Palliative Care And Their Importance

Palliative care and their importance

Introduction

Palliative care are not the same as the care of terminal patients. The latter are offered when the patient’s life expectancy is 6 months or less. The terminal patients also receive palliative care, but they are care that focus on the person’s last months and in patients who no longer receive treatments to cure the disease. 

The World Health Organization (or.M.S) Expose as fundamental objectives of palliative care

• Pain relief and other symptoms.
• Do not extend or shorten life.
• Reaffirm the importance of life.
• Consider death as something natural.
• Offer support systems so that life is as active as possible.
• Give psychological, social and spiritual support.
• Support the family during the disease and during duel.

Palliative care helps a person of any age to feel better in a serious illness and help improve their quality of life. It focuses on preventing, relieving symptoms and side effects caused by treatment. These care can be given before, during and after treatment. It has been shown that palliative care at an early stage of the disease, not only improves the quality of life, but that it can help live more. They do not advance or delay death and respect at all times the fundamental rights of the person. With these care the symptoms, pain and stress of the disease are relieved. Palliative care is provided as long as possible, together with medical treatment.

The ideal is to start these care at the same time as diagnosis. The Diana population in the palliative care strategy will be children, youth, adults and elderly with an advanced disease and their families, with limited life forecast and frequent crisis. They enter into this profile

1- oncological patients and their families:

• Documented, advanced, progressive and complex cancer disease, in which treatment has no impact on survival and quality of life or is rejected by the patient himself. The socio-family risk due to lack of support or claudication of the main caregiver should be assessed.

2-Advanced chronic diseases and their families:

•  Advanced AIDS.
• Liver diseases. Advanced liver cirrhosis.
• Respiratory diseases (COPD, restrictive diseases, etc.), in which the management is support.
• Chronic renal insufficiency Non -tax terminal dialysis.
• Neurological diseases (ACB, dementia and neurodegenerative diseases) in advanced and complex situation.
• Cardiocirculatory diseases: heart failure refractory to treatment.

Palliative treatment takes into account, not only the patient, but also his family, the latter, help at certain times to be able to make difficult medical decisions and to control stress, when the disease is distressing. It is characterized by providing comprehensive patient-family care in which the prevention and relief of physical, psychological, social and spiritual stress is very much careful.

Multidisciplinary team

In a provision of quality palliative care, the work team will compose specialized professionals who work interdisciplinary, with coordination and flexibility, making personalized evaluations and considering each case in a particular way. 

Each multidisciplinary palliative care team can be of several types:

• Basic: It will consist of 1 doctor, 1 nurse, with the participation of a psychologist and a social worker.
• Complete: it will consist of the professionals who participate in the basic type, and 2 more full -time professionals.
• Other professionals to involve can be: physiotherapists, occupational therapists, pharmaceuticals, nutritionists and other professionals.
• Connections by specialists directly involved in patient care, such as: oncology, geriatrics, internal medicine, pneumology, primary care and other complementary palliative care services such as the pain unit.
• An important component, already related to connections in society and that is highly recommended are volunteers.

Each palliative care team is different and can include: doctors, nurses, social workers, religious or spiritual advisors, pharmaceutical, nutritionists, advisors and others.

All team members must have basic training in palliative care, such as: a postgraduate degree in oncological nursing and more than 50% must have intermediate training. Unit leaders must have advanced and accredited training (postgraduate degrees, magister degrees). In Spain, access to units that do not have continuous training is being denied, with an annual training and training program for its members.

The team must have knowledge in relation to the estimation of the life forecast, to recognize the symptoms to take into account when a fatal outcome is approaching and knowing how to recognize the support and care needs of the patient and relatives before and after death.

It is very important a good communication between family members, the patient and the medical staff responsible for palliative care. Communication must be based on the knowledge, skills and skills of the assistant personnel, so that the family and patient receive adequate information to them, based on their cultural, social, emotional and cognitive development. The information that the health professional transmits, as well as the way it is treated, will be essential and decisive when facing their concerns and fears.

It should be taken into account and considering whether the family is physical and psychologically prepared to serve the patient properly. The person in charge of the patient should also be identified to be able to give him the support he may need and value and observe the impact that will be produced on the caregiver.

The main person in charge of caring for the patient and the socio -family support network must appear in a prominent place in the medical history of patients.

