Response 1:
Palliative care is an approach incorporating the management of spiritual, psychological, and physical symptoms, communication concerning planning for care transitions, support for families and clinicians, and goals of care for terminally ill patients. Annually, approximately 40 million individuals require palliative care, and 78% of them reside in middle and low-income countries (WHO, 2020). Initiating end-of-life measures is essential for it ensures the quality of life of patients and their caregivers. Palliative care incorporates a team approach to assist caregivers and patients through bestowing bereavement counseling and addressing practical needs. Advanced practice nurses need to deliver compassionate care during the end of life since a patient opens up about their discomfort and pain levels when they are at ease with nurses (George, 2016). Also, APNs should be well informed about a patients illness and treatment, and possess enough training in palliative care. Nurses also assist families in decision making given that critically ill patients are often incapable of making decisions independently. It is usually hard for parents to talk about death with their children.
As a nurse, it is imperative to inform the parents of the benefit of discussing the illness with the child given that the majority request information on the severity of their prognosis. The parents need to be able to verbalize the understanding that palliative care may ease the symptoms, discomfort, and stress of the childs serious illness. Hence, it is important that parents learn and understand their childs disease and its process in order to assimilate that palliative care may help avoid symptoms, provide relief from physical pain, and enhance the childs quality of life. As George (2016) contends, APNs are leaders and specialists in offering attention, symptom and pain management, and overall disease-modifying care with the most optimum life quality. If a child is young and does not understand the illness, an APN should help the parents break down the illness into simple, comprehensive terms. This way, a child can relay their wishes on how they want their end-of-life care to be so that they are comfortable. Thus, APNs need to ascertain that healthcare workers, family members, and the child understand the communicated information and that the family feels respected, cared for, and heard. Guidelines from the American Nurses Association (ANA, 2021) assert that the nursing code of ethics regarding end-of-life should underpin human and ethical rights towards dignified and humane care. Communication that is honest and open is important for it supports and empowers families and offers an opportunity to clarify and share care goals.
In the TED (2013) talk, Judy MacDonald Johnston discusses about planning for a good end-of-life by 5 practices:
Making a plan such as where you want to be when you are no longer independent, medication interventions, and who will make sure the plan is followed.
Recruiting advocates such as getting more than one in order to make sure that the end-of-life plan is being respected and followed. The chosen people do not need to be ones children or spouse. The indicated person must be able to work under pressure in order to accomplish ones goals.
Being hospital ready such as making sure that one has medical history, medications, physician information, insurance information, and advance directive.
Choosing the right caregivers by taking time to meet them.
Discussing last words such as what you want to hear when you are ready to let go.
Gaining ones trust and listening to their needs is the most crucial thing in planning end-of-life care. When approaching death, individuals need to know that their loved ones, valuables, and assets are better-taken care of when they are gone. I believe that as an APN, incorporating compassion when taking care of such individuals ensures that patients are comfortable and feel content during their last days. Also, honoring the patient’s wishes is essential during end-of-life care, for this gives them a sense of spearheading their own lives. Professionally, I have approached the palliative care practice through diverse strategies for caring for patients with life-threatening health illnesses. These include patient-centered care, inter-professional collaboration, following advanced clinical procedures, ordering and interpreting diagnostic tests, and having competency and autonomy to diagnose conditions supported with evidence-based practice (Collins & Small, 2019). In the end, it is about respecting the individuals wishes and recognizing the degree to which cultural values also shape ones thinking about death and dying. Acting as advocates helps ensure that the individuals and the familys final wishes are met.
Response 2:
Palliative car is focused on the whole person in order of ensuring the best quality of life from the time of diagnosis through bereavement. Before a nurse can effectively work with a patient who is in need of palliative or end of life care and their family, it is extremely important for nurses to assess their own beliefs and biases about death and dying. Kaakinen et al. (2015) mention that in order to strengthen ones nursing skills and become more comfortable in such settings, furthering education, attending workshops, reading up to date literature can all make a big difference. With that being said, nursing interventions and relationships between nurses and families are extremely necessary in creating positive outcomes in palliative and end of life care (Kaakinen et al., 2015). The family usually provides the most care to the individual who is ill and tend to need the most help in maneuvering through this particular time. According to Kaakinen et al. (2015) nurses hold a position that can either make the experience a negative or positive one when pertaining to the loss of a loved one. It is important to remember that regardless of the patients age, family inclusion in interventions is of upmost necessity. When pertaining to pediatrics patients who are the ill individuals, support needs to be given to both the patient, the family members, and the family as a unit (Kaakinen et al., 2015). The patients interventions and plans need to include the childs developmental, social, educational, recreational, and relational needs. When the patient is old enough to understand that their family members are hurting or not well due to their condition, it can be more difficult for them to relax and reduce their suffering, therefore, nurses need to focus on the family as well and ensure that appropriate help and interventions are being offered to the family members as well.
The TED talk speaker mentions that part of the process that makes the end of life transition a plausible and fulfilling one is ensuring that patients are able to make decisions on their own about what makes their days meaningful and complete so that the items they find most important continue to be offered to them. I believe that she was correct. Ensuring that patients are able to continue to do what they love via the assistance of multiple individuals allows for them to continue to feel fulfilled and allows them to continue to feel happy. The speaker also mentions the importance of having a plan that includes not only medical decisions but also small decision that make a difference in day to day life.
DeCourcey et al. (2019) mention that usually advanced planning focuses on adults who are terminally ill, however, in a survey they offered parents who had lost a child, they found that all parents mentioned that advanced planning was extremely important for terminally ill children as well. Parents mentioned that having this tool allowed them to prepare better for their childs last day, gave them the ability to choose the location where the child would live the remainder of their life, and allowed for the quality of life of their child to be excellent at the end of their life. The advanced care planning tool allowed for parents to feel more in control of a situation that felt uncontrollable. This particular tool has proven to help adult patients and has also shown effectiveness when dealing with pediatric patients. Therefore, the day I transition to be an advanced practice nurse, I will ensure to mention this tool to both the parents of chronically ill children and adults who are over the age of 18 regardless of health. By educating patients on the importance of this tool and promoting the use of it, I give patients the right to make medical decisions for themselves even when they no longer can.
