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Beneficiaries of Palliative Care

Introduction

Palliative care entails satisfying the bodily, rational, and social demands of patients or caregivers. It improves patients’ livelihood and ability to recover. This care applies to persons experiencing challenges related to life-threatening conditions. The objective is to prevent or reduce suffering through prompt recognition, perfect examination and management of pain (Twycross, 2003). Management of diverse problems such as physical, mental or spiritual is inclusive of this phenomenon. A time comes when a patient develops a disease that leads to death. However, with excellent clinical care, the suffering reduces due to assessment of symptoms and assistance. The care offers pain relief, improves livelihood, and presents death as a normal stage. In addition, its objective is not to accelerate or delay death. Through palliative care, there is integration of both the mental and spiritual needs of patients. Additionally, an assistance system exists that enables patients to lead an active life (Mitchell, 2008). Moreover, there is application of team strategy in addressing the demands of patients or families. The result is an enhanced livelihood and manipulation of the disease. This is applicable in addressing the disease through varied therapies. Procedures such as chemotherapy and radiotherapy eventually manage these conditions. This paper describes palliative care and affiliated services offered within an Aged Facility Care. Furthermore, it describes the main beneficiaries such as the elderly persons suffering from dementia, Alzheimer and Parkinson’s complications.

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Where Palliative Care Is Offered

Palliative care targets patients with critically disabling or indicative chronic complications particularly in the end of living. Although children presently need attention regarding palliative care, the highly affected group includes the elderly, who are present within Aged Facility care centers (Abbey, 2008). This is especially in developed nations. Palliative care is significant in the management of terminally ill adults. Severe complications including cancer mostly render the sufferers disable thus posing pain and death as the end. Consequently, the families of such victims are traumatized since they can suffer psychologically. Aged Care Facilities provide suitable areas for offering end-of- life care to patients (Clark, 2002). In these facilities, complete attention is applicable to the residents who pay for these services. The care in these facilities provides the occupants with an admirable quality of livelihood. Most of these facilities minimize the possibility of patient transfer to hospice and hospitals. Because of this, the patients together with their kin stay within the environment and get assistance. They feel valued, secure, and comfortable within these facilities. In nations like Australia, there are stringent regulations and policies regarding the accreditation of such facilities (McNamara, 2004). Such policies ensure that there is proper management, safety, and patient dignity. External palliative assistance applies when there are conditions surpassing the existing internal competency.

In Australia, there exist guidelines for “Palliative Approach” in these facilities (McNamara, 2004). These offer assistance and direction for the dispensation of a palliative approach within these facilities across Australia. Moreover, the operating facilities follow these regulations and varied state workshops create awareness. In these facilities, the elderly get admission based on their health conditions. Those suffering from terminal illnesses such as cancer and dementia receive preference. There are trained professionals deployed within these facilities responsible for dispensation of palliative services to these patients. Occupants of these facilities are older and frail. They also have complex co-morbid complications and workers herein face problems in satisfying the complex care requirements of this varied group of persons. Aged care centers increasingly gain global popularity, with developed states leading with statistics. For example, there exist approximately 3,000 of such facilities within Australia alone (Cancer council, 2009). There are procedures, which contain quality scientific evidence present relating to the facets within palliative approach. These include prompt recognition and treatment of mental, physical, and other needs. The facilities form environments where occupants and families stay jointly without disturbing other people.

Persons Involved

Palliative care entails a multi-dimensional intervention procedure that covers the entire realms of life of the patient undergoing care. As a result, there are various personalities involved during the process. Each personality plays a distinct role, which culminates with other interventions that improve the patient’s lives. The residence of the patients within facilities provides an opportunity for full attention. With the elderly patients, there are more interventions (Rio-Valle, Caro & Juarez et al., 2009). Family members of the patients are also chief beneficiaries of these services. It is evident therefore that there is need for many professionals to offer the distinct services depending on the patient’s illness type and condition. In wider perspective, there is indulgence of many personalities such representatives from relevant sectors and beneficiaries. An efficient multi-disciplinary team must dispense palliative approach. Such teams ought to recognize and admit the significance of unity and teamwork in dispensation of such services (Abbey, 2008). Recognition of the centrality of positive team endeavors advances job fulfillment and increase the care quality to patients or family members.

