Posted at 11.24.2018
PHYSICAL AND PSYCHOLOGICAL DOMAINS OF PALLIATIVE CARE
Taking good care of critically sick patients is challenging process and it requires proficiency. Its very difficult to handle a family group and terminally ill patient without the proper knowledge. To resolve the issues and deal with the difficult situation during palliative health care is proper training and knowledge about palliative care. It also needs proper training and experience for nurturing terminally ill patient. Relating to Kaasa & Loge, (2003) in palliative health care quality of life is the essential and central theory. Standard of living is has been found in vast concept which include physical, psychological, spiritual, and communal life of a patient. it is an approach to improve the standard of living of patient who run into life threatening condition for example tumors. The main reason for palliative attention is rest from suffering or even to early recognition of symptoms as early as possible. During my palliative scientific rotation I have experienced a 60 years old, feminine patient who was simply diagnosed with liver cancer stage III. Patient was only on palliative good care she had not received any chemotherapy or radiation. Now she was accepted in clinic for draining ascetic substance and for pain management. WHENEVER I was taking history of patient I emerged to learn that patient was concerned about her condition and she was unaware about her identification and prognosis. She was very depressed and stressed about her health. She was struggling to do her daily routines due to abs distention, pain and tenderness. Furthermore she was actually very poor.
While caring for patient I found all four domains of palliative care and attention in my own patient which includes physical, psychological, emotional, religious and sociocultural. But physical and mental health domains were the most effected domains in my patient. With this paper I will
focus on physical and internal domain name of palliative care and attention. In literature it is mentioned thatPalliative care is aimed at improving the quality of life for patients and their own families who are confronted with life-threatening illness by giving support and look after pain, physical symptoms, psychological and public stress, and spirituality. (Weiner et al, 2013). While caring for patient I came to the realization that patient was suffering from pain. Some other physical symptoms which can be found in patient are stomach distention, basic weakness, shortness of breath, fatigue, and lack of appetite. Corresponding to Skevington & Lofty (2003) pain, fatigue, general weakness, loss of hunger, nausea, vomiting will be the common symptoms in cancer tumor patients. Furthermoreit is mentioned inClinical practice recommendations for quality palliative attention (2008) regular, ongoing assessment of pain, nonpain symptoms (including however, not limited to shortness of breathing, nausea, fatigue and weakness, anorexia, insomnia, stress and anxiety, depression, misunderstandings, and constipation), treatment area effects, and efficient capacities should be documented through a organized process. in case there is my patient due to stomach distention she got pain, sense fullness and shortness of breathing. To rest from pain first I urged patient to consider deep breathing and staff placed drain to drain out ascetic substance. After draining 1000 ml liquid she felt rest from pain. Furthermore in mypatient scheduled to nausea and anorexia she's low appetite. Because of poor intake she thought lethargic and unable to do her daily activities. Therefore I motivated patient to eat frequently however in bit and I also educate her attendant about the value of proper diet.
The second important domains affected in my own patient was subconscious domain. Due to physical deterioration mostly patient become frustrated of their life, nor want to live
furtherand finish up with sadness, loneliness, nervousness anticipated to hospitalization and they worried about the prognosis of disease. My patient also faced previously listed problems as she did not know about her prognosis and she was worried about intensifying symptoms likeabdominal distention, pain, tiredness and general weakness. Furthermore in case there is my patient she was concerned because she was unaware of her diagnosis. ONCE I was taking history her attendant said that we didn't disclose the analysis to the patient because she already concerned about disease. As every patient has to find out about their identification and their disease process. Corresponding to Jhordy et al (2007) physical weakness and impairment disturb most areas of life like internal, social, erotic, spiritualand other daily activities of life. Due to limits in activities patients at the risky of psychological problems. Therefore most of terminal patients feel that they are reliant on family and they burden on the children and spouse. In literature it is stated that ambiance disorder, panic, and depressive disorder are coexist with advanced health problems. Psychological stress with terminal unwell patient is very common in palliative care setting. Patients response in different ways showing the major depression, for example sadness, dread and grief in various stages of these progressive disease. 35 to 50 % of tumor patient experience subconscious problems. The experience of internal problems influence on a person coping mechanism with health issues, physical symptoms and on their treatment. (Kelly, Chonchinov &McClement, 2006). Therefore its very important to examine the mental health problems of patient to give a quality health care and is as important as to assess physical condition of patient. Additionally it is stated in above point out article. That we should inform patient about different psychologist, interpersonal groupings who support them. To relief from stress I also encourage patient to verbalize her feelings and inspired her to have deep breathing. We also organize an activity that we compiled same diagnose patient and cause them to become verbalize their emotions and I provide a paper expressing her feelings in writing. After activity patient described that she experienced better and it effects positively on patients. Furthermore I spend most of the time with patient to encourage her expressing her thoughts and I also instruct her attendant to support her and spend time with her.
The challenges that we faced during specialized medical were to communicate the prognosis of disease. Because patient was unacquainted with her prognosis and their family didn't want to tell the individual bout her prognosis. Therefore because of this reason I got unable to talk the condition process properly and it hinders me to use the idea of palliative care. Furthermore anticipated to insufficient resources I used to be struggling to give holistic treatment.
As a nursing student I want to recommend that palliative course should be compulsory in the medical university and medical, so they can offer knowledge about end of life. There must be proper training for students so they can easily handle the difficulties while caring for terminal unwell patient. Its not important to provide palliative care to only terminal patient but its our responsibility that from the identification we have to taking care of patient. On institutional level different seminar should be arrange to provide understanding about the palliative treatment. In addition we can organise different periods for patients and individuals to give consciousness about palliative good care and disclosure of life intimidating medical diagnosis. it also important to provide proper training to the personnel of healthcare system so they can give comfort and help the patient to finish up with a peaceful death. There must be a separate bereavement room for family members so they exhibit and spend previous time with their patients. Moreover there should be a palliative care and attention team so they give proper training to staff ongoing basis to achieve competency in palliative good care. Corresponding to Ramjan et al (2010) palliative procedure can improve comfort and dignity of patient through the first identification and diagnosis as well as knowing the patients
psychological, emotional, social and spiritual concerns. Furthermore we can provide awareness through communal media, that everyone can deal with aware about the value of palliative good care. Usually patients want to perish in home in the existence and support of family. Among article it is talk about that doctor need to support and present education to the family on indicator management so they can simply continue good care at home also(Luckett et al, 2013).
In bottom line, palliative care is very important part of health vocation. The essential theme of palliative treatment is not the treatment of the disease but it is focused on to diminish the sufferings of patient. There are different domains in palliative good care which are damaged due some of progressive disease, such as physical, subconscious, religious, socio-cultural and intimate domains of life. The most important is physical which disturb other domains of life. Moreover when I indicate back I realized that overall specialized medical and palliative attention is very beneficial and successful. Now I can simply integrate theoretical knowledge in a clinic setting up. Furthermore now we can teach patients and their family abut palliative good care and be able to evaluate all domains of health.