Discuss the historical, legal, and sociocultural perspectives of palliative and end-of-life care in the United States.

Discuss the historical, legal, and sociocultural perspectives of palliative and end-of-life care in the United States.

Define palliative and end-of-life care.

Compare and contrast the settings where palliative care and end-of-life care are provided.

Describe the principles and components of hospice care.

Identify barriers to improving care at the end of life.

Reflect on personal experience with and attitudes toward death and dying.

Apply skills for communicating with seriously ill patients and their families.

Provide culturally and spiritually sensitive care to seriously ill patients and their families.

Implement nursing measures to manage physiologic responses to terminal illness.

Support imminently dying patients and their families.

Identify components of uncomplicated grief and mourning and implement nursing measures to"

Historical and sociocultural and Legal approaches to Palliative and End of Life Care in United States

 Palliative and End-of-Life Care Definitions:Palliative and End-of-Life Care Definitions:

 Palliative Care: An interfaced model of care that focused on the enhancement of the well being of patients with potentially terminal diseases, acute or long-term diseases, or terminal elderly patients. The approach aims at the control of symptoms