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The aim of this assignment Is to write a report on a chosen topic of Interest that demonstrates the knowledge and understanding of the factors that shape community practice. The topic that will be discussed throughout will be palliative care. I feel passionately about this topic, as I sometimes find myself consoling family members on the death of their relative as the role of a student nurse.
Part of me wishes that if we as a larger culture stood up to the fear of talking about death, we might really change how we all cope with the Inevitable and have more understanding of the matter. This assignment will firstly discuss the factors that impact upon the health of the dying patient, from the environmental setting that they are In when In the community to achieving quality and cost-effective care when staying at home through their end of life. Secondly, review the strategies that promote health to the end of life for instance the consequence of a preferred place of dying and the outcome of the Liverpool Care Pathway (LCP).
Furthermore, analyzing the impact of working within a multidisciplinary team will be considered, by understanding the role of different community practitioners and their contribution towards the palliative patient. Finally, to critically evaluate the professional, ethical and legal issues that have an effect in community practice. From ethically giving the end of life patient a decision about their care and place of death and the legal issues that the Nursing & Midwifery Council (NC) considers. Health Is Influenced by a number of factors which exist within the individual and the society.
The important factors which will be discussed are social, political, economic and environmental Influences of health. Many aspects of health are subject to political legislation. A government initiative that is in place to promote service users awareness of the range of services available other than A&E, is the National Health Service (NASH) entitled Choose Well. This high profile awareness campaign Is designed to help people get the best possible treatment by selecting the service that is right for them. Choose Well was first developed by certain NASH services in 2007.
The campaign was further developed In 2010 where all the materials where made available to all NASH teams. NASH, 2007). This campaign is set out in a thermometer style in which there are clear messages about what service to attend in relation with the illness. The categories are self-care, NASH choices. Pharmacist, GAP, Walk-in centers and A&E or 999. I believe by giving people a choice and providing a campaign to understand the range of services available this will help them choose the correct service if they are Ill or Injured and reduce the risk of hospital admissions.
Hushes (2012) supports this point by stating that “helping people make the right choice in accessing services ill not only benefit patients themselves but also assist our doctors, nurses and other healthcare professionals to maintain high quality services” (p. 1 b Studies show that the leading factors that influence society’s health are related to these factors link together to either increase or decrease the likelihood of good health. Income plays a big part in the health of an individual. The higher the income of an individual the more likely they are to be in good health.
Brotherhood, White, Ortega ; White (2007) state that, “the higher one’s income, the longer one’s life expectancy and the better one’s health” (p. 31), this is because people of a higher income are able to afford more expensive health care, in addition upper income individuals may be able to cope with stress and problems at work by taking a vacation abroad whereas lower class income have fewer options. Lower class society may turn to smoking and alcohol misuse or other negative health risk behaviors to reduce stress.
Linked with economic factors is the time in which individuals spent in formal education, this has important effects on the essential occupation which is striver for at the end of education and can have crucial changes on income. Regaling (2009) declares that, education “may change health outcomes and increase longevity by encouraging behaviors that provide protection against disease and likewise reduce behaviors that put people at the risk of disease” (p. 57). In other words the higher the education of the individual the better decisions they are going to make about their long term health.
For instance, health professionals such as nurses and dentists will realism from their education of their Job the effect fatty foods and sugary drinks will have on health in the long term, therefore this will change their perspective as hey are aware of the consequences of poor health. In addition, people with higher education are more likely to be able to find profitable Jobs. This increases their chances for stable incomes, Job security and Job satisfaction, which again reduces stress. There is a strong association between environmental hazards and disease and poor health.
As identified by the World Health Organization (WHO, 2006) there is as much as 24% of global disease is caused by environmental exposures. Environment is composed of all external conditions to which an individual is exposed. This can be from the air in which we breathe to land in which we live on. Poor housing conditions can have had effect on health. Internal conditions of the home, for instance asbestos and mould can cause serious health problems such as respiratory problems and cancer (WHO, 2011). Overcrowding can also be hazardous as disease can be transmitted more easily between family members.
Lower class society for example with poor income will not be able to afford the luxury of having the heating on throughout the day and “cold temperatures lower resistance to respiratory infections” (Harder, 2006, p. 13). It is seen throughout this section that there are considerable health inequalities in many efferent factors and how they are linked together. These inequalities have been largely persistent across time and have, in some cases, widened. It is seen how health chances differ according to housing, income, education and working class.
