quality palliative Care Clinical practice guidelines

One significant area of worry in the delivery of healthcare is palliative care for patients. To guarantee the provision of high-quality palliative care, clinical standards are provided. This essay examines the application of palliative care, decision-making regarding end-of-life issues, the review of clinical palliative care standards, and steps that can be taken to guarantee the delivery of high-quality care.

A number of clinical guidelines have been established by the National Consensus Project for Quality Palliative Care to guarantee the administration of Quality Palliative, these guidelines have been designed in such a manner that they are able to meet all urgent and relevant care settings. These guidelines represent a philosophy of care and an organized system that has high standard structures that ensure care is delivered to the patient. They are aimed to support all patients who are experiencing life lethal or chronic diseases regardless of age. The guidelines here are a representation of the collaborative process that involve all the national major palliative care organizations. They also include the American Academy of Hospice and Palliative Medicine and the National Hospice and Palliative Care Organization (NHPCO). The formation of the guidelines was a collective contribution of more than 100 nationally recognized experts of the care provision (In Ferrell, In Coyle & In Paice, 2015). The guidelines developed, however provide for a review and an endorsement of the clinical practice guideline. The provisions of the guidelines consist of the following domains:

Domain 3: Psychological aspects of care

This domain has been significantly revised over time and expanded to cater for the collaborative assessment process of psychological concerns and the psychiatric diagnoses. Some of the essential elements include: diagnosis, and treatment options that are common for the specific disease while respecting the goals of the patient and the family and the description and required elements of a bereavement program.

Domain 4: Social aspect of care

This is the guideline that caters for the total contribution and participation of members related to the patient. It lays greater emphasis on the engagement of both patients and families to identify and support the patient. The main social elements of palliative care are defined in this scope. There is also a role played by the professional social worker here.

Domain 5: spiritual aspect of care

This domain majorly focuses on the spiritual values of the patient and the family members. Its broader aspect defines the religious aspect.it also performs a strong assessment of the religion, access of the religion, and also takes into consideration the staff that will attend to the spiritual concerns of the patient and the family during the ailment season. It therefore incorporates the staff training and education that regard to spiritual handling and ensuring provision of quality spiritual care. This domain requires high level of responsibility in the team, and an appropriate chaplain will be required to ensue exploration, assessment, and attendance of spiritual needs of the family and the patient. It is a major discipline that provides comfort and relief.

Domain 6: Cultural aspect of care

Cultural aspect of care defines all the culture and cultural competence of the team handling the patient. It involves understanding the culture of the patient as a source of strength and reinforcement for the patient and the family. Understanding of culture should incorporate language, literacy, and linguistic related services that are appropriate for the patient and the family.

Domain 8: Ethical and legal aspect of care

This domain is further subdivided into: Advance care planning, ethics and the legal aspects of care. Planning caters for all the ongoing goals of care and an inclusion of the documents involving care planning. Ethics handles the competences of the team in identification and handling the ethical issues with close proximity to ethical committees for advice and counsel. The legal issues handle the complex legal and regulatory issues that may occur due to provision of palliative health care. The services of an expert legal counsel are necessary to intricate and create a sensitization of the of the legal and regulatory issues.

With regard to the above domains and the guidelines on provision of care for palliative patients, my stand is that a comprehensive care provision of the palliative patients has been taken into consideration, however, practical applications of these guidelines require a close consideration of the core values of specific community’s with regard to respect and integrity. In my case, to apply these guidelines and majorly in the community hospital, while ensuring upholding of community core values of respect and integrity, all professionals while implementing these guidelines should be able to be accountable for their actions by responding to the patients’ needs and assuming the responsibility of change and learning the change involved. They should also be compassionate and caring by understanding the socio- cultural, psychological and the economic influences on the patients they handle and their families and should be able to recognize and refrain from acting on their social, cultural gender and sexual bias nature. They should have integrity such that they should be able to abide by the rules and laws that are stated in the guidelines regarding care given to the palliative patients, they should also adhere to the highest standards of professionalism that involve practice, ethics and reimbursement and they should also be able to perform their professional and social duties such as promoting professional physical therapy and advocating for the health and wellness needs of society and promoting cultural competence and social policy that effect the function, health and the wellness needs of the patient.

Q1

some of the potential, foreseeable financial and medical yet unintended harmful consequences that may occur when the family and friends of the patient may incur for failing to provide a properly executed will and living will prior to ones’ final illness and death include: life insurance money can’t be released since it was not clearly stated in the will and therefore, the family and friends will have to incur the funeral expenses and other accumulated bills. Any money belonging to the deceases will be in probation and the decision on the distribution of any property that the deceased had will remain in the courts hands (Ackley & Ladwig, 2014). Absence of a living will pose challenges to the family and the friends of the deceased since they will not be in any position to prove the wishes of the deceased much as they may have discussed it with the deceased before the demise. Legal documents are very vital in passing of a loved one as they make their passing slightly bearable as the financial and emotional stress of the family and friends incurring the loss could be prevented.

Q2

Recuperative care is a program that provides short term medical care to homeless people who are recovering from serious illnesses of injuries. palliative care on the other hand is a comprehensive care approach that is designed to improve the quality of life of people who are living with fatal diseases which could claim their lives eventually and involves a team of doctors, therapists, counselors, nurses and social workers to provide the care required to cope with the burden of the serious disease (Acquaviva, 2017). If a decision regarding hanging a patient from recuperative care to palliative care is to be made, then the medical community should be the one to make the major decisions. The medical community involves the doctors, therapists and the nurses since they are the people who have the most information regarding the health state of the patients and can predict the possible health wellness and welfare of the patient. The transition as it is considered is integral in living and when the medical practitioners predict a possible progression of the disease, they can therefore make the decision to transfer the patient (In Matzo & In Sherman, 2015). The decision, however may be filled with uncertainties for the patients and their families and health professionals and it is therefore very important for the physicians and the nurses to know what the palliative care involves any competent person has the right to refuse medical treatment either temporarily or permanently and according to the laws, no treatment should be imposed on a patient. The physician on the other hand has the role of informing the patient of the likeable consequences that they may incur including death for failure to undertake treatment. Some of the palliative patients may be aggressive, however, it is very important for the physician to adhere to the patients demands and failure to do this is a violation of the rules governing medical treatment and this decision made by the patient should actually be supported majorly because the patient may have lost hope in living or the treatment and present futility for further treatment.

Q3

Decisions regarding end of life matters are some of the most difficult ones to be made, regardless, they still need to be made. The decision making process involves a large number of individuals which include both medical practitioners and family members. Some of the medical practitioners involved in decision making include the physicians, the nurses, therapists and the social workers whose role is majorly to help both the patient and the family to get over the trying situation. In most cases, the nurses and doctors avoided the patient and the family and referred them to the other team members, however, current provisions in the palliative care guidelines provide that health care professionals should help the patients and the families to determine the shared values (Meier, Isaacs & Hughes, 2011). Family is considered to be the integral part of the patient’s life and should therefore be the main aspect in the end of life decisions especially when the consequences of the decisions are serious or irrevocable. In some cases, decisions regarding euthanasia and cessation may be called for. Euthanasia is the act of ending the life of a person owing to various motives but it is mostly done on the basis of compassion when the patient is terminally ill and their pain has become unbearable, however, it is considered illegal and unethical. It is mostly a voluntary aspect and done on the requests of the patient. Cessation of treatment on the other hand can be defined as passive euthanasia and is majorly done by forfeiting treatment of the patient or withholding lifesaving medical treatment. In both cases, the patient eventually dies. In cases where the palliative patients have no family and close relatives to take part in the end of life decisions, it is therefore the role of the medical practitioners and the social workers to aid in the decision making, since the patient has been under their care. However, the services of an attorney may be needed for legal evidence concerning decisions that may be needed for future reference

Q4

The following measures can be taken to ensure the quality of ongoing family and social relationships individually and as a group to end of life patients: Knowledge of the family concerns and communication. Establishment of a healthy communication channel that addresses the concerns of the patient and the family members, however, some of the pitfalls that can be avoided include decision making capacity that fail to reach a shared appreciation of the patient’s condition and prognosis, failure to apply the principle of judgement while offering the decision of care and no care and the literal interpretation of the isolated and the patient statement made earlier in life. To ensure spiritual processes of the patient are respected and incorporated, a spiritual assessment of the patient’s spiritual hopes and fears should be examined and identification of their beliefs about afterlife and preferences should be carried out (Bern-Klug, 2010). After that, the services of a qualified chaplain depending on the religion could be incorporated to ensure the spiritual requirements of the patient are attended to.

Conclusion

From the above discussion, provision of quality care to palliative patients is important since it is one way of implementing the dying wishes of patients. The services of medical professionals, family and other professionals are highly required to achieve this care. It is important to take into consideration factors that majorly contribute to provision of quality care while upholding core values of specific communities.

References

Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: An evidence-based guide to planning care. Maryland Heights, Mo: Elsevier.

Acquaviva, K. D. (2017). LGBTQ-inclusive hospice and palliative care: A practical guide to transforming professional practice.

Bern-Klug, M. (2010). Transforming palliative care in nursing homes: The social work role. New York: Columbia University Press.

In Ferrell, B., In Coyle, N., & In Paice, J. A. (2015). Oxford textbook of palliative nursing.

In Matzo, M., & In Sherman, D. W. (2015). Palliative care nursing: Quality care to the end of life.

Meier, D. E., Isaacs, S. L., & Hughes, R. (2011). Palliative Care: Transforming the Care of Serious Illness. Hoboken: John Wiley & Sons.