Essay on Palliative Care in Nursing: Competencies, Ethical Considerations, and Symptom Management Strategies

Introduction

This paper will discuss palliative care in nursing and its related competencies in the management of people living with terminal illnesses. Palliative care is a specialization in nursing practice focusing on the improvement of quality of life and minimization of suffering, especially from pain in people with terminal illnesses, as well as supporting their families (Paice et al., 2018). Palliative care if often dubbed as care for the dying. It is carried out by medical doctors, nurses, chaplains, and other facility social workers. The health care specialists in the palliative center help the patient understand the treatment modalities available, as they incorporate the treatment to meet the client’s set goal.

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Palliative care is offered in a hospice setting or even outside the hospice. A hospice setting is preferred for at least two palliative care medical doctors who have certified that they can live for only six months or less based on their current illness course. Those benefiting from outside the hospice setting for palliative services are those medically certified to cope with their disease condition for more than six months and likely to benefit from life-prolonging therapy, such as those suffering from leukemia or dementia.

Palliative care has its main outcomes geared towards the improvement of the patient’s experience of care by minimizing pain and suffering, a reduction in unnecessary nursing and medical interventions, and finally, the improvement of health. Evidence-based practice has shown improvement and prolonging of life in patients suffering from lung cancer as compared to when they receive just the prescribed treatment regimen and usual care only.

Hospice and Palliative Care

Hospice and palliative care are both involved in patient provision of care and its associated comfort. The difference between hospice care and palliative care is that hospice care is usually given after the stoppage of the treatment regimen and when it is evidently clear that the chances of survival of the illness by the patient are minimal or rather zero whereas in palliative care, caring begins after diagnosis of the underlying condition and at the same time as treatment (Meier et al., 2017).

Palliative care addresses mostly the illnesses that affect more than just the physical body. Specializes on physical problems such as pain in the body, loss of appetite, and trouble sleeping, among others with therapies such as nutritional guidance, medication administration, and occupational and physical therapies (Paice et al., 2018). It also addresses social, emotional, and coping problems. Stress and its related anxiety and depression during illnesses can be managed in palliative care by offering counseling services, social interaction through friends and support groups or referrals to mental health centers. Spiritual-related problems can be effectively addressed by the chaplain, as earlier indicated.

Hospice and palliative care overlap with each other. In their approaches to the management of chronic illnesses such as advanced cervical cancer which has a high prevalence in older post-menopausal women, management of pain is proposed in both care modalities. Depending on the degree or stage of the disease, the decision by the medical team on which approach to go by, solely depends on the stages of the disease on the disease course and is the determinant of how long a patient may live. A start with palliative care may at some point necessitate hospice care hence the correlation between the two care modalities.

Ethical Considerations

There are several ethical considerations that people at their end of life should be accorded. The use of patient advocacy and education in honor and recognition of the patient's sense of autonomy and sense of determination are some of the actions in line with patient ethical considerations. Medical and healthcare providers have an obligation to provide individualized and respectful care to all patients in need of medical attention despite the patient's race, characteristics, or beliefs. There exists a number of factors that constrain the nurses’ obligation to meet the patient's requirements, that is to relieve pain and its accompanying suffering. Among these constraints are:

Moral Disengagement

There is some interaction between the person and the social interaction which brings about moral disengagement. Some of these moral disengagements include the dehumanizing and blaming of patients with substance-use disorders (Meier et al., 2017). Another incidence of moral disengagement is the disregard of the possible repercussions of pain management such as a case where there is a prescription of morphine but the nurse is in a dilemma of the possible drug addiction associated with morphine use in pain relief. Nurses’ code of ethics outlines nurses’ obligations to reinforce ethics through the embracement of ethical policies and work settings.

Bias

Nurses’ bias impacts their approach to the management of patient pain. Some of the prejudices regarding patients include sexual orientation, societal influences, culture, gender expressions, and race, among others. These biases can only be minimized by first identifying them. Recognition of these biases necessitates a trajectory pain experience thereby motivating the healthcare providers to meet their goal which is to alleviate the pain.

The nurses’ code of ethics emphasizes that “respect should be extended to the recipients of nursing care in line with health promotion, prevention of diseases, curative services or the alleviation of pain and supportive care.” (Chow & Dahlin, 2018). Establishment of a good patient rapport and trust and provision of health services according to patient needs with avoidance of any form of biases of culture, sexual orientation, spiritual beliefs, or gender expressions. Nurses should use probe questions to determine the level at which they may be biased, for instance, a nurse may enquire himself or herself if he or she feels guilty while alleviating pain.