There are many different policies and care pathways in place for the end of life not Just about delivered care in the last stages of life but ensuring quality of life for patients and those who are close to them. Care pathways vary depending on the condition the patient has and is tailored to be precise to the individual needs of the patient. Care pathways also known as ‘clinical and critical pathways and care maps’ (Courtney ; Enhancement, 2010). Integrated care pathways did not come into account until the late sass’s. The first set of tools were invented at New England Medical Centre and begun as case managements.
Problem-orientated medical records were researched and soon became clinical tools that are used today based on patterns of care (Gander, 2002). There are many areas in which the care pathway has potential issues and barriers to care. An example of a care pathway is the Liverpool Care Pathway (LCP) for the dying patient. This was developed in 1997 and is used to improve the care of patients who are coming to the end of life (Allergens & Wilkinson, 2011). The aim of the LCP is to keep the patient comfortable by controlling their symptoms and pain management.
The LCP does provide an efficient checklist, however after the initial assessment of the patient and the use of a standardized approach as Kelly (2003) states, ‘a series of boxes to be ticked by professional caregivers’, risks reducing care of the dying and professionals need to consider all potential needs of the patient. This does not allow for variances in a tangent’s condition if they were to be unexpected as when nurses are doing a series of ticking boxes they are not assessing the patient throughout the care pathway. Not all care pathways have a positive effect on the patient.
It is very important to consider the views of the patient so that the maximum level of care is provided as much as possible with promoting their quality of life and looking at the patient with a holistic approach. As holistic care is described as “the wellbeing of the whole person- body, mind and spirit” (Tierney, 2006, p. 2), so therefore holistic care is not Just a pacific treatment, but an overall view of treatment and health including the patient’s emotional and spiritual well-being, not Just their physical needs that should be met.
Preston (2007), suggests that the LCP is not meant to “replace sensitive and holistic end-of-life care, it exists as a tool to complement this approach” (p. 64) but Taylor (2005) expresses that, “it is crucial that the health care worker understands the background and principles of palliative care and the LCP in order to use the document to its full potential, and used as guidance when offering high-quality, individualized care” (p. 6).
A negative effect of this care pathway shows that the LCP only focuses on physical, mental and social wellbeing by discussing medication, comfort, skin care, nutritional needs, hydration and communication for patients between varied multidisciplinary teams. It does not respond well and lacks knowledge about a service user’s spiritual needs. In the Nursing and Midwifery Council (NC), the professional code of conduct states that ‘all nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, psychological, spiritual factors’ (Nursing ND Midwifery Council, 2008).
In order for nurses and other multidisciplinary team members to perform effectively and take care of the patient with a holistic approach further problems of the patient. Multidisciplinary collaboration and effective communication have a positive influence on a patient’s healthcare Journey (Banks, 2002). Multidisciplinary teams (MAT) are described as group of “professionals from diverse disciplines who come together to provide comprehensive assessment” (Lloyd, Hancock & Campbell, 2007, p. 1 10). Without team work in nursing there would be critical problems for both patients and ruses.
There are many impacts of working within a MAT several important issues include those in a research paper entitled End of Life care. Roe, Machined and Sandy (2008) indicate that: ; The relationship that the care staff have with the residents is very important to ensure that needs are met at the end of life. ; Advance care planning is beneficial to identify the disease trajectory, to prepare for the death of a relative and identify personal choices that the patient may have. ; The importance of good communication between care staff and the resident’s family and owe this can be facilitated through the use of the LCP (p. ). The research paper highlights the perspectives of families dealing with end of life and the result of communication between health care teams. There are many different members in association with end of life care. “Specialist palliative care services are provided in a number of ways, for example day hospice, bereavement care and home support from general practitioners and district nurses” (Brown, Chambers and Gelling, 2007, p. 184). Although it seems that there are many advantages to MAT approach in addition there are also barriers.
It has been highlighted that “inadequate communication between specialist and primary care is inconsistent and delayed” (Vaudeville, Kay and Berger, 2013, p. 15). Confusion about roles and responsibilities is a barrier to the MAT approach as all members who deal with a patient play an important part in their care. There must understanding in one’s role and your colleague’s. Macmillan nurses complete specialists courses in end of life issues such as managing pain and psychological support. Macmillan nurses are a valued and trusted source of expert information, advice and support free of charge (“Macmillan Nurses,” 2013).
They help with the side effects of chemotherapy, help diagnosis and support women with early signs of breast cancer. Macmillan nurses also provide emotional reassurance to women who need a mastectomy and finally they also provide pediatric care at home and also in hospitals. United Kingdom Central Council for Nursing, Midwifery and Health Visiting Code of Professional Conduct (CHUCK, 1992) suggests that nurses should act at all times in such a manner as of safeguard and promote the interests of the individual patients and clients. This cannot be achieved without effective communication.