A multidisciplinary strategy is vital since the wide array of anguish faced by occupants and their kin necessitates an expansive variety of skills. Such teams must focus its endeavors on solving the challenges that face the occupants. Persons involved include care assistants who act as personal aids to the patients and have special training. Others might also be from the patient’s family. General practitioners, (GP) who undergo training and have qualification on varied medical procedures exist (Bostro, Sandh & Lundberg, 2004).They render medical support involving specialized treatment and are available on call within the age care centers. Because patients may suffer from different ailments, there are different specialized GPs who offer skilled medical attention when appropriate. Registered nurses also form part of this team and assist the GP in their routine duties to the patients. Enrolled and specialized nurses may also be involved in palliative care within these centers (Soden, Ali, & Alloway et al., 2010). Specialist nurses may offer wound care and continence services. The aboriginal health staff, volunteers, and other coordinators form part of staff within the care centers. Volunteering is an essential component of palliative care. Pharmacists offer prescriptions and are responsible for drugs used within the care center.

The spiritual component of palliative care is critical and chaplains or pastoral care workers are responsible for spiritual nourishment and improvement. Additionally, recreational activities specialists provide vital recreation directives to patients, thus enhancing their physical components. Pain specialists and other healthcare specialists such as occupational therapists and physiotherapists form part of palliative care team. Social workers are vital members of the team. Moreover, nutritionists, music therapists, and skilled physicians such as surgeons exist. Neurologists and wound care persons also provide specialized services (Abbey, 2008). Among other important team members include the psychologists who provide psychological assistance to the patients. Lastly, the patients themselves as well as family members as residents of the care centers are recipients of the services and form essential component of any palliative team.

The People Who Receive Palliative Care

Most elderly persons around the globe face serious chronic complications while approaching the end of living. There exists a significant public health problem in trying to meet the demands of such persons. Better palliative care is necessary specifically for these elderly people. Because most elderly persons suffering from terminal illnesses are enrolled within care centers, these form the basic target especially in developed states (Agar, 2009). Despite high death cases in the elderly population, little guidelines regarding their particular needs towards death exist. As populations age, there is a gradual up scale of people into the elderly stage. Disease trends also transform and individuals die due to chronic devastating complications such as dementia and Alzheimer’s disease among others (Abbey, 2008). Because these diseases usually occur among the elderly, they face several health complications and disabilities. Therefore, there is need to provide proper and relevant palliative care to these groups.

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According to “World Health Organization” (WHO), the percentage of persons of 65 years and above is gradually growing globally (Bostro, Sandh & Lundberg, 2004). The elderly suffer pointlessly, owing to prevalent underassessment and lack of therapy based on palliative care. Thus, elderly persons are the main beneficiaries of palliative care services. Within this category, keen attention is applicable to those suffering from dementia and Alzheimer’s illness. Additionally, those who suffer from Parkinson’s disease are inclusive. The elderly who suffer from dementia experience serious irreversible cognitive decline. Other associated conditions include swallowing difficulties, weight reduction, anorexia, and dysphagia (Miyasaki, 2011). Advanced dementia refers to a progressive and degenerative illness. This is because it is life-limiting thuspalliative approach is necessary. The team offering the care should understand the nature of this illness and the patient’s family ought to comprehend the condition. In addition, they should have opportunity to understand the importance of the palliative assistance.

Alzheimer’s disease leads to dementia, which is more likely to cause death. The condition also predisposes persons to other infections that cause severe human suffering. Communication on the therapy course is important amongst participants including the patients. Parkinson’s disease presents as a chronic and neurological illness that affects several people annually (Abbey, 2008). The elderly are most at risk and palliative care becomes necessary. Although significant progress is evident, treatment benefits in advanced stages reduce and symptoms get more complex to manage. This life threatening condition thus requires palliative care as recognized by WHO (Agar, 2009). Its model applied in care directs specialists in provision of care to families and individual patients. All these conditions are life threatening and affects the more vulnerable elderly population. It is therefore evident that the group needs a proper palliative care.

What Is Good About the Services Offered?

Provision of care to facilitate good death is a remarkable medical practice that also gives the backdrop that permit the bereaved to mourn appropriately. A comprehensive approach is applicable for service provision within these facilities. Symptoms control, sustained care, and minimizing caregiver strains are essential fundamentals of care used in managing patients approaching death. Provision of these services within the facilities enable the patients to regard positively their status and may consequently transform the disease course. Clinical management of various conditions reduces depression in patients (Bostro, Sandh & Lundberg, 2004). The integration of progressive care planning initiatives within various care centers helps to improve the patient conditions. Training of stakeholders such as care providers assist in advancing care. Pain management offered in these facilities is a vital component of excellent terminal care. There are complimentary interventions such as body massage and music therapy for patients. These services help to build the physical as well as the social aspects of these patients. The general practitioners are always present to the disposal of patients and services such as acupuncture help to reduce pain and increase patient comfort.

