Guideline on Palliative Care, Research Paper Example

Evidence Based Practice Guideline on Palliative Care

The World Health Organization (WHO) defined Palliative Care as a method that enhances the patient and families’ quality of life in times of problems associated with life-threatening disease conditions. This method is done by providing preventives and treatments against the patient’s suffering through early diagnosis and faultless assessment and remedy of pain and other physical, emotional, psychological and spiritual sufferings. This method is recommended by WHO to be provided upon the beginning of any life-threatening condition and simultaneously, providing curative efforts (National Perinatal Association, 2009). Palliative is often associated with individuals who are suffering from an active, advance and progressive illness with little or zero prospect of treatment. This method mandates interdisciplinary and a complete person approach with an objective of allowing an opportunity for an individual to obtain physical, spiritual and emotional comfort (Vancouver Island Health Authority, 2008).

According to the British Columbia Medical Association’s (2010) Guidelines and Protocols on Palliative Care for the Patient with Incurable Cancer or Advanced Disease: Approach to Care, poor prognostic factors that would result to the requirement of palliative care include progressive loss of weight equivalent to more than 10% within the span of six months, rapid weakening level of the palliative performance scale (PPS), dysphagia, dyspnea, and cognitive impairment. The guidelines and protocols also included relevant instructions regarding (1) investigations, (2) management, and (3) rationale. Prior to investigation, the requester should guarantee that the procedure would be able to improve the patient’s quality of life as well as the prognosis. Investigation may be performed during the necessity of further understanding and managing the stressful clinical complications of the disease, clarifying the proper objectives of care, assisting in providing prognosis and determining whether all alternatives have been considered prior to the admission to hospice.

The Vancouver Island Health Authority (2008) also defined Hospice Palliative Care (HPC) as a nationally accepted word that refers to the treatment of patient’s suffering and alleviation of one’s quality of life and dying. This method facilitates patients and their families in addressing physical, social, psychological, practical and spiritual issues as well as their associated presumptions, expectations, hopes, needs and fears. It helps the involved individuals manage and become prepared for the conclusion of their lives as well as the process of dying. On the other hand, it helps families to cope up with grief and loss during the one’s disease and bereavement. Thus, HPC aims to remedy all active issues and prevent new problems from occurring. It helps in the promotion of valuable and meaningful experiences as well as personal and spiritual growth and self-realization all throughout the dying process of an individual. End of life care, on the other hand, refers to the scope of support and clinical services that are appropriate for patients with terminal illnesses and families. End of life care and hospice palliative care have the same objectives.

The Concept of Evidence Based Palliative Care

Evidence Based Palliative Care has four important points to consider which include the (1) explicit, judicious and conscious utilization of present evidence in creating decisions regarding care of each patients, (2) the higher difficulty level in measuring the quality of living and altered results in patients and families whose disease or weakness make it harder to collect data, (3) quality of living measures and outcome that are necessary for one’s sensitivity to a broader symptom and (4) utilization of present research in providing appropriate systematic assessment to optimize the value of data collected in providing care for patient and families by those professionals involved in delivering palliative care. With these points, it is also important for healthcare providers to become aware of Clinical Practice Guideline (CPG) that will help them systematically develop statements that are necessary for assisting practitioners and individual’s decisions regarding the proper health care for specific clinical conditions (Vancouver Island Health Authority, 2008).

According to the National Concensus Project for Quality Palliative Care (2009), there are eight domains of palliative care. These include the (1) framework and procedures of care, (2) physical aspects, (3) psychiatric and psychosocial aspects of care, (4) social aspects, (5) religious, existential and spiritual aspects of care, (6) cultural aspects, (7) care provided to an imminently dying individual, and (8) legal and ethical aspects of care. The National Concensus Project’s Clinical Practice for Quality Palliative Care is a document that clinically promotes optimum level of palliative care. This reference provides guidelines and programs for evidence based practices and programs adopted by healthcare providers. These eight domains of palliative care aim to promote both awareness of the need for quality palliative care and philosophical aspects of palliative care with all the suggested practices.