It is necessary to implement a family claudication risk identification protocol. After the death, psychological support to the family will be assessed. It is recommended to implement a protocol in case of pathological mourning. Within these protocols, especially consideration, adolescents, elderly spouses, and people with little social support will be taken in special consideration. Specialists in case of complex duels must be established in case. A serious illness and their treatment can cause physical and emotional symptoms, as well as side effects that may depend on several factors, such as the type and stage of the disease, its location, treatment and the state of health.

Physical symptoms

They depend on each person, as well as the side effects related to treatment, such as diarrhea, vomiting, lack of appetite, nausea, etc

Before starting the treatment, the medical care team will help the patient to understand that the side effects are more likely to manifest and a stress prevention and control plan will be put into practice, using the combination of therapies, such as: medications, occupational therapy, physiotherapy, nutritional advice, relaxation techniques, massages, acupuncture, physical exercise programs, etc

Emotional symptoms

Emotional symptoms can also affect everyday life. Palliative care specialists and medical care team have a lotFear of the future, etc

Home care

The palliative care team is normally located in the hospital or clinic, although it is already frequent, to offer its services in an outpatient manner. At home you can also meet the needs of the patient. The palliative care team can provide both the patient, caregivers and relatives, support and education to face the disease from home. The support team can prescribe medicines and other methods that may be required during their illness or in the process of their death, it will be determined by its personal characteristics, their health, if it is a man or woman, the age of their closest relatives, theiraddress, the availability of palliative services and the support network. To make a good decision, the patient must receive exhaustive information of his situation, the real possibilities and the pros and cons of care in one or another place to achieve greater well -being, respecting at all times his prominence and constantly maintaining aGood communication with him, where open questions are asked, always using active listening.

The home is the place chosen or preferred by patients with a serious illness. Their house gives them more security, since it provides the feeling of normality, routine and autonomy. Being a less medicalized place, it gives the impression of being less aggressive and more ease and comfort to relatives when making visits to the patient. 

Factors

While the explicit desire of the patient is priority to stay at home, we must also consider whether that possibility is realistic and feasible. An important factor is that the patient is supported by his family in this decision and actively participate in his desire to be fulfilled. Another important factor to consider is the sex of the person in charge of the care of the patient;If it is the wife or daughter. There are many possibilities that your desire is not fulfilled whether the care depends on the husband or son.

Another factor, not least, is the age of the caregiver or caregivers, the training they have and the progressive advance of the disease, such as the needs that will be created in the development of the degenerative process. 

A sick relative alters the normality of the family nucleus, especially when it is the head of the family and economic support. In this case, the caregiver must be especially careful and attended by the social group, so that he does not burn this work.

Home visits are beneficial to first hand the limitations that the environment could put and be able to suggest certain positive and necessary changes (crane, hospital bed with lateral protectors, higher toileAccess (as in the bathroom), elimination of carpets and annoying objects to the step, placement of light points, etc.or erroneous or inaccurate ideas created by family members.

Home visits are practical since the functioning of the family and environment is observed in person, it allows us to observe the degree of adaptation of the patient at home, positive links between the family and the doctor are created, it favors that the sick better express theirfeelings and can also be detected if the family is vulnerable. You can see if there are more people at home, values are revealed and the knowledge of the family and family orientation is deepened at home.

The patient, in addition to having medical support, also needs to feel security about his spiritual and personal problems. If you have young children, if you are head of the family, if you are unemployed, if you are immigrant, etc. … are situations that make your well -being staggered and have deficiencies and concerns. Support will generally be your family and friends, necessary to manage stress and better focus your situation. 

The care of the patient is expensive, physically, emotionally and economically. The early detection of these problems will offer the necessary help to caregivers, avoiding hospital admission and being able to facilitate professional support and health care to those who need it and demand.

Caregivers are often already elderly and with little health, which favors failure in house care because of stress and is physical effort that is the care of a dying. Some of the fears that caregivers have are: the fear of the unknown, not to endure the final phase, fear of harming the patient, if he bleeds, if he convulses, if he is wrong with the medication, not to recognize the signs ofDeath, etc

Family members will be informed to take into account certain complicated and difficult moments such as: that parenteral fluids or food in agony will not be administered since in this phase of the disease is not hungry or thirst and vomiting can be causedand secretions. They will be instructed on the use of rescue preparations, diazepan or extra doses of neuroliptic. Ensure sedative possession and towels in patients from certain tumors. There are patients with lung cancer who care because they cannot breathe in the last phase, before this you have to reassure them, exposing that in that phase the majority of the patients die as a result of the general effects on the body and that they will be off slowly. The sick at no time will suffer, since they will have at all times available to relieve dyspnea. After the final phase, the caregiver will tend to extend life or shorten it …, it will be explained that palliative care are neither for one thing nor for another, simply to offer comfort and dignity to the patient.