Notably, systemic apprenticeship for workers caring for the facility residents as well as application of acknowledged care methodologies are important. Availability of specialist services and interventions within these facilities enable proper management of diverse conditions. The holistic approach to service provision is a great achievement in enhancing patient progress and comfort in all realms of life. Furthermore, the execution of “advanced care planning” provides room for management of severe terminal illnesses such as advanced dementia (Hall, Petkova & Tsouros et al., 2011). The elderly are more vulnerable and can easily succumb to distressing and agonizing conditions. Palliative care to these groups therefore provides a timely intervention and support for the almost dying elderly population. Proper management of Alzheimer’s disease may reduce the changes for progression into advanced dementia. Moreover, the availability of drugs and other prescriptions coupled with medical attention within the facilities offers opportunity for prompt diagnosis and therapy. Assessment, management, and family assistance play constructive roles in completely transforming the patient’s view and attitudes towards their conditions. The family members’ support system provides a holistic approach to problem handling. Provision of cognitive behavioral therapy, (CBT) by psychiatrists is vital for improvement of the mental capacity of the elderly particularly suffering from conditions such as dementia (Hicks & Rees, 2008).

There is minimization of stress and other effects likely to be transmitted form victims to other family members. This consequently minimizes the percentage of patients to be attended. Symptom assessment coupled with efficient pain management includes some of the vital services in these centers. The patient dies in relief and stigma reduces significantly at the –end –of-life stage (Agar, 2009). Other complications including fatigue and nutrition problems such as anorexia exist. Provision of psychological support minimizes likelihood of depression and anxiety by individual patients as well as their families. Family and social assistance initiates positive effects. Additionally, spiritual support nourishes the dying individuals and their kin and consequently potentiates death as a normal occurrence in a lifetime. Support from volunteering initiatives and terminal care all improve the quality of living before death. Lastly, bereavement support is vital in consolation of the family and offering psychological assistance. It is evident that with growing complications in the enlisted diseases such as dementia and Parkinson’s illness, critical clinical as well as other approaches to palliative care matter.

How to Improve the Services Offered

There still needs to be a lot done in order to improve on the services offered within these age care centers. Foremost, adherence or compliance to existing guidelines on palliative care present within nations like Australia is necessary. These guidelines exist to provide the fundamental premises on which palliative approach should follow. Due to the existent of several age care centers in certain states such as Australia, there needs to be a more harmonized system that regulates their operations and protects the interests of the patients (Edith Cowan University, 2006). Without such systems, there can easily be abuse of patient rights and maltreatment particularly with euthanasia issues. There should be additional research about potentially valuable interventions and other complications including newly emergent illnesses such as Parkinson’s disease other than cancers (Hicks & Rees, 2008). Due to the transformative nature of current disease trends, further empirical and, medical investigations are necessary to develop beneficial strategies to palliative management. Consequently, results should initiate the adjustment of existing palliative approach guidelines and enforce change in the medical management procedures applicable in normal situations. A complete overhaul of palliative care systems is necessary with growing contemporary concerns in clinical arena.

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Proper empirical diagnosis is necessary to establish whether a patient is dying and provide him adequate care. There should be an evident-based system of enrollment of patients and families in any age care center. This will support the medical ethics relevant for specific life-threatening conditions (Soden, Ali, & Alloway et al., 2010). However, effective diagnosis requires adequate familiarity and qualification within different medical fields. Qualified professionals and practitioners are therefore applicable for such undertakings. It is important to practice participatory decision making as members involved in dispensation of palliative care. However, critical decisions regarding the condition of the patients, whether they are to die or not solely rely on qualified medical personnel. Effective communication as well as feedback sharing amongst the care team and families of patients is necessary to improve their relationships and prohibit false hopes (Mitchell, 2008). Some indicative signs of a dying patient may include change in complexity, gauntness, minimized oral intake, temperature fluctuations, disoriented concentration, and others. The caregivers must be aware of these signs to be competent of recognizing terminally ill patients.

