Introduction
In the field of health care, Palliative management is referred to as a form of nursing care process that aims to provide significant care for those who are elderly and patients experiencing terminal illness for a certain period of time. The reason for choosing palliative management is because there are significant nursing insights that can be learned and appreciated while attending patients experiencing distress. These are patients that need full medical intervention in order to have the opportunity to improve their health and wellness for a certain period of time as mentioned by Muster (2008). Palliative management is concerned with patients suffering from severe illness, in which only holistic approach is the only remaining intervention in order to improve the patient’s well-being.
Pertaining with the age appropriate nursing care, elderly patients are the most targeted patients because they need palliative management to decrease severe distress associated with their physiological impairments. Palliative management usually takes place in hospital institution where there are complete facilities that can attend with the patient’s health care needs. In some cases, palliative management can be applied to the patient’s home as requested by the patient or being requested by the patient’s family especially if the patient is capable to have home facilities to render their health as supported by Peterson (2011).
To expand understanding, palliative management is applied for elderly population because there is underlying information that can be attributed with palliative care for people suffering from chronic disease, which has not been fully understood by the public in the long run. Elderly individuals are often the recipients of cognitive and emotional degradation. It is because as their body becomes older, the elasticity of their smooth muscles around their body deteriorates, leaving behind inefficient muscle contraction in order to release energy as well as to require hormones to regulate physiological continuum. In this case, elderly individuals suffer from poor mental comprehension that allows their thinking ability to be affected. This includes gradual inability to recall past scenarios, which is responsible for hindering their cognition as well as hampering their memory skills. Patients with chronic disease are just some of the situational problems associated with patients suffering from mental distress, which needs palliative management in order to prevent further degradation of their mental and cognitive well-being. Without the help of palliative care, patients with cognitive impairment could experience rapid brain degradation that could lead to numerous damages to their nervous system particularly with their nerves as well as to their brain as mentioned by Truman (2007).
Functional assessment of palliative care
Physical assessment aims to determine the present physical condition of the patient by checking the patient’s vital signs because these will seek to find out signs of distress if there will be inaccuracy of the patient’s abnormalities to the heart rate, respiratory rate, temperature, and blood pressure. In addition, physical assessment can also deal with the nursing responsibility for collecting objective data to the patient by conducting head to toe assessment by using ocular inspection, palpation, percussion, and auscultation to observe signs of any abnormalities aside from assessing the vital signs as mentioned by Aniston (2009). Psychological state refers to the patient’s anxiety level and as a nursing role for this kind of assessment is to assess the level of the patient’s emotional pattern. As we know that the patient is very anxious, we should always establish rapport for the patient to increase their trust and gain cooperation. In the same manner, it is important to clarify the possible diagnosis and explain the patient regarding their present medical condition. Identifying the patient’s psychological assessment helps to identify potential causes of weakness that can be attributed with the patient’s mental capacity that is going to be used as the center of palliative care. In this case, the health care provider can now have the chance to become more functional with providing palliative care. Other issues that needs to be considered is all about taking vital signs for the patient for the reason that vital signs aims to secure any normal and abnormal physiological as well as psychological well-being of the patient while being confined in health care facility to comply with palliative management.
Planning
After important details such as documenting subjective and objective data has been already collected as part of assessment procedure, the health care provider is now going to establish a relevant diagnosis such as classifying the patient to be in moderate or severe chronic disease. In addition with the diagnostic procedure, the health care provider such as the doctor as assisted by the nurse to be identifying potential secondary diagnosis such as at risk for safety, poor cognition, and productive lifestyle due to inefficient memory capacity. Dodge (2011) stated that understanding potential behaviors that could be emitted by the elderly elderly patients is also a significant process of planning because it seeks to control any environmental risks that could affect the health of the patient. After diagnosing the patient’s condition, formulating essential health care practices can now be established in order to ensure that the patient’s health and wellness are going to be managed efficiently. Palliative planning is usually facilitated by a physician on duty who has the sole responsibility to handle elderly patient’s health and mental status accompanied by the nurse and nurse assistants on duty as stated by Muster (2008).