With improving communication with patients, professionals should show empathy in order for patients to trust them effectively. Showing empathy consists of identifying with another’s feelings. It is the situation where you emotionally put yourself in the place of another. The ability to empathic is directly dependent on your ability to feel your own feelings and identify them. This will improve quality and skills and these are needed in order to maintain a good team as promote tools for good communication for the end of life care.
Use of the LCP implements as a framework of care to enable staff to assess, monitor and implement appropriate care to meet the needs of the dying patient. This includes communication from MAT meetings. They are identified as being valuable in the predication and diagnosis of the spiral of decline in the patient with advanced diseases. Care at the end of life focuses on making the patient comfortable and understanding their last wishes from the place of death to whether to keep treatment on going. Providing good care for patients are the end of life requires health practitioners to be knowledgeable of professional, ethical and legal issues.
In any patients care consent is a very vital component in the individual’s rights and it is n established part of law. Consent as defined in the Oxford’s Nursing Dictionary (2008) as being the “agreement to undergo medical treatment or to participate in medical research. Conditions must apply for consent to be valid; the patient must be competent and the patient must be in the condition to decide voluntarily’ (p. 145-46). The patient must also be aware of the information about the treatment for example the dangers and problems that the treatment can cause if done wrong.
Health practitioners have professional matters that they must abide by to protect the public y ensuring that they provide high standards of care to their patients and clients. The Mental Capacity Act (MAC, 2005) provides guidance to those who are unable to make rational decisions. According to the MAC a person is unable to make decisions if they are unable to ‘understand information, retain information, to use that information as part of the process of decision making or to communicate his decision’.
When an individual is unable to make decisions for themselves, then a Lasting Power of Attorney (LLC) can be appointed to make decisions on their behalf. The MAC also declares that La’s can make Judgments with financial matters such as property and affairs but can also cover personal welfare including healthcare and consent for medical treatment. However, in some cases patients may not have the mental capacity but they also have not been appointed a LLC.
In these situations, “there will be a hearing before the Judge to determine whether or not the proposed treatment is in the person’s best interests” (Kenilworth, Snowline & Killing, 2002, p. 77). NC (2008) states that consent should be gained before any treatment and respect and support people’s rights to accept or decline treatment. Professionals should also be aware of legal aspects of consent which links to MAC and other legal acts. Patients have rights to refuse treatment without any reason given if they have the mental capacity.
In addition, Diamond (2002) found that patients on entering hospital give their consent to treatment; however implied consent is required before any nursing intervention is performed whether in hospital or in the community. Effective advance care planning can assure that patients independence at the end of life even if the patient has lost their mental decision making capacity. Advance care planning recognizes preferences about an individual’s care and treatment. These choices may include the place in which the individual would like to die or choosing which person they would like to appoint as their LLC.
Advance care planning has the potential to improve end of life care and ethical issues as future health wishes are known. Also in reference with the community setting euthanasia can have an described as “the painless killing of a patient suffering from an incurable and painful disease” (Oxford’s Nursing Dictionary, 2008), but this is not always the case. In some cases, doctors can make the decision whether to withhold certain life sustaining drugs to patients this is not illegal and is in the best interest of the patient in accordance with the MAC. The Human Rights Act (HEAR, 1998) has been on both sides regarding the act of euthanasia.
The legal act declares a right to life, but also states that people should not be subject to inhuman or degrading treatment and free from torture. I agree with not to subject people with inhuman treatment, if individuals have the mental capacity to decide whether they would like to be killed due to the reloaded pain or any other reason, than I believe that this way of euthanasia should be made legal as well as physician assisted suicide. In addition, the only humane choice is to allow individuals who are suffering at the end of life to choose to end it their way.
In conclusion, throughout this assignment it has been stated about all the important issues regarding the end of life. Specific health factors were discussed about dying patient and it was seen that each factor alone contributes to health. The LCP was reviewed and showed it relation with the community setting and the positive and negative aspects that the strategy has. The different practitioners of a multidisciplinary team were considered so that there was understanding of the roles and how these contribution towards the palliative patient.
Finally, professional, ethical and legal issues that have an effect in community practice were stated. Personal thoughts about euthanasia were pronounced and the legal issues for consent. This assignment places together the main issues with health in the community and how that links with my chosen topic of palliative care. With the right training on how to deal with the end of life patient and understanding about their deeds then there should be an end result of the patient dying with dignity.