Adoption of holistic approach by those offering palliative care is vital in examination and management of pain. Additionally, all components within palliative care are equally useful and disregard of any such as psychological component may cause dangerous implications on patients and families. There also exist notable training demands regarding pain assessment and critical clinical decision procedure (Qaseem, Snow & Shekelle et al., 2008). Teamwork amongst the care providers is vital in order to initiate these transformations and focus on forward movement. Strategic management of existing care centers for the elderly is necessary also to offer excellent services and meet the client demands. Patient satisfaction with the offered services should be the major goal for these care homes. Voluntary service should also accompany as an important aspect for palliative care since some patients maybe unable to meet the high fee demands procedures (Hall, Petkova & Tsouros et al., 2011). Standard professional ethics is necessary in palliative care because the patients face death and controversies from legal bodies or families might arise. Due to this, adequate information and discussion is necessary between parties before any procedure is undertaken.

There is a demand for improvement on virtue ethics and professional conduct. Consequently, there is need for care providers such as nurses to be honest during service (Erichsen, Danielsson & Friedrichsen, 2010). Individual assumptions should be outplayed to enhance open and candid communication according to clients independence and recognition of preferences (Powis, Etchells & Martin et al., 2004). Feelings and instinct should not lead to improbability and ethical variance. Principally, human beings require special attention even in death. Therefore, care is necessary while dealing with terminally ill persons. Initially, one cannot declare a fellow before prior intensive medical diagnosis. As indicated in most sources, simple complications are likely to develop to severe forms with incorrect diagnosis and admission of patients for palliative care. In conclusion, palliative care is a crucial; furthermore, distinct medical field that is globally gaining recognition with the advancing age of most populations equally assumes the same stature. High attention to ethical procedures is necessary for such a practice. Furthermore, a multidisciplinary strategy offers complete care when various guidelines existing within different nations are followed. Other than developed states, emergent nations presently face the need to consider palliative care as a critical public health concern.

References

Abbey, J. (2008). Develop, trial and evaluate a model of multi-disciplinary palliative care for residents with endstage dementia. Web.

Agar, M. (2009). Changes in anticholinergic load from regular prescribed medications in palliative care as death approaches. Palliative Medicine, 23(3), 257-265.

Bostro, B., Sandh, M., Lundberg, D. & Fridlund, B. (2004). Cancer-related pain in palliative care: patients’ perceptions of pain management. Journal of Advanced Nursing, 45(4)410-9.

Cancer council. (2009). Understanding Complementary Therapies: A guide for people with cancer, their families and friends. New South Wales: Cancer Council New South Wales.

Clark, D. (2002). Between hope and acceptance: The medicalisation of dying. British Medical Journal, 324(1), 905.

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Edith Cowan University. (2006). Guidelines for a Palliative Approach in Residential Aged Care. Web.

Erichsen, E., Danielsson, E. &Friedrichsen, M. (2010). A phenomenological study of nurses’ understanding of honesty in palliative care. Nursing Ethics, 17(1)39-50.

Hall,S., Petkova, H., Tsouros, A., Costantini, M. & Higginson, I. (2011). Palliative care for older people: better practices. Web.

Hicks, F. & Rees, E. (2008). A ‘pain-free’ death. British Medical Bulletin, 88(1), 23-41. Web.

McNamara, B. (2004).Good enough death: autonomy and choice in Australian palliative care. Web.

Mitchell, G. (2008). Palliative care: a patient-centered approach. Oxon, OX: Radcliffe Publishing.

Miyasaki, J. (2011). Palliative Care in Parkinson’s. Web.

Powis, J., Etchells, E., Martin, D., MacRae, S. & Singer, P. (2004). Can a “good death” be made better?: A preliminary evaluation of a patient-centred quality improvement strategy for severely ill in-patients. BMC Palliative Care, 3(2), 1-8.

Qaseem, A., Snow, V., Shekelle, P., Casey, D., Cross, T. & Owens, D. (2008). Evidence- Based Interventions to Improve the Palliative Care of Pain,Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline. American College of Physician, 148(1), 141-146.

Rio-Valle, J., Caro, M., Juarez, R., Pena, D., Vinuesa, A., Pappous, A.& Quintanna, F. (2009). Bad News for the Patient and the Family? The worst part of being a health care professional. Journal of Palliative Care, 25(3), 191.

Soden, K., Ali, S., Alloway, L., Barclay, D., Perkins, P., & Barker, S. (2010). How do nurses access and manage breakthrough pain in specialist palliative care inpatient units? A multicentre study. Palliative Medicine 24(3), 294-8.

Twycross, R. (2003). Introducing palliative care. Oxon, OX: Radcliffe Publishing.

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