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Health Sciences School. MSc Nursing Administration

Introduction

Evidence based health and social care is understood as to take care of patients and their families depending on results of studies conducted on the same field of practice, and/or depending on policies and guidelines set by expertise and governments authorities.

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The author of this paper selected “palliative care” to investigate as at is an important piece of health and social care which the person needs at different stages of life especially during illness. In Oman – where the author is working – one type of palliative care is practiced in some hospitals that is “pain management”. Palliative Care is a form of medical care that tries to reduce the disease symptoms instead of providing cure to the disease suffered by the patient. It attempts to mitigate the severity of the symptoms rather than halting the disease itself so as to boost the quality of life of the patients that are suffering serious diseases. The main goal of palliative care is to relieve such patients of their suffering so as to ensure they live better lives despite their complex illness. According to WHO, “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 caused by the illness” (WHO, 2010, 1). Palliative care therefore helps the patients suffering from serious illnesses to relieve themselves from pain and also saves them the distress that is associated with the symptoms that culminate from the illness. It makes them to live normal lives despite their critical conditions.

Palliate care enable the family of the patient to cope when their patient is experiencing the critical conditions of the disease. It is applied at early stages in the course of illness and is combined with other therapies meant to prolong the life of the patient.

Palliative are generally alleviates symptoms of the disease irrespective of whether the other curative methods makes progress or not. It could therefore be used to alleviate the side effects of illness, mostly of curative treatments. In the United States, two kinds of palliative care namely general palliative care and hospice care depending on where (location) the services are offered and also the payment systems that each of them use.

However, the two kinds of palliative care share the same philosophy and are not distinguished in some other place like the UK. The United Kingdom and Canada talks of hospice and non-hospice based palliative care depending on the condition of illness being experienced. Hospice based palliative care is meant for those patients in critical conditions while non hospice based palliative care is provided to those with life-limiting illness connected to their diseases. Palliative care is therefore worth reviewing because of its importance in improving the quality of life of patients suffering from complex illnesses.

The main focus of this paper is to undertake a critical review of the literature relating to “Palliative Care” and a justification of how palliative care can be used to improve health care practice. The aim of this literature review is to prove that evidence based health and social care is an important aspect of care in today’s healthcare arena.

Literature Review on Palliative Care

This section will focus on the critical review of the literature that has been written about the palliative care. There are many authors that have attempted to shed a light on the understanding of the palliative care, its practical application and the role it plays in improving the quality of life of patients suffering from chronic illnesses. The history of palliative care dates back in 1960’s and it was aimed at addressing the needs of the patients who were terminally sick together with their loved ones (Charlton, 2002).

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Definition of palliative care

Different authors have attempted a definition of palliative care describing what it entails and how it is applied. Morrow (2010, 1) defines palliative care as a form of medicine that specializes in improving the quality of life of people with conical diseases and also improving the life of their families by enabling them to cope with the illness and its symptoms.

This means that the palliative care is meant at increasing the comfort of the sick person and that if his filmily by mitigating the effects of the illness and reducing the distressing symptoms experienced by the patient. It is a form of expert symptom management that ensures that the severity of the illness does not disturb the patient and his family. According to Morrow, “In addition to expert symptom management, palliative care focuses on clear communication, advance planning, and coordination of care” (Morrow, 2010, 1).

In this very strategy, palliative care ensures that all aspects of life of the patient are considered during treatment or delivery of any other form of care. The symptoms of the illness are reduced and the patient is made comfortable as he copes with the illness and gets on well with daily life.

The World Health Organization (WHO, 2010, 1) describes palliative care to mean an approach that is aimed at boosting the quality of life of patients and that of their families during the period that the patients are experiencing severe illness. It is aimed at relieving the pain experienced by the patient and therefore it focuses on treating pain rather than the disease itself.

Concerning the palliative care for children is explained by WHO as “Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family” (WHO, 2010, 1).