Framework and Procedure of Care

According to the National Consensus Project for Quality Palliative Care (2009), the guidelines that can be adopted by healthcare providers and institutions in providing palliative care include (1) the timely planning of care according to the comprehensive interdisciplinary examination of the patient and his family, (2) the planned care is according to the expressed and identified preferences, goals, values and needs of the patient and his family and is established with guidance and support from professionals for decision making, (3) there should be an interdisciplinary team that will deliver services to the patient and family with consistent care, (4) utilization of proper supervised and trained volunteers including in the interdisciplinary team, (5) support for training and education is available for the members of the interdisciplinary team, (6) the program should be able to develop, implement and maintain an existing process that shows the complexity of the organization while focusing on the program to provide palliative care, (7) the program should be able to recognize the emotional effects of palliative care team to the patient and family, (8) there should be a relationship among the program and hospices and other community resources to guarantee continuity of the project, lastly, (9) the setting where care is provided should meet the standards, needs, preferences and circumstances of the individual suffering from a terminal disease as well as his family.

The Attitude of Nurses for the Enhancement of Palliative Care in Greece (Independent and Dependent Variables)

Evidence Based Practice was applied on the chosen quantitative study entitled The Attitude of Nurses for the Enhancement of Palliative Care in Greece authored by Theodosopoulu et al. (2005). The purpose of the paper was to study and estimate the knowledge and attitude of nurses for the enhancement of palliative care in Greece. The research was conducted with the use of questionnaires containing closed queries that were used to support the research’s hypothesis. There were eighty one nurses who participated while the data that was gathered were analysed using a software called SPSS. Out of 81 nurses who participated, 59 (72.84%) were female while the remaining 22 (27.16%) were male. The average year of working of the participants is 37.19±9.16.  On the other hand, their experience was 14.83 ± 9.02 on the average in different units. According to the study, 34.2% believed that palliative care is considered as a specialty, 23.5% as a course and majority of 43.2% answered that it should be a specialization. The purpose of the study is relevant to the EBP guideline because it determines whether the participants are able to practice the procedures needed for the provision of palliative care. Independent variables refer to the participants who are nurses. While the dependent variables are the answers of the participants that were then analysed using SPSS.

Hypothesis and Title

The hypothesis of the study is that majority of the nurses who participated in the study claim that working experiences in different units won’t provide them the capacity to deal with patients who are in need of palliative care. This means that the attitude of the nurses for the enhancement of palliative care in Greece is somewhat negative because they are not confident with their skills. At the same time, it is positive because they’re willing to undergo trainings.

Existing Knowledge in Palliative Care

Palliative care has been in the practice since 1970’s when a palliative care movement was first established in the United Kingdom. The movement was established to address the needs of terminally ill and suffering patients. Theodosopoulu et al. (2005) stated that it is very essential for nurses to become familiar and recognize the significance of nursing response to the needs for attention and care of patients who are currently suffering from an advanced illness. The authors also added that according to the International Council of Nurses, nurses has a unique and key responsibility in guaranteeing patients that they would have a meaningful life experience and peaceful death. The authors also cited that according to some studies, both clinical and didactic components should be included in the curriculums of undergraduate and post graduate nursing students.

Application of EBP on a Quantitative Study and Assumptions of the Researcher

The study of Theodosopoulu et al. (2005) revealed that over 34.6% of the participants responded that palliative care is a specialty, 43.2% see it as a specialization while only 22.2% consider it as a course. This may imply that palliative care should be more than just a course because majority of the respondents believe that they should have sufficient knowledge and background before providing special care to their patients. In addition, 34.6% answered that basic training for palliative care provides them sufficient capacity to cater the needs of patients with advanced illnesses while only 14.8% said no. The remaining 50.6% believe that their working experiences in different healthcare departments gave them the sufficient capability to cater the needs of patients with terminal diseases. Since cancer was the highlighted disease in the study, 49.4% answered that they would have greater capacity to deal with patients suffering from terminal cancer if they had experience in the Oncology department whereas 9.9% said no. The remaining 40.7% believe that they should undergo special trainings first before dealing with such situation. Majority (86.4%) of the participants also believe that palliative care should be included in the undergraduate curriculum of nursing students while only 13.6% answered otherwise. Likewise, majority (72.5%) answered that palliative care should be included in post graduate programs for nursing students. These responses mean that the participants believe that it is necessary to include palliative care in programs of universities to further educate practitioners such as doctors and nurses and prepare them for future experience with patients suffering from terminal diseases.

