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Hospice and palliative care

Hospice and palliative care

Sample Answer 

Hospice and palliative care

Introduction

The term hospice care refers to a category of healthcare that primarily focuses on providing palliative care in hospital settings to terminally sick patients, with the intention of relieving symptoms and pain by addressing their spiritual and emotional needs (Blinderman & Billings, 2015). The underpinning of hospice care is palliation without the intention to cure. On the other hand, palliative care is an interdisciplinary medical practice that principally focuses on maximizing patients’ quality of life with complex and serious diseases by alleviating suffering and can entail curative measures. The World Health Organization (n.d.) defines palliative care as a strategy that is aimed at improving “the quality of life of patients and their families facing the problem associated with life-threatening illness” through the relief and prevention of distress and suffering. In most instances, palliative care requires early recognition and flawless diagnosis and cure of pain as well as other psychological, physical, and spiritual needs. Regardless of the slight differences in definition and meaning, it is generally agreed that both hospice and palliative care apply the same principles and practices. This paper, therefore, primarily seeks to explore the common practices in hospice and palliative care as well as the advantages and disadvantages of these types of healthcare.

Care Practices in Hospice and Palliative Care

As mentioned in the introduction, hospice and palliative care are primarily focused on alleviating pain and suffering, especially among patients that are terminally ill, including those with cancer, blood and bone marrow conditions, heart diseases, cystic fibrosis, dementia, stroke, Parkinson’s disease, lung disease, or end-stage liver disease (World Health Organization, n.d.). Some of the symptoms associated with hospice and palliative care patients range from anorexia, constipation, nervousness and anxiety, excruciating pain, vomiting and nausea, difficulty breathing, fatigue, to sleeping problems. As such, it is very imperative to provide these patients with topnotch, advanced, and evidence-based nursing care. The following section highlights some of the key practices of hospice and palliative care.

a.      Symptom Assessment

Assessing the symptoms of patients before admitting them to hospice and palliative care is one of the key practices in dealing with terminally-ill individuals. Just like any other diagnostic tool, symptom assessment is vital in ensuring that the right patients and their health needs are identified, which can also serve an important role in the provision of tailored care that can focus on these specific needs. The Edmonton Symptom Assessment Scale is one of the few accepted and recognized techniques used in the assessment of hospice and palliative care patients (Miyasaki et al., 2012). This tool uses eight visual analog scales (which range between 0-100) and indicates the presence of nausea, activity, pain, appetite, drowsiness, anxiety, depression, shortness of breath, as well as sensation. A score of ten shows the worst severity, and a score of one implies the absence of any symptom.

b.      Spiritual, Psychosocial, and Physical Pain Management

The primary intent of hospice palliation is to provide individuals suffering from serious and life-threatening diseases specialized in medical care. Most of these patients recruited for hospice and palliative care are imminently staring at death, and the question is always when. In most instances, the remaining thing for patients diagnosed with these life-limiting and terminal illnesses, such as stage 4 cancers, is living a comfortable life with each day that passes. Therefore, the best assistance physicians, nurses, and the entire medical team can offer these terminally-ill patients (especially with their fate having been sealed) is holistic comfort as they wait for their death.

In most hospice and palliative care settings, providing comfort calls for the management of physical pain using pain drugs that can produce fewer side effects. According to Blinderman & Billings (2015), physical pain management is a prerequisite in hospice palliative care because most patients at the end of life experience excruciating pain associated with dyspnea, delirium, constipation, nausea, pharyngeal secretions, xerostomia,  and many others. Besides the physical pain, hospice and palliative care often seek to control psychosocial pain. Caregivers listen and empathize with patients by listening to factors causing their distress. According to Rome et al. (2011), medical experts can use psychosocial assessment to foster patient-family comprehension of support, coping, and adjustment. After addressing the physical and psychological pain, Kelley & Morrison (2015) also deem it necessary to solve the spiritual aspect. According to the two researchers, spiritual care is an intrinsic and dynamic component of humanity that is linked with improved well-being and quality of life, particularly for patients facing terminal chronic illnesses. Most religious practices and beliefs can positively affect perceptions of distress, suffering, and pain.

