Schweitzer Fachinformationen
Wenn es um professionelles Wissen geht, ist Schweitzer Fachinformationen wegweisend. Kunden aus Recht und Beratung sowie Unternehmen, öffentliche Verwaltungen und Bibliotheken erhalten komplette Lösungen zum Beschaffen, Verwalten und Nutzen von digitalen und gedruckten Medien.
Megan Rosser is Director for CPD/Non Professional Undergraduate Programmes at Swansea University. She is an established palliative care practitioner and educationalist, with previous oncology training and experience. She is experienced in the provision of palliative nursing care in primary and secondary health care settings.
Helen C. Walsh is Tutor in Nursing at Swansea University. This involves teaching and its associated activities for students on a range of levels from health care support workers, pre and post registration and Masters. The majority of her teaching relates to palliative care and its associated subjects.
About the series xi
The Authors xii
Acknowledgements xiii
Preface xiv
About the companion website xv
Section I The principles of palliative care 1
Chapter 1 The development of palliative care 3
Introduction 3
What is palliative care? 4
Where is palliative care provided? 8
Widening access 9
Influential documents and strategies 11
Conclusion 14
Chapter 2 Holistic care in palliative care 16
Introduction 16
Total pain 17
Holism 17
Holistic care 18
Spirituality 21
Quality of life 26
Conclusion 27
Chapter 3 Team working 31
Introduction 31
What is a team? 32
Why is interprofessional team work important in palliative care? 33
What makes a team work well? 41
What stops a team from working well? 44
Conclusion 46
Chapter 4 Legal principles in palliative care 48
Introduction 48
Identification of legal issues surrounding the provision of palliative care 49
Consent 50
Best interests 55
Withholding and withdrawing treatment 56
Do not resuscitate orders (DNR) 57
Euthanasia and assisted suicide 57
Verification of death 60
Conclusion 61
Chapter 5 Ethical principles in palliative care 63
Introduction 63
The meaning of ethics 64
Ethical theories 70
Euthanasia 75
Conclusion 76
Section II The practice of palliative care 79
Chapter 6 Communication in palliative care 81
Introduction 81
The importance of communication in palliative care 83
Communication theory 84
The importance of self-awareness in good communication 86
Key communication skills 87
Enablers of and barriers to good communication 91
Influencing factors 92
Communicating with groups who have particular needs 94
Conclusion 95
Chapter 7 Pain management and nursing care 98
Introduction 98
Pain 99
Pain assessment 101
Principles of pain management 106
Non-pharmacological approaches to pain relief 110
Conclusion 111
Chapter 8 Management and nursing care of gastro-intestinal symptoms 116
Introduction 116
Nausea and vomiting 117
Assessment 118
Management of nausea and vomiting 120
Nursing care 122
Malignant bowel obstruction 123
Constipation 124
Cachexia 126
Other gastrointestinal symptoms 127
Conclusion 128
Chapter 9 Management and nursing care of breathlessness and fatigue 133
Introduction 133
Breathlessness 134
Assessment of breathlessness 135
Pharmacological Management of breathlessness 135
Nursing management 137
Fatigue 138
Assessment 139
Management of fatigue 140
Nursing care 140
Conclusion 141
Chapter 10 Management and nursing care of psychological symptoms 145
Introduction 145
Psychological concerns 147
Depression and Anxiety 148
Management and treatment of anxiety and depression 153
Sexuality 154
Assessing sexuality 156
Psychological care 159
Conclusion 162
Chapter 11 Caring for the family 169
Introduction 169
Defining the family 170
Role of the family in care giving 172
Effects of caring on the family 173
The needs of carers 176
Communicating with the family 179
Conclusion 180
Chapter 12 Palliative care emergencies 184
Introduction 184
Palliative care emergencies 185
Spinal cord compression 185
Superior vena cava obstruction (SVCO) 188
Hypercalcaemia 189
Conclusion 191
Chapter 13 Nursing care at end of life 195
Introduction 195
Recognising that a patient is dying 196
End of life care 196
Physical nursing care for the dying patient 198
Bronchial secretions ('death rattle') 201
Terminal restlessness 201
The syringe driver 203
Being with a dying patient 204
Nurse's role after death 205
Conclusion 207
Chapter 14 Loss grief and bereavement 212
Introduction 212
Coping With Loss 213
Common emotional responses to loss 215
Bereavement theories 216
Helping the bereaved 219
Conclusion 223
Section III Personal and professional development in palliative care 229
Chapter 15 Looking after yourself 231
Introduction 231
What is stress and why do we need to know about it? 232
Some of the reasons nursing is stressful 236
Effects of stress 237
Coping strategies 237
Managing your stress 241
Conclusion 244
Chapter 16 Professional support 247
Introduction 247
Key people 248
Clinical supervision 250
Conclusion 258
Chapter 17 Learning from your practice through reflection 261
Introduction 261
Types of reflection 263
Why use reflective practice? 265
Starting your reflective practice 266
Conclusion 272
Index 275
This chapter explores the history and development of palliative care from the early days of the hospice movement through to the development of specialist palliative care and end of life care. It will track the extension of palliative care beyond cancer diagnosis, which is underpinned by the principle of provision of care according to need, not diagnosis. The differences between palliative care and other areas of care will be explored. The provision of palliative care for patients in minority groups is considered as well as the policies and strategies that have shaped the development of the speciality.