Many concerns decrease with good information and with the existence of an emergency telephone and palliative care where the doubts that arise will be clarified. Family members have to keep in mind the wishes of the patient and when the time comes, consider the option that the patient changes his mind and decides to finish their days in the hospital.

The final phase is a moment that fear almost all relatives and caregivers, in the face of uncertainty due to inexperience of what will happen, so it is necessary to explain what are the signs or symptoms that the moment is close. Details such as the final phase is preceded by a period of much sleep and little verbal communication. At that time, you just have to be, accompany and respect. 

House care problems

• Anxiety due to lack of medical professionals.
• Doubts when managing medicines.
• Opiophobia.
• Fatigue due to excess visits to the patient.
• The patient is pressed more to eat.
• Less participation of suffering.
• Family claudication.
• Family silence conspiracy.
• Feeling of inability to take care of their relatives.
• Emergency anxiety.
• Scarce social resources.
• Health training problems.
• Inadequate socio -health coordination.

Methodology

In the realization of this work I have based on numerous databases, such as: MD Anderson Center, the World Health Organization (or.M.S.), Medlineplus, Spanish Society of Medical Oncology (S.AND.EITHER.M.). I have also taken information about the Basic Nursing Techniques Course. I have also made a bibliographic search on Academic Google with the following keywords: "Palliative", "Care", "Symptoms", "Treatments", "Team". I have omitted all the data that were not in Spanish.

Results

Nursing staff is the part of the healthy team closest to the patient and his family that, together with the palliative care team, will make these, at certain times of the disease, fulfill certain purposes, such as: such as:

• Get a higher quality of life for the patient and his family, thanks to the care provided by specialized personnel.
• Achieve a physical, psychic and environmental balance despite alterations in their quality of life, caused by disease and treatments.
• Prevent and cope..
• Before a terminal patient, reduce their suffering and increase their well -being. Know how to identify somatic symptoms of psychosomatic ones, to make a degree of prioritization.
• Knowing how to detect and enhance the resources available to the patient, to reduce or eliminate the feeling of impotence.
• Increase your feeling of control over the situation.
• Before a depressive or anxious state, know what techniques to avoid making it chronic and pathological.
• Dominate the use of strategies in the face of a state of suffering, such as distraction, information, relaxation, hypnosis, etc
• Get the patient to show us his attitude towards the disease, this will be achieved by active and carefully listening.
• Get the patient not to have the feeling of being alone or abandoned in the process, offering sincere, respectful and comprehensive company.
• It is also important to avoid fear and anxiety in the patient. It will be possible to feel safer using physical contact;hold his hand, dry his forehead, sit next to her, treat him with kindness. All these gestures are the best remedy against fear.
• Have empathy. Before the closeness of death, priorities and values change in life. Many care about family members, children or parents who stay behind the hard outcome, financial, economic problems, order in the family, etc. … it is necessary to spend time and listen to them to know exactly what worries them.
• Take care of physical, emotional, social and spiritual needs with a comprehensive and holistic way.
• Take care of your comfort and comfort at all times, for this a certain personal attitude is required. It is necessary to take care of dignity before, during and after death.

Conclusions

After everything read, we can conclude that palliative care are a multidisciplinary specialty dedicated to improving the patient’s quality of life that is suffering a serious illness and supporting the family throughout the disease process and after it. Palliative care are aimed at reducing symptomatic load and caring for psychosocial needs. This is achieved by working together; The palliative care team, the patient, the family and the doctors. In this way a consensus is achieved regarding the objectives for the patient.

It is not its purpose to accompany the patient at the end of his life, her task goes further and is not so simple. Its purpose is a continuous and personalized help, mainly to patients of any age and serious illness, together with their families, while offering their availability to the doctors of these. Our duty as sanitary, regardless of where death happens, is to be prepared for it to be calm, without pain and that the patient is surrounded by their loved ones. We will try, as health professionals, not only that the patient has, within his illness, a dignified life, but that the time comes, also has a decent death.

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