Theodosopoulu et al. (2005) also found out that majority of the respondents believe that nurses can become coordinators of an interdisciplinary team providing palliative care. This response implies the crucial role that can be played by nurses in providing special care and attention to terminally ill patients. However, 41 out of the total of respondents believe that doctors should become coordinators while 26 answered that nurses should be the one coordinating the interdisciplinary team. This finding means that the responsibilities and roles of doctors are more prevalent while the roles of nurses can be considered as inferior. Majority (42%) of the respondents believe that to become a coordinator, a nurse should be registered and have all necessary special trainings. The second highest answer is that nurses should be registered and has experience under the oncology department for them to be considered as coordinators of interdisciplinary team for palliative care. According to the National Consensus Project for Quality Palliative Care (2009), the interdisciplinary team for palliative care should be composed of people who are skilled in providing care for targeted patient population. This may mean that it would be more ideal if majority of the participants answered that coordinator should have proper and sufficient training under the department of Oncology. This will assure that the coordinator of the team has ample knowledge and background when it comes to dealing with cancer patients.

Palliative care can also be provided by non-members of the healthcare system. In fact, majority (81.5%) of the respondents believe that volunteers play an important role in providing palliative care to terminally ill patients while only 3.7% believe that volunteers are not needed, lastly, 14.8% believe that volunteers can participate only in rare situations (Theodosopoulu et al., 2005). It was also stated that the team can be composed of volunteer coordinators and trained volunteers which mean that the answer of the participants conform to the guidelines of the National Consensus Project for Quality Palliative Care (2009). The assumptions of the Theodosopoulu et al. were identified because they were able to gather quantitative data that would support their hypothesis.

Conclusions

Based on the findings of Theodosopoulu et al. (2005), nurses are not yet confident with their skills unless sufficient training under the appropriate department and inclusion of palliative care program in both undergraduate and post graduate curriculums would be provided. This may imply that nurses are not yet aware of the EBP guidelines on Palliative Care regarding their crucial roles in providing palliative care to patients. However, it is also good that these healthcare providers are willing to be trained and gain experience because according to the guideline, members of the interdisciplinary team should be well-skilled and trained.

References

British Columbia Medical Association. (2010). Palliative Care for the Patient with Incurable Cancer or Advanced Disease. Web. Accessed from http://www.bcguidelines.ca/pdf/palliative1.pdf

National Consensus Project for Palliative Care. (2009). Clinical Practice Guidelines for Palliative Care. Second Edition. Web. Accessed from http://www.nationalconsensusproject.org/guideline.pdf

National Perinatal Association. (2009). Palliative Care. Web. Accessed from http://www.nationalperinatal.org/advocacy/pdf/Palliative-Care.pdf

Theodosopoulou E., Konstantinou E., Toulia G., Koutsopoulou V., Chadzopulu A., Krajewska-Ku?ak E., Wro?ska I., Tsokantaridis C., and Kamba E. (2005). The attitude of nurses for the enhancement of palliative care in Greece. Roczniki Akademii Medycznej w Bia?ymstoku. 50 (1). Web. Accessed from http://www.advms.pl/roczniki_2005_supl_1/volumes/13_Theodosopoulou_E.pdf

Vancouver Island Health Authority. (2008). Vancouver Island Health Authority End of Life Program Practice Guidelines. Web. Accessed from http://www.viha.ca/NR/rdonlyres/46F4FFD9-6CDE-4420-A131-88CAF4346BDF/0/EOLGuidelines2.pdf