To children, this kind of care commences when the illness is diagnosed and remains an ongoing process irrespective of whether the treatment for the illness is provided or not. This is meant to alleviate the distress that might culminate from the diagnosed illness. The physical, psychological and social disturbance suffered by the child as a result of illness is reduced through palliative care and they live better and healthier lives (WHO, 2010, 1).

Twycross in his book introduction to palliative care (2003, 2) describe palliative care as aggregate active care given to patients with diseases that are capable of limiting their lifespan especially when the disease is still worse despite the prolonged treatment.

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Dr. Samantha Winemaker who is a consultant of palliative care defines palliative care as a means through which a person together with his or her family is helped to manage the process of dying as well as to manage the self determined closure of life. He argues that palliative care enables people to cope with grief as a result of bereavement and illness (Kirschling, 1990, 74).

Palliative care entails taking care of the entire person i.e. the body mind as well as the spirit and it views the death process as something that is personal and personal. Its main objective is to ensure that one enjoys a quality life during the period that he or she is alive. This entails that everybody is entitled to a palliative care that is good and so the doctors should have adequate knowledge of palliative care (Bass, 2006, 8).

It is very hard to cope with bereavement especially the death of a loved one. It is also hard to deal in situation whereby a loved is faced with an illness that is hard to treat. Only a small percentage of people are ready to accept the hard decisions concerning the life of another.

Palliative care usually forms an important aspect of the medical care professionals role. Caring people who have terminal as well as advanced diseases is usually rewarding. The palliative care is usually enhanced through having confidence with respect to the symptoms management.

Palliative care forms part and parcel of the entire patient management, including the patient, family members of the patient and doctors among others. The main objectives of palliative care includes enhancing the lives of the patients together with their families, controlling the disease symptoms, helping people to adjust as a result of loss of their loved ones following terminal and advanced illness, preventing the problems that arise as a result of bereavement and ensuring that patients dies in a dignified manner.

Thus patients who are suffering from ailments that are cannot be healed are advised to seek palliative care. They need to talk to their doctors so as to access the services of palliative care. The patients also need to ask the health professionals to explain to them the kind of illness that they are suffering form and also the procedures that are involved during treatment (Charlton, 2002, 51).

Palliative care might start in such instances as when a medical treatment becomes ineffective, or when one decides to get rid of the aggressive treatment ,or when there is failure of the important body organs, or when loved ones decides to have their patient discharged. Palliative care may be undertaken either in hospitals or in home. In hospitals, the care is usually provided by trained nurses whereas in homes, family members together with the loved ones undertakes care once a patient has been discharged. In both the hospital as well as home settings, there are important interventions that are usually used in order to take care for the persons who are about to die (Speck, 2006, 97).

Palliative care philosophy

Different countries hold different approaches as far as palliative care is concerned. Despite the various approaches by different nations, there are however certain values that are widely accepted by professionals of palliative care which includes the need to consider the ones’ autonomy, the need to respect personal judgement as well as the holistic approach. With regards to autonomy, the palliative acre considers one to be independent and unique in one way or another. Palliative care thus cannot be provided if the patient is not ready for it. Palliative care is thus concerned with ensuring that adequate information is provided to the patients so as to enable them make informed decisions. In Oman, pain management programme gives the right for pain management options for the patient if he/she is above twelve years of age where he is considered an autonomous adult, or otherwise the parents decide for if he is a child or an elderly with diminished consciousness.

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The other aspect that is accepted with regards to palliative care is dignity. It is believed that the activities relating to palliative care should be carried on in a manner that is sensible so as not to violate the rights of the person. The patient should feel valued and this will enable them to disclose as much information as possible so as to facilitate treatment (Buckley, 2008, 97).

The healthcare experts should develop a cordial relationship with the patients and their loved ones so as to facilitate the management and planning of the sickness. Another aspect with regards to palliative care is communication. Good communication ensures that dissatisfactions as well as complaints are handled and this helps to enhance the palliative care quality. Also, palliative care needs to be conducted in a multiprofessional approach i.e. it should encompass both healthcare as well as mom-health care experts who should work together as a team to enhance the health conditions of the patients (Randall & Downie, 2006,14-25).

