INTRODUCTION TO PALLIATIVE CARE NURSING

1. How does Palliative Nursing reflect “whole person” care?

Palliative care denotes the optimization of quality of life for both the patients with serious
illness and their families using special measures to expect, treat, and prevent misery. This
care includes the continuum of illnesses which encompasses the physical, psychosocial,
emotional, and spiritual needs of seriously ill patients (Lorenz & Schroeder, 2017).
Palliative nursing reflect “whole person” care because palliative care does not only focus
in one system of the patient however, palliative care is appreciated through relieving
suffering and enhancing quality of life by providing successful pain and symptom
management; addressing psychosocial and spiritual requirements of the patient and family;
including cultural values and attitudes into the plan of care; supporting those who are
undergoing loss, grief, and bereavement; promoting ethical and legal decision-making;
promoting for personal wishes and preferences; utilizing therapeutic communication skills;
and facilitating collaborative practice. (Coyle & Ferrelle, 2006).
Also, in palliative nursing according to Coyle & Ferrelle (2006), the individual is seen as
an important part of the healing relationship in which this affiliation together with knowledge
and skills, is the essence of palliative care nursing which sets it apart from other zones of
nursing practice.

2. Why is it important for the nurse to collaborate with a team member while providing
end of life care?
 It is important for the nurse to collaborate with a team member while providing end life
care, because they have their own roles in the palliative care settings; the nurses are the
one that communicate to the patients and families, they are the one who provides bedside
care and with that they serves as patient's advocate. The patients and including their
families will vent their emotions to the nurse in regarding to the patients condition. And
with that, the nurse will collaborate their concerns to the physician. In order to provide
quality of life for the patients as a nurse they should collaborate with the other health
team member.
 It is also important since when the nurse are collaborating to other team member like
physician to provide end of life care since the physicians are the one who providing the
medications that the patient will take in order to relieve other distressing symptoms such
as anxiety, pain, and stress. While the nurse are the one who will provide themselves to
the pt. to listen what they wanted to share in order to lessen their sufferings.

3. How does the philosophy of hospice differ from the philosophy of traditional healthcare?
The philosophy of hospice care differs from the traditional healthcare in terms of their
goals. The goal of Hospice care is to provide best/improve quality of life to the patient. Also
for their family, hospice care provides autonomy and improve decision-making throughout the
disease process. Bereavement support also includes in the hospice care to support the family
after losing family member. While the traditional health care focuses on the curative approach
where death is a failure of medicine. As death occur there is failure in the health system.
4. Discuss the barriers to accessing hospice care by families of terminally ill infants and
children.
A. Personal Issues and Biases – This situation may lead may affect the professional role of
the nurse by quickly giving way to the perspective of a parent, mother, or father toward the
child. Expressions of transference may emerge and become problematic to the parents, the
child, the nurse, or other team members.
B. Professional Issues – Nurses may lack pediatric physical assessment and symptom
management skills, as well as knowledge of the diverse disease processes and
developmental stages and related needs essential
C. Uncertainty in Determining the Child’s Prognosis – Determining the required 6-months-
or-less prognosis is extremely difficult for pediatric physicians because of the wide
variability of prognoses in children, often varying from days to weeks, or months to years
D. Reimbursement Issues – Pediatric hospice care typically requires longer, more frequent
home visits; more coordination of care with multiple physicians, other providers, and
insurance companies; visits to schools by members of the team on behalf of the sick child or
siblings; and hiring or access to pediatric experienced nurses, social workers, and aides and
insurance coverage may be inadequate or nonexistent for hospice services
E. Lack of Knowledge and Awareness of What Hospice Care Is – Successful Strategies-
Physicians and nurses dealing with neonatal and pediatric patients may be completely
unaware of the option of hospice/ palliative care, how to access it, and the appropriate
conditions or diseases for eligibility.
F. Myths About Hospice Care for Children – Dispelling myths about hospice care can be
helpful in creating an appropriate message about end-of-life or palliative care for pediatric
patients. Many misconceptions need to be addressed, such as hospice care equals death;
hospice care means giving up; hospice care means no more hope; hospice care means letting
go or failure
G. Resource Availability – In developed countries, cancer patients are relatively well
provided for, with good access to palliative care units and hospices, at least in urban centers.
Community hospitals and rural areas are, however, less well served, and people living with
chronic noncancer diagnoses have much poorer access to specialist Hospice care programs.
Home hospice is inconsistently available, and very few countries have enough palliative care
specialists to meet their current workforce needs, let alone meet anticipated future needs.

H. Patient and Family Reluctance – Reluctance to accept a referral for specialist hospice
care on the part of the patient and family can vary from one culture to another, but there are
common threads to this hesitation, namely, the association of hospice care with dying.
“Magical thinking” is the idea that avoidance of talking about death will allow avoidance of
death itself or that discussing death may bring “bad karma.” Patients may also not want to
upset their regular doctor, thinking that their doctor will see them as giving up or worry that
they may have disease-controlling treatment withdrawn.
 I. Restrictive Program Eligibility – Rationing of services according to patient characteristics
is seen as an unfortunate necessity for palliative care and hospice programs; however,
assumption of all aspects of care by specialist palliative care programs propagates an
inefficient model of service delivery that is neither sustainable nor patient centered. Family
doctors and referring specialists tend to drift away from providing care once a palliative care
program becomes involved, either because of a perception that their skills are no longer
relevant or that their involvement is not welcome.

REFERENCES

Ferrell, B., & Coyle, N. (2006). Textbook of Palliative Nursing. Oxford University Pres, Inc:
New York. pp. 5 , 13 , 909

Schroeder, K., & Lorenz, K. (2017, July 10). Nursing and the Future of Palliative Care.
Retrieved September 25, 2018, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763437/

Hawley, P. (2017). Barriers to Access to Palliative and Hospice Care. Retrieved on September 25
2018 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398324/

International Association for Hospice and Palliative Care (n.d). Principles of Palliative Care.
Retrieved on September 25, 2018 from: https://hospicecare.com/what-we-
do/publications/getting-started/6-principles-of-palliative-care