By the end of this chapter you will be able to
Simply put, palliative care 'focuses on the relief of pain and other symptoms and problems experienced in serious illness. The goal of palliative care is to improve quality of life, by increasing comfort, promoting dignity and providing a support system to the person who is ill and those close to them.' (dying matters 2012).
Since the development of St Christopher's hospice in 1967, the growth of palliative care has been driven by charities, health care providers and government policy. The significant early developments and key policies are presented in Figures 1.1 and 1.2.
Figure 1.1 The early development of palliative care services in the United Kingdom.
Figure 1.2 Key policy developments in palliative care in the United Kingdom.
Cicely Saunders the founder of the modern day hospice movement was driven by a profound Christian faith and a fundamental belief that 'You matter because you are you, and you matter to the last moment of your life'. Whilst the influence of religion has diminished over time the central belief of the value of people is paramount to palliative care. Today there are over 200 inpatient units and palliative care is provided in a number of other care settings, including hospitals, the community and day care centres. Most hospices are independent, local charities, only receiving a minority of their funding from the NHS.
There are a number of definitions relating to the provision of palliative care and each is discussed in the following text.
Palliative care has come to be regarded as part of supportive care formally introduced by the National Institute for Clinical Excellence (NICE) in 2004. Supportive care describes all care provided to patients, friends and family throughout their illness, including the time before diagnosis has been reached, when patients may be undergoing a number of investigations. The aim of supportive care is to help the patients and their families to cope with their condition and treatment. It helps the patient to maximise the benefits of treatment and to live as well as possible with the effects of the disease (National Council for Palliative Care (NCPC) 2010). Figure 1.3 shows the components of supportive care.
Figure 1.3 The components of supportive care.
Palliative care is defined in Fact Box 1.1.
The World Health Organization (WHO) (2014) defines palliative care as:
'an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
The WHO principles of palliative care are listed in Fact Box 1.2:
WHO principles of palliative care
These principles highlight an holistic, humanistic approach to caring for the whole person throughout their illness, rather than focusing on the disease or condition. Palliative care responds to the changing needs of the patient and family over time, recognising that the disease progression and the associated experiences are unique to each person.
As the palliative care movement developed and grew there was an expressed need to differentiate between palliative care and specialist palliative care to ensure that patients and their families were receiving the most appropriate care. It was acknowledged that a minority of people with complex needs would require direct or indirect input from specialist teams, identified as 'those services with palliative care as their core speciality with a high level of professional skills from trained staff and a high staff: patient ratio' (NCHSPCS, 1995).
Once the differences between palliative and specialist palliative care had been established there was an expectation that everyone living with a life-threatening illness was entitled to receive appropriate palliative care regardless of health setting; therefore, each health professional has a duty to practice the palliative care approach as an integral component of good clinical practice, referring to specialist palliative practitioners when necessary (NCHSPCS, 1997).
As the meaning of palliative care has developed beyond care provided for those who are dying it became necessary to coin a new definition - 'end of life care'. This is acknowledged by the Department of Health (2008) as care that helps all those with advanced, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement.
Palliative care services have extended far beyond the hospices of the early movement (Figure 1.4).
Figure 1.4 Sites of palliative care provision.
As stated by NCHSPCS (1997) fundamental palliative care should be provided by the patient's primary carers, be it the ward teams or the district nurses or GPs. Specialist palliative care practitioners may be involved in the management of more challenging situations such as complex pain or symptom problems or complex psychological needs or family dynamics. Specialist practitioners should withdraw once the problem has settled or if the patient is admitted for specialist palliative care. Nowadays, hospices are used for specialist palliative care rather than respite, which was not the case in the early days. Respite is often provided by nursing homes, or by Marie Curie nurses who provide periods of respite overnight or during the day in the patient's home. Hospice at home teams may become involved towards the very end of the patient's life to enable them to die at home.
Traditionally, palliative care was only offered to patients with a diagnosis of cancer; thankfully in 1998 the government stipulated that the principles and practice of palliative care should become needs led, integral to NHS practices and available to patients, wherever they are, irrespective of diagnosis (DH, 1998). This belief is echoed in the National Service Frameworks (NSF); for example, it is noted that people with heart failure have a worse quality of life than people with most other common medical conditions. There is marked impairment of...
Dateiformat: ePUBKopierschutz: Adobe-DRM (Digital Rights Management)
Systemvoraussetzungen:
Das Dateiformat ePUB ist sehr gut für Romane und Sachbücher geeignet – also für „fließenden” Text ohne komplexes Layout. Bei E-Readern oder Smartphones passt sich der Zeilen- und Seitenumbruch automatisch den kleinen Displays an. Mit Adobe-DRM wird hier ein „harter” Kopierschutz verwendet. Wenn die notwendigen Voraussetzungen nicht vorliegen, können Sie das E-Book leider nicht öffnen. Daher müssen Sie bereits vor dem Download Ihre Lese-Hardware vorbereiten.Bitte beachten Sie: Wir empfehlen Ihnen unbedingt nach Installation der Lese-Software diese mit Ihrer persönlichen Adobe-ID zu autorisieren!
Weitere Informationen finden Sie in unserer E-Book Hilfe.
