What Are The Principles Of Palliative Care
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- 24-10-2022
This article looks at the principles of palliative care. Find out more about the key principles for care at end of life and how to access palliative care.
The principles of palliative care
The process known as palliative care is not simply a process that a patient can go through in the hospital by themselves. It is more like a philosophy that is then integrated into every aspect of the individual's overall care, as well as the care that their family receives.
Palliative care:
Affirms the individual's life and regards dying as being a normal process of life
Will neither hasten nor postpone the process of death
It can provide kinds of relief from pain and other upsetting end-of-life symptoms
Commonly integrates spiritual and psychological types of care
Offers a system of support to assist the patient to live as actively as they can until death
It also offers a support system to help the patient's family cope during the time of the patient's illness and in their own bereavement process.
The key principles for care at the end of life
Unfortunately, due to the coronavirus, health and social care professionals have had to provide end-of-life care much more commonly and on a much wider scale.
In more critical situations, end-of-life care will require incredibly swift decision-making and conversations that most will find difficult. In order for professionals to deliver personalised care, they need to treat individuals with kindness, compassion, respect, and dignity.
Below is a summary of the key principles that are important for end-of-life care
Sensitive Communication
Having sensitive communication ensures that the individual and the family have a complete understanding of what is happening and understand any previous care plans that have been created in the past.
Of course, any religious and cultural needs will be continued to be respected. If, prior to this, there were no discussions about DNACPR (Do Not Resuscitate) or place of death held, then this must be placed as a priority
If there are any major changes to a person's condition, then this needs to be reported to the family. This is absolutely essential when caring for someone who has coronavirus, as deterioration can take place quickly.
Ensure Comfort & Dignity
Even though there can be various clear signs that a person is dying, a diagnosis needs to be made by the team that is caring for the individual.
If any attempts to reverse any reversible causes of decline are made, then these must have been thought through completely or attempted. Any non-essential medications need to be discontinued as soon as possible.
The essential goals of the care need to be focused on making sure that the individual feels comfortable and dignified in their dying phase.
A Holistic Approach To Care
It is required to have a continuous review of the individual's symptoms and needs. This is done using a holistic approach to care.
This is important when it comes to considering a person's needs as they relate to spiritual, physical, emotional, and social aspects.
What some call "just in case" medicines also need to be prescribed. Families need to be offered the opportunity to have a full understanding of what they should expect when their loved one is dying.
Support For Family & Loved Ones
It is important that loved ones and family feel supported during this hard stage, as well as after the person has died.
If the relatives are not supported, or the person is considered to have not had a "good death", then the consequences of this can be extensive.
A Holistic Approach To Managing Pain
Pain Is Subjective, And Because Of This, There Is A Huge Amount Of Variation In How People React, Feel, And Report Their Pain. Pain Is Far More Than Just A Physical Phenomenon.
There Are Many Different Factors That Contribute Towards The Experience That We Describe As Pain. This Is Often Referred To As "Total Pain".
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Physical Pain
Physical pain is a disturbance or a disruption in the relationship between the individual and their own body.
Social Pain
This is a disturbance or a disruption in the connection between the suffering individual and their world. This includes their work, family, and society.
Spiritual Pain
A Disturbance Or A Disruption In The Relationship Between The Person And Their Values Or Beliefs.
Emotional Pain
A Disturbance Or Disruption In The Connection Between The Suffering Individual And Their Emotions. It Can Also Be A Disturbance In The Way The Individual Sees Themselves.
Pain management
Unfortunately, physical care is a large part of various different health conditions, especially when it comes to the end-of-life stage. Even though pain is a highly common symptom, not everyone who is receiving palliative care support will experience pain. This means that pain relief should be something that includes physical, psychological, social, and spiritual aspects of pain.
Due to pain being so multifaceted and complex, there is really no clear way of treating the condition. Physical pain cannot be treated on its own as a separate effect from the psychology and anxieties of pain. This works the other way around too. Any mental suffering cannot be treated separately from the pain of the physical experience.
The first important principle when it comes to managing pain is a full and thorough assessment of where exactly the source of the underlying pain can be found. You should remember that patients will often have more than one area of pain and that different types of pain will have different causes.
The World Health Organisation has designed a three-step ladder which should be used for pain relief in adults. This can be used in palliative care. The World Health Organisation recommend that pain medication should be handed out "by the clock", essentially meaning every three to six hours rather than being on demand. When pain occurs, there should be a swift oral administration of medication in the following order:
Non-opioid treatment (paracetamol and aspirin)
Next, when necessary, mild opioids (codeine)
Finally, strong opioids such as morphine should be used until the patient is pain-free
In order to quell any anxieties and fears, additional drugs can be used. These are named "adjuvants".A deep understanding of the underlying pathophysiology of pain is absolutely vital in order to achieve effective pain management. The three-step plan of administration for the right drugs in the right doses at the right times is considered to be inexpensive and somewhere between eighty to ninety percent effective.
It is important that there are always considerations given to the treatment of the underlying cause of pain. This may be in the form of surgery, radiotherapy, chemotherapy, or another appropriate method.
Where can people access palliative care?
Palliative care is given whenever the individual and their family would prefer, when possible. Palliative care is not exclusively locked away, only to be done in a hospital or a clinical setting. These locations can include the following:
At the individual's home
In a hospital
In a hospice
In a residential aged care facility
For many people, their preference is to die at home, and in order to make this a possibility, several different factors need to be considered.
For example, the nature of the person's illness, the amount of care that the person will need, the amount of support that the person receives from their family, and whether the individual has someone at home who can help to provide support and physical care for them.
Support for friends, relatives & carers
When an individual is in the final days of their life, when possible, the family needs to be involved in all the decisions that need to be made about care.
The family needs to be prepared for the inevitability of the individual's death and what they should expect when their family member begins to worsen over their final days and hours of life.
The family members and loved ones of the dying individual are likely to express a huge amount of different emotions during this time.
If you have questions about the needs of a person who is in need of palliative care we hope this information has been useful to you.
We offer specialist palliative home care services and live-in care for vulnerable adults throughout London. Get in contact today if you have a loved one that would benefit from professional care at home.