c.       End-of-life care practices and medications

The ultimate goal of hospice and palliative care is usually to provide patients facing terminal illnesses (especially those whose fate is death) appropriate ‘end-of-life care.’ For example, specialized antipsychotic regimens are often administered to treat nausea, while anticonvulsants and morphine are injected to treat pain and dyspnea, respectively. It is also important to note that the route of administration of these drugs usually varies as the conditions progress from acute to chronic, especially as individuals enrolled in hospice and palliative care lose their swallowing ability. Another optional route most practitioners prefer is subcutaneous, which is easy to maintain and less traumatic compared to intravenous. The other routes include transdermal, intramuscular, and sublingual.

Benefits of Hospice and Palliative Care

Placing patients with life-threatening, terminal diseases in hospice and palliative care can come with a string of advantages. The first benefit is that hospice palliation offers all-inclusive and multifaceted care that cuts across all disciplines. In hospitals, patients can enjoy the services of all hospice volunteers and professionals, including home social workers, home health aides, case manager nurses, physicians, as well as chaplains (Rome et al., 2011). Hospice care is also offered on a 24-hour-a-day basis, including holidays and weekends. Besides reducing the costs (due to Medicaid subsidies), hospice care can also assist in fulfilling the wishes of the patients, personal caregivers, and family members, who might desire to avoid unnecessary medical procedures, hospitalizations, or drugs.

The Setbacks and Challenges in the Delivery of Hospice and Palliative Care

Even though it can assist in fulfilling the desires of patients or their family members, choosing hospice and palliative care can sometimes be unfavorable because of the many restrictions associated with certain treatment procedures. This problem originates from a lack of comprehensive federal policy that addresses hospice and palliative care. Under the Medicare program, hospice beneficiaries are not allowed to overstay in hospitals. Their hospitalization is discouraged, and in-patient care is only provided for a short time. Also, patients admitted under hospice and palliative care are often discouraged from taking part in clinical and experimental trials because these studies are regarded as life-prolonging. In fact, the Medicare program offers flat per-day hospice benefits, meaning that all other additional bills and footed by patients out-of-pocket. According to Morrow (2019), this implies that some patients cannot obtain certain expensive and specialized tests and procedures, such as X-rays, CT-Scans, blood tests, and many others.

Conclusion

From this discussion, it has been established that hospice care primarily focuses on providing palliative care in hospital settings to terminally sick patients, with the intention of relieving symptoms and pain by addressing their spiritual and emotional needs. Palliative care focuses on maximizing the quality of life of patients with complex and serious diseases by alleviating suffering and can entail curative measures. Some common hospice and palliative care practices identified include symptom assessment, end-of-life plans, and physical, psychosocial, and spiritual pain management. Lastly, it has also been demonstrated that even though hospice palliation offers all-inclusive and multifaceted care that cuts across all disciplines and several other benefits, unsupportive national policies are impacting effective care delivery.

References

Blinderman, C. D., & Billings, J. A. (2015). Comfort care for patients dying in the hospital. The New England Journal of Medicine, 373(26), 2549–61.

Miyasaki, J. M., et al. (2012). Palliative care for advanced Parkinson disease: an interdisciplinary clinic and new scale, the ESAS-PD. Parkinsonism and Related Disorder, 18, 6-9.

Morrow, A. (2019, May 6). Advantages and disadvantages of hospice care. Very Well Health, https://www.verywellhealth.com/pros-and-cons-of-hospice-care-1132299

Rome, R. B., et al. (2011). The role of palliative care at the end of life. The Ochsner Journal11(4), 348–52.

World Health Organization. (n.d.). WHO definition of palliative care. Retrieved from https://www.who.int/cancer/palliative/definition/en/

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