Principles of palliative care

The palliative care principles are concerned with describing the kind of care that should be accorded to persons who are facing death. Usually, there are five principles with regards to palliative care which includes the following; palliative care holds respect with regards to the objectives, preferences as well as choices of a dying person. Palliative care thus respects the desires and wishes of the family members and friends. It is concerned with finding out whom the patient prefers to be attended to by and also helps one to understand that the kind illness he or she is suffering from as well as the future expectations. Thus it addresses such issues as where one can get good palliative care, where one aspires to live as well as the kind of health services that one desires. This therefore enables one to cooperate with the medical professionals so as to solve the problems (Beresford, 2007, 12).

The second principle of palliative care is that it takes into consideration such issues as religious, social as well as the emotional ones (Bass, 2006). This ensures that ones health is enhanced. Palliative care thus offers ways in which one feels safe and comfortable as it recognizes the fact that death is an important aspect as far as person together with his or her family members are concerned. By doing this it assures one that he or she is not alone and that there are other people who are involved too. It thus offers a chance whereby the dying person as well as the familiy members can make the necessary changes once the illness worsens. This indeed enables one to grow by examining the past hence making the correct decisions to move forward (Bass, 2006).

Thirdly, palliative care offers support to the rest of the family members i.e. it takes into considerations that the family members also have needs and so they too require to be helped. The health professionals thus provide the family caregivers with such support as setting time where they can relax as well as contacting them through telephone. Palliative care recognizes the fact that family members are exposed to a risk of getting ill during the time they are providing care to the dying person and so it caters for the special requirements. Providing care to a person whop is dying is expensive and therefore, the palliative care considers ways through which the family members can raise funds. In addition, palliative care helps the family members during the bereavement by providing them with encouraging words so as to cope with grieve (Boog & Tester, 2008, 76).

Fourthly, palliative care provides an environment whereby persons can have access to appropriate health care with ease. Palliative care usually encompasses the patients and the medical professionals and acknowledges the right to life as well as considering the normal dying process. Dying is usually a unique and personal issue and so the hospital staffs has a routine role of ensuring that they accord care to the patients so that in the event of death, then they are not to be blamed for negligence.

The manner in which the medical professionals perform their roles usually affects the patients as well as their relatives. The lack of proper communication may however hinder the hospital staff from providing the necessary care with regards to dying patients. Ineffective communication may contribute to more suffering of the patients as compared to the terminal disease symptoms as it can be challenging on the part of the medical staff to know when the curative care comes to an end and when the palliative care starts.With regards to palliative care, people are allowed to decide whether to be attended in hospitals, homes or any other place that they deems fit (Jesse, & Kurent, 2003, 82).

Finally, palliative care provides dying people with appropriate care by providing them with the required education and help. It exists to ensure that there are good policies that govern the dying process. Talking about the end of life is usually difficult due to such reasons as the fear of hurting someone by saying that he or she is about to die, the fear of giving out unnecessary information, lack of effective communication, fear of making someone to lose hope among others.

Palliative care therefore addresses the above by encouraging people to think in a positive way as well as discouraging the reflections with regards to death. It encourages people to remain hopeful and not to give up. It also gives hopes of peaceful death, pain relieving as well as symptom control (Forman, 2003, 23).

Justification for the use of palliative care in healthcare practice

Many people including the loved ones are bound to suffer from life threatening diseases such as cancer. Furthermore, everyone is bound to die at one time and so there is the need for a system which can help to provide the required guidance as well as support i.e. the palliative care. Palliative care is useful in practice because of the following reasons; Palliative care as a health field usually helps to provide coordinated care to patients so as to help to ease pain as well as suffering.

