Hospice is not merely a specialized hospital for the dying people, the philosophical aspect of patients’ treatment plays one of the crucial roles there. The initial hospice philosophy is very simple – a dying person needs a special care while passing through the boundaries of life and death.
The palliative care is meant to improve the quality of patient’s life. Through the timely indication, assessment, and treatment of multiple physical and psychological symptoms, as well as the spiritual support, the therapists aim at the prevention of distress and relieve of patient’s pain. “The needs of the hospice patient are wide-ranging and include physical, emotional, social, and spiritual challenges” (Maue-Johnson and Tanguay 13). Thus, the therapeutic intervention should be of the multidimensional character.
The Physical Needs
Among all the medical problems and emotional problems a hospice patient may face, the physical pain and dysfunction are usually the most evident. The therapist obtains information about the patient’s physical condition from the previous medical assessments. It is also possible to receive the patient’s self-report using the verbal complaints or multiple scales such as visual analog scale (VAS) or others (Maue-Johnson and Tanguay 17). The therapists may also observe the patients’ activity and their physical potentials for the elaboration of the appropriate intervention.
Emotional and Psychological Needs
Among the psychological problems of the terminal patients, the inability to cope with the approaching death and all the complex of the thoughts and feelings related to it comes to the fore. As a consequence, the problems with the caregivers and friends’ interrelations as well as the issues of the emotional closeness and mutual understanding arise.
“A psychological profile of patients in hospice includes assessment of areas including mood, sources of anxiety, coping skills, and progress in anticipatory grieving” (Maue-Johnson and Tanguay 19). The therapists need to evaluate the patient’s mood and the level of his/her anxiety prior to the intervention. In case the observed anxiety level is excess, the hospice specialist should inform the family members. For the designing of the efficient intervention plan, it is also important to detect the source of anxiety (i.e. psychological or physical/environmental).
It is suggested to pay attention to the unique experience of each patient for the evaluation of his/her coping skills and mechanisms. The appropriate intervention plan may be created only in accordance with the character of the patient’s coping skills. In this case, the family observation and report plays a significant role. It is important to pay attention to the individual’s willingness to express the emotions and fears or grieving, adapt to changes, and accept the help because the avoidance of problems interferes with the achievement of positive results.
Spiritual and Cultural Needs
“Defining spirituality may be difficult, particularly because it is an aspect of human existence that it is experienced and interpreted differently by every individual” (Milligan 47). Usually, the term of spirituality is defined through the individual’s belonging to a particular faith tradition that is interrelated with his/her cultural background. Through the identification of the patient’s spiritual tradition, the therapist can establish good relations with the patient and improve the communication process.
It is observed that “making sense of the world is a major factor in an individual’s management of stress and illness, and staying healthy” (Bentur et al. 1). Moreover, the human psychological system has skills of counteracting with the stress when facing disease. These resources of coping with physiological distress may be of the spiritual and existential character, and there is a growing interest towards these abilities in the practice of hospice care.
When facing the end of life, a patient inevitably experiences the existential and spiritual issues. When an individual doesn’t feel adequate about the approaching death and has a desire to hasten it, he/she is more prone to the depression and anxiety. In this case, the anxiety is regarded as the protective mechanism helping to avoid the misery. It is also observed that a higher level of the spiritual implication in the individual is related to the lower depression rates (Bentur et al. 2). The psychological, emotional, and sociological aspects of patient’s performance play more significant role in the creation of distress than the physical ones. Therefore, therapists need to focus their attention on these criteria.
The goal of the palliative aid is the increase in the quality of life without the direct influence on the death arrival. In this way, the hospice therapy is oriented to a patient rather than a disease. The palliative therapy is focused on a set of individual’s life aspects: social, cultural, and spiritual. Along with the pain relief and cupping other physical symptoms, the psychological and spiritual support of a patient and his caregivers is necessary.
It is found that the music and landscape therapies are highly effective in the reduction of patients’ anxiety (Hilliard 161). The aesthetic, cognitive-behavioral therapies may help the patients and their relatives to cope with anxiety, grief, and disorientation through addressing them through the methods of musical improvisation or meditative practice.
The information related to the accessing the hospice programs is available at the Official US Government Site for Medicare (Medicare.gov par. 1). There a client may find the links to the multiple health care and governmental resources where the comprehensive data related to the palliative care is located.
Family plays a significant role in the fulfillment of the emotional and social needs of a patient. The development of fine communication between the family members and the patients depends on the relatives’ ability to accept the terminal status and prepare for it. Therefore, the therapy must address the caregivers’ negative emotions as well. Through the evaluation of family psychological distress and its effective intervention, a therapist may support the establishment of an open communication characterized by a free discussion of conflicting feelings, issues, and emotions regarding the disease.
The patients and caregivers’ response to the hospice care is defined by the multiple aspects of age, gender, and education level. However, the patient and caregivers’ preferences may be considered a decisive factor for the hospice treatment utilization (An et al. 983). The personal preferences are usually determined by the demographic background of a patient, and especially the cultural and religious aspects. Thus, the understanding of patient’s personal history will assist the development of the culturally appropriate intervention practice that would be easily accepted by the patient and his family.
It is suggested that the establishment of positive and productive communication with the caregivers plays a critical role in the improvement of the hospice care practice and therapist’s competence (An et al. 985). It is especially important in the case if the patient comes from a minor ethnic group and experiences the cultural and linguistic difficulties in the access to the health care service.
The religious views play a significant role in the determination of the individual’s attitudes towards illness and death. In different cultures, death and the related issues are regarded differently. When this fundamental part of a human’s mentality is neglected, the hospice care intervention is likely to fail in addressing the patient’s needs effectively. The comprehension of individual’s cultural background and preferences as well, as a well-developed communication, is important because they let to impact the patient and caregivers’ state through intervention more efficiently.
An, Ah Reum, June-Koo Lee, Young Ho Yun, and Dae Seog Heo. “Terminal Cancer Patients’ and their Primary Caregivers’ Attitudes Toward Hospice/palliative Care and their Effects on Actual Utilization: A Prospective Cohort Study.” Palliative Medicine 28.7 (2014): 976-985. ProQuest.
Bentur, Netta, Daphna Yaira Stark, Shirli Resnizky, and Zvi Symon.“Coping Strategies for Existencial and Spiritual Suffering in Israeli Patients with Advanced Cancer.” Journal of Health Policy Research 3.1 (2014): 1-21. Print.
Hilliard, Russelle. “The Use of Music Therapy in Meeting the Multidimensional Needs of Hospice Patients and Families.” Journal of Palliative Care 17.3 (2001): 161-166. ProQuest.
Maue-Johnson, Elizabeth, and Carla Tanguay. “Assessing the Unique Needs of Hospice Patients: A Tool for Music Therapists.” Music Therapy Perspectives 24.1 (2006): 13-20. ProQuest.
Medicare.gov 2016, Contact Information.
Milligan, Stuart. “Addressing the Spiritual Care Needs of People Near the End of Life.” Nursing Standard 26.4 (2011): 47-56. ProQuest.