PALLIATIVE CARE

Palliative care is the way to deal with advanced, incurable disease that aims to improve the quality of life of patients facing illness and their families, through the prevention and relief of suffering by means of early diagnosis, assessment the timely adequate treatment of pain and other problems both physical and psychosocial and spiritual

In my opinion the mission of hospice nurses must go beyond providing direct assistance to physical needs only. Rather care plans from the continuity, flexibility, accessibility.

It poise and accompany in daily life of the patient and his family, the family integrates the act of caring. Supports from the listener, must be sensitive and are awaiting the details that give comfort to the patient.

Major concerns of any healthcare professional when communicating with the patient

Death and dying cause health professionals and caregivers in psychological reactions that lead directly and indirectly to prevent patient communication terminal (away).

To ensure proper communication, the nurse must overcome:

-          Anxiety generated disclose bad news

-          Afraid to provoke an overreaction in the patient

-          Fear of an over identification (similarities with patients for age, sex, study, children of the same age ...)

-          Fear of lack of response to certain questions:

o   Is it wrong right?

o   How am I going to die?

o   How long do you think I have to live?

o   Why to me how young I am?

o   Why me if I've never done wrong to anyone?

Basic principles of communication

-          Communication speed adapted to the rate of uptake of each person

-      Never reported in the same session: diagnosis, treatment, prognosis. Ongoing process, not an instantaneous act

-          If at any time the patient does not want to receive information on your situation, remember if you change your mind we will be available

-          When a patient does not wish to receive information, is that it has detected at least that something is wrong

-          Many times the patient does not seek answers to certain questions, but relief

-          Never remove the hope but also generate

-          Spain, 50-70% of patients with cancer want they receive their diagnosis. Progressive increase in numbers in younger populations

-          Northern European Sick demand higher levels of information, while in Spain and Greece less detailed information is preferred

How to communicate:

1. Strategy communication theoretical Buckman Bad News: it consists of 6 stages, unable to advance to the next if you have not passed the previous
1. Stage 0: chances are that the result shows a complementary exploration malignancy

Have you considered that there is the possibility that the result is not good?

2. Step 1: Prepare the environment. Diagnosis of certainty and not suspected

3. 2nd stage: What does the patient? Before reporting, figure out what you know so far

What you have said so far the doctors have you visited?

4. Stage 3: What does the patient know? What does and what does not, and how far you want to know

You want to talk about all this is happening?

5. Stage 4: sharing information. Just get here if the patient has a desire to be informed.

Gradual process of assimilation time, especially if it is asymptomatic.

6. 5th stage: responding to the patient's feelings. If we will not be able to support you emotionally afterwards, best delegate responsibility to other professional. With certainty diagnosis and prognosis overshadowed, staff often cling to "there are still possibilities." This creates hope and false expectations

When the patient hears that there is still hope, are forced to eat, to get out of bed ... when you see that still does not improve, ends on the grounds that to blame

7. Stage 6: Plan of care. Objectives:

                                                              i.      Support

                                                            ii.      Relief of symptoms

                                                          iii.      Listen to fears and concerns

                                                          iv.      Sometimes we do not recognize their true symptoms to avoid being branded a "soft" or non-recognition of their disease worsening

Main stages of grief

1. Denial phase. Denying oneself or the environment that loss has occurred.

2. Phase of anger and indifference. Euphoria or anger at being unable to prevent the loss.

3. Negotiation Phase. Negotiate with yourself or the environment, understanding the pros and cons of the loss.

4. Emotional pain phase. You experience sadness and grief over the loss.

5. Acceptance phase. Loss is assumed, but never forgotten.

BIBLIOGRAPHY: 

1. Martin M. Evers, BS, Diane E. Meier, MD, and R. Sean Morrison, MD
«Assessing Differences in Care Needs nd Service Utilization in Geriatric Palliative Care Patients» 2002
Available on: 
http://www.net/publication/11363113_Assessing_differences_in_care_needs_and_service_utilization_in_geriatric_palliative_care_patients/file/32bfe50f97944856de.pdf

2. Lukas Radbruch; Julia Downing; Guide to pain Management in Low-Resource Settings; Chapter 8 Principles of Palliative Care;   http://www.iasp-pain.org/AM/Template.cfm?Section=Home&Template=/CM/ContentDisplay.cfm&ContentID=12167

3.- HOFFMAN, Gloria Basic Geriatric Nursing 5th Edition. Elsevier 2012.