Palliative care provides calm as well as support to patients as well as their family members. It is not meant to people who are about to die rather it also offers care to those patients who might be cured. It is hard for one to know the suffering that another person faces due to the fact that we cannot feel the pain of another person. Despite these, we are bound to offer others treatment so as to ease pain. Patients who are nearing death usually needs symptom management that is cautious.

Palliative care helps to recognize the signs as well as the symptoms that occurs frequently during the last moments of a person’s life and comes up with important measures of managing these signs so as to help both the patient and the loved ones (Fallon & Hanks, 2006,18).

Palliative care usually enables the life of people to have a meaning i.e. it enhances the quality of life of people instead of living somehow until death arises. It also addresses the specific needs of persons and treats each person as a unique being with unique needs (Faull, 2005, 37).

Critique of palliative care

According to WHO (2004 p.32) palliative care is meant to benefit cancer patients by helping relieve pain in the body. There are however other scholars who have a divergent view. According to them palliative care has not been as successful as others have tended to portray. For instance, according to Davies (2004 p 34) palliative care can only work effectively when the illness is discovered early so that other modes of treatment and therapies can be initiated. Therefore, according to him, patients who fail to learn of their conditions early in life are not applicable when it comes to palliative care. He argues that as much as this process helps the patients in living a comfortable life while suffering from the disease, it is discriminative on the grounds that it does not take care of those patients who have been heavily affected by this killer disease. He says that individuals fail to learn of their condition not because of ignorance but also as a result of symptoms that resembles cancer as a disease. Therefore, caring for those who have just suffered from cancer alone should be discouraged because it can accelerate the rate at which cancer cells eats the white blood cells in a patient. This according to Webb (2005 p 231) can be brought about by the fact that such patients may feel discriminated and hence stigmatized. In addition Pathmavathy (2004 p 121)has contented that palliative care helps in the alleviating pain from the patient as well as providing a relief from other related symptoms that may befall the victim. However, he has noted that different people have different cultures, and as a result different ways on how they perceive patients suffering from cancer. According to him in the developing countries for example, there are some communities who believe that people suffering from cancer are usually bewitched. As a result such kinds of people are stigmatized and treated as outcasts. Therefore he argues that in such a case palliative care does not relief pain but rather adds suffering to the patients thus making them die fast compared to others who are cared for by their members of the family.

In addition, Foley (2004 p 543) has noted palliative care uses a holistic approach in the attempts to address the needs of all those people who are suffering from cancer. However according to Hain (2010 p 65) palliative care does not embrace a holistic approach because according to him, the whole idea of just addressing only those patients who have just been diagnosed with cancer makes it less of an effective approach. He further recommends that palliative care should be improved in such a way that even those who have suffered for a long time without such care are taken care of. According to him such measures would help in improving their state of surviving. If this fails to be initiated he argues that all that it has achieved would all be in vain.

According to Clark (1999 p 232) palliative care does not help in alleviating the suffering of the patients fully as initially intended. To him an attempt to cure this killer disease leads to some very serious side effects. He adds that use of chemotherapies and other medicinal care leaves the patient with some of his cells destroyed that emanates from the machines producing the rays used to kill the cancerous cells. For instance during the cure for prostrate cancer, he says that the patients’ productive organs are usually rendered ‘useless’ that is they cannot produce the fertile semen for fertilization purposes. Therefore, this leads to more suffering by such people and especially stigmatization by other people who may consider them irrelevant to the society by their failure to give forth a young one. In regards to neck cancer, he says that patients are normally left with skin lashes that do not disappear. Therefore, instead of reliving the pain for the patients he says that palliative care adds immense suffering to some of patients.

Other scholars like Russell (2003 p 386) have noted that palliative care is not as perfect as thought to be. For instance he says that people believe that palliative care helps the victims of cancer a chance to live an active life despite their conditions. However, according to him and other scholars, some of the palliative care given to the patients makes them feel better in the short run but in the long run these patients becomes weaker and ends up dying to conditions associated with palliative care. For instance, radiations meant to cure cancer makes the patients addictive to them and ends up making them develop a weak body immunity thus becoming vulnerable to attacks by other disease causing micro organisms.