Strategic palliative approach
- Interpersonal strategy: When initially dealing with elderly patients, it is best to show positive environment such as greeting the patient because even if they are not suffering from full blown chronic disease, their memory is still finding for affection and calm environment. This includes greeting the patient, introducing health care provider’s identity helps to establish therapeutic relationship as part of the palliative care management for patient. Introducing the condition of the patient is the next thing that should be applied because the patient is always has the right to know about their medical condition even if their mental and physiological capacity is already deteriorating. Setting up with the patient with regards to the duration of their therapy is also essential so that patients are aware regarding the limitation of their palliative activities and procedures. The main rationale for these interpersonal approaches is to develop trust and cooperation with the patient so that all palliative procedures are going to be applied efficiently. When patients established their trust with the health care provider, their confidence and self-esteem arises, which is a significant benefit due to chronic disease as supported by Delch (2010).
- Management/therapeutic strategies: As a palliative management for elderly patients, doctor’s orders are now being followed basing from their orders from the charts as well as verbal orders. Pharmacological intervention includes administering medications, which is an essential part of palliative management so that patients with chronic disease could have the chance to reverse the degrading pattern of chronic disease affecting the body. This includes providing oral, intravenous, or inhalation therapy that aims to relax their smooth muscles as a way for helpful chemical materials to improve patient’s physiological well-being. Safety is one of the most significant considerations while providing significant medical intervention as part of palliative care for elderly patients with chronic disease. It is because they always wander around the corners of the health care facility due to delirium made by degrading cognitive integrity. When elderly experiences extreme agitation such as delirium, their vision is temporarily malfunctioning that allows them to experience severe near sightedness. In this case, they are vulnerable to falls when wandering near the stairs or might hurt themselves when tapping furniture that could hurt any of their body parts as claimed by Baasten (2008).
- Educative management: Patients that are suffering from chronic disease are always experiencing loss of memory pattern, lack of physical exercise, and immunocompromised. As a therapeutic response, education is still a significant part of palliative management. It is because it helps to contain the memory pattern of elderly individuals with chronic disease to stop the progress of memory loss pattern by helping them to recall needed therapies in order to improve their mental well-being. Observing cleanliness is another significant activity such as emphasizing elderly patients with chronic disease regarding the significance of hand washing for the reason that it helps to prevent infectious diseases that can affect their health and wellness while being confined in a medical institution. Involving significant others such as family members, relatives, and friends is another significant action in order to help increase their knowledge on how to efficiently cooperate and render their support with the patient. Nurse or doctors that are always keeping an eye for the patient round the clock still confronts unexpected hazards or physiological reaction to a certain triggering response, which is why reporting to any health care professional on duty is always encouraged to prevent any injuries according to Aniston (2009).
Implication
It has been learned that in palliative management, formulation of diagnosis is important that is the baseline for the development of care plan. It is important to provide rapport to gain the trust and cooperation with the patient as an initial approach for nursing intervention. As a therapeutic response, administering medications as prescribed by the physician will promote the patient’s state of well being by decreasing signs and symptoms to recover. After administration, it is important to emphasize the importance of drinking water to loosen phlegm that helps to improve the patient’s well-being. Upon evaluation, determine if the patient’s signs and symptoms decreased which is an indication of a successful care plan as indicated by Truman (2007).
Education is always significant for attending patients with chronic disease as part of palliative management in any health care facility. It is because patients that are experiencing chronic disease are always at risk for injuries caused by their poor mental integrity at all times. Following doctor’s orders are important in order to prevent any ethical or legal challenges that might affect the patient’s health care integrity at a certain point in time. Securing the safety of patients should be always done with proper management because elderly patients that are experiencing chronic disease shows regular signs of agitated behaviors that is one of the leading causes of injuries if they are not being monitored efficiently. Referring to the patient’s charts should be always considered as a routine in order to prevent any issues of failing to comply with the doctor’s orders that could significantly result to injury against the patient’s mental health status as part of palliative management process as mentioned by Anderson (2010).