Knowledge Deficit

Evidence-based practice in the management of pain is a key element in the nursing care of patients suffering from acute and chronic pain. The nursing code of ethics calls for individual and collective competence when managing the pain and the associated suffering it imposes on patients. Regular training on new and updated pain management technicalities, education, intensive research, and reading of peer-reviewed articles and literature on pain management equips the nurse with the relevant knowledge and skills in the management of pain.

Economic Restrictions

Following high economic spending on the cost of pain management drugs such as opioids has been a burden to most countries. With the increase in spendthrift on drugs, it has necessitated health facilities to shift to non-pharmacological management of pain such as cognitive-behavioral therapy. The nurses’ code of ethics outlines that as patients’ advocates, they should negotiate with the medical providers and governing bodies to have coverage in all effective pain management modalities ranging from pharmacological to behavioral therapies. In all these anticipated and proposed modalities, respect for one’s autonomy and dignity should be taken into consideration.

Unconducive Environment

Nurses are leaders in society, and therefore they advocate for mutual co-existence and live harmoniously with each other. Proper client-nurse and nurse-nurse relationship promotes a conducive environment that promotes the nurses’ output in the management of patients with terminal illnesses by ensuring the appropriate use of interventions to promote quality healthy care, which includes a reduction in medication errors or even unwarranted medical treatment.

The nurse, as provided in the nurses’ code of ethics, has a chief role in maintaining an ethical environment to promote the quality of health care, especially in the alleviation of pain and the associated suffering in patients with terminally ill diseases. Traits in nursing practice such as transparency, honesty, good communication, generosity, and taking responsibility are some of the key components of a conducive environment.

Nurses must be prepared to promote an ethical practice environment that enables excellent patient care, alleviating pain, and promotion of health. Nurses must take proactive action in the legislation of policies, programs, and health projects that work objectively towards health promotion and restoration, alleviation of pain, and prevention of suffering. Incidences of unjust processes and structures affecting people deteriorate the burden of illnesses, and trauma and even lead to premature death.

Professional Organizations

Several organizations and institutions are dedicated to the promotion of palliative health care among the critically and terminally ill and the alleviation of pain and associated suffering. Some of the professional organizations that help in the promotion of palliative care and hospice are the American Academy of Hospice and Palliative Medicine (AAHPM), the Association of Professional Chaplains (APC), the National Hospice and Palliative Care Organization (NHPCO), among other reputable organizations.

The chief mission of these organizations is to advocate for the formulation and implementation of health care programs and policies to have a united and strong campaigning power to the public and the policymakers as they advocate for restoration and improvement in health and reduce suffering and trauma to the affected patients, their families, and loved ones.

Symptom Management Strategies

The health interventions applied in this category aim at basically alleviating symptoms such as acute pain and fever. Use of pharmacological, non-pharmacological, and behavioral therapies to reduce pain and alleviate suffering as well as possible trauma associated with the pain, thereby improving the quality of care. Management of symptoms remains the key approach in which these chronic infections are managed since they are not curable. Pain is the most common symptom, especially among cancer patients, The use of analgesics such as opioid drugs to alleviate pain helps minimize suffering. Nurses must portray a high level of nursing practice competencies in which the health care facility ought to provide the necessary tools such as policies and health guidelines, to realize restoration of health.

Psychosocial, emotional, and spiritual

Promotion of family and group visits to these terminally ill patients in their palliative centers to promote a sense of belonging, reduce anxiety, and fight depression (American Nurses Association, 2018). Guidance and counseling can be consoling to the soul. Severe depression may warrant a referral to a mental health facility for further management. The involvement of support groups to help in meeting the client’s personal and basic needs can be a relief to the tension they undergo during the disease process.

Resource Management

Financial support is accorded to these terminally ill patients to enable them to meet the medical costs for their management. The provision of basic food requirements is key in maintaining their health status and promoting the restoration of health. Financial and moral support to their families will be a motivating factor for the patient and therefore not lose hope in life. Such acts of kindness go a long way in their hearts.

Grief and Loss

Spiritual support in times of grief and showing empathy give the patient a sense of belonging when family members and other friends dedicate their valuable time to spend together with the patient. Client education and counseling on how to avoid grief and maintain a happy life, thus ensuring the client maintains a healthy lifestyle.