Furthermore, William (2008 p132) has also noted that palliative care has been found to be a source of misery to the other members of the family who are the care takers of the patients. He says that the cost of acquiring such kind of care is usually a night mare to many especially those from marginalized areas particularly in the third world countries. To add on that, the cost of receiving these services in the designated centres is usually a very expensive affair that is far beyond the reach of the majority poor. Thus according to him palliative care fails to meet its intended function. William (2008 p134) says that if the government decentralized the palliative care centres then there would be a decrease in the number of deaths related to cancer since people will have learnt to live positively despite their ilnesses. His argument is that if these ideas are adopted, the government would in the long run record a decreased number of cancer related deaths and hence the economy would always be moving in the positive direction.

According to Dickman (2010 p 211) palliative care has no intention of accelerating nor postponing the death of a patient. However according to Clark (2002 p 342) the whole idea of palliative care is to help a patient live longer without experiencing a lot of pain in the affected part. He says that if the a cancer patient is left alone without care from the government or the members of the family as well as medical practitioners, he or she is likely to die very fast as a result of eating away of white blood cells by the cancerous cells. Therefore, the act of providing palliative care according to him is meant to help the patient live longer and as a result postponing his or her death. He says that what Dickman (2010 p 211) should have stated is that palliative care is meant to help the patient die without experiencing too much pain that is usually part and parcel of cancer.

As argued by some scholars that palliative care incorporate both the spiritual and the psychological needs of the cancer victim Penson (2002 p 543) disagrees with this by stating that this has not been proven to be the case universally. He says that not all communities in the world accept patients diagnosed with cancer. Therefore, according to him, the acts of segregating them from the other cancer free population may affect them psychologically as well as spiritually regardless of the care that they may receive in the care centres. He has cited ignorance as the main reason for treating cancer patients in such a way. In regard to this he says that it is the noble duty of the government to try and spread cancer awareness to her people so that patients can be treated as any other people and be accepted within the society.

Lellehear (1999 p128) disagrees with the notion that palliative care looks at dying as a normal process. He argues that, although protection is better than cure, palliative care attempts to provide a form of cure to the patients and as a result they view death of a patient as a result of them failing to provide adequate medication. This way he argues that death is not viewed as a normal process. To add on that palliative care as earlier thought does not put a lot of emphasis on ones religion. Levy (1985 p 98) contends that palliative care is administered to all people in the same way regardless of ones denomination or faith.

Conclusion

From the discussions above it is quite evident that palliative care is meant to benefit the patients suffering from cancer. As some writers have noted today cancer has become one of the leading killer diseases in the world. Clark (1999 p 238) points out that the most interesting thing about it is that it cuts across all generation. That is to mean whether one is young or old all of them have an almost equal chance of contracting cancer. He notes that in the contemporary world, researchers and doctors are yet to establish the actual cause of this disease. Lellehear (1999 p130) notes that what the researchers have established is that the body reproduces abnormal white blood cells that have been responsible for the disease itself.

When it comes to carrying out a deeper research on this killer disease, William (2008 p134) argues that researchers should ensure that they at least try and cover a majority of the population in a given region so that they can have develop a clear insight pertaining to the disease.

Furthermore bearing in mind that the world is comprised of different people with different cultural backgrounds, Morrow (2010, 7) says that it is important for researchers to try and understand these variations so that when they are writing their conclusions they ensure it covers a greater portion of some of these communities. For example the issue of looking down upon people characterized in some communities should have been known by researchers if they had carried out their research comprehensively. As Lughton ( 2006 p 237) argues no culture is greater than the other and therefore people should never despise what other people believe in as this is important in trying to enlighten them so that they can change the way they look at certain things like people suffering from cancer. The government should use all its machinery in such a case to help the people move from such old believes in order for cancer patients to feel appreciated in spite of their condition.

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