

In supporting life, the palliative care does not just focus on the patient but also integrates both the patient and family as units of care. This model of care appreciates the importance of family support to the patient at end-of-life stages. Palliative care thereby offers a chance and resources for families to heal relationships through providing counseling, financial counseling and bereavement support.

The third attribute on palliative care is that is offered by an interdisciplinary team who collaborate in their efforts. The team engaged in the palliative program include physicians, nurses, social workers, chaplains, nurse aides, dieticians, and other volunteers. These team members collaborate with the patient and family in creating the best goals of care for the patient (Meghani, 2004).

Antecedent and Consequence

One key antecedent that has been considered before on is put under palliative care is that is initially focused patients in their end-of-life. These include patients who may be suffering from terminal illness such as cancer. This has been of late expanded to cover a wide spectrum of patients including patients with advanced cancer, neurological disease, lung disease and other older patients suffering from multiple co-existing conditions and frailty (Kelly & Morrison, 2015).

The major consequences that have been found in palliative care are the effectiveness in promoting the healthcare for the patients involved. The improvement acquired from palliative care include; reduction in pain and other distressing symptoms, improved communications of patients, family members, and the healthcare providers, and provision of emotional support. Palliative care is thereby an important model that ensure maximization of the comfort of the patient and that of the family. It offers an opportunity for setting goals for the future that helps contribute to meaningful, enjoyable life as one gets treatment from the illness (National Institute of Nursing Research, 2011).

Empirical Referents

Some of the empirical referents that can be used to ascertain the presence of palliative care are the structure and process metrics. The structure metrics may be measured by the proportion of the interdisciplinary team members who have had training in palliative care. It may be determined by the days of week and times of day that the service is availed to the patients and families.

The process metrics may measure the number of patients served in the palliative care unit and those who may have received a comprehensive assessment. The process may also be measured as a proportion of the number of patients who may have had a documented discussion.

The other measurement metric is the outcome metric that is useful in the description of clinical contacts. The outcome metrics include clinical or patient reported pain score; where the initial pain score is compared to pain score after 30 days. There measures here may be family satisfaction as well as cost in the final six months of life for patients under the palliative care as compared to costs by similar patients not enrolled in the program (Kerr, 2016).

Cases

Model case

William a 29-year-old man has been diagnosed with Leukemia after experiencing regular fatigues and nosebleeds. Her symptoms include bone pain, dyspnea, anxiety and panic attacks. His parents refuse to have him put under opioid treatment due to substance abuse in the family. The alternative prescription offered does not help much, and he keeps crying out in pain. The pain relievers would only be administered after 6 hours. An intervention by the palliative care team leads to a change in the treatment regimen. Observations were made how his symptom and psychological distress had improved. They helped him in the safe use of opioids with improvements in existential, spiritual, economics, and emotion conditions.

Borderline case

Jennifer has diagnosed with lung cancer at advanced stage. The team in the hospital put he under a palliative care unit. One shortcoming in setting up the procedure was that the family was not consulted. This brought issues and obstacles to the program as the family members felt some insincerity due to lack of open communication.

Theoretical Background

The theory prescribed to enhance an understanding in the concept of palliative care is Parse’s theory of human becoming. The world Health Organization has prescribed the need for having an expert and palliative end-of-life care as a way of improving the global health. To specialty nature of the palliative care nursing requires the adoption of the theory of human becoming by Parse Rosemarie. The theory of human becoming considers man as a combination of the biological, psychological, sociological and spiritual factors. This principle is exemplified in the concept of palliative as being important to the enhancing the wellbeing of a patient. The theory further prescribes that a man is connected with their environment and this affects their experiences. Concerning this, the palliative care aims to improve the patient’s satisfaction by following a holistic approach.

The theory of human becoming is highly relevant and promising in its capacity to build on palliative care. This is by informing and guiding the nurse practice to be applied in palliative care. Nurses involved n the art of palliative nursing will find the elements of congruence as prescribed in the theory of human becoming very important in the practice of palliative care (Hutchings, 2002).

Conclusion

The concept under analysis in this paper was the palliative care. This was defined as an approach used to help improve the quality of life of patients as well as their family. The palliative care main approach includes; taking an individualized care, offering support to the family and being effected by an interdisciplinary team. The concept is more related to the theory of human becoming. As I have learned, it is important to put people diagnosed with end stages cancel, respiratory failure, kidney failure and other life-threatening conditions. I have to understand how palliative can help improve health outcome, patient and family satisfaction and over some challenges other care models.  

References

Hutchings, D. (2002). Parallels in Practie: Palliative Nursing Practice and Parse’s Theory of Human Becoming. Am J Hosp Palliative Care, 408-414.

Kelly, A., & Morrison, S. (2015). Palliative Care for the Seriously ill. The New England Journal of Medicine.

Kerr, K. (2016). Metrics and Measurement for Palliative Care. National Hospice and Palliative Care Organization.

Meghani, S. (2004). A Concept Analysis of Palliative Care in the United States. Journal of Advanced Nursing.

National Institute of Nursing Research. (2011). Palliative Care. National Institue of Health.

Rome, R., Luminaias, H., Bourgeois, D., & Blais, C. (2011). The Role of Palliative Care at the End of Life. The Oscher Journal, 348-352.

Word Health Organization. (2007). Palliative Care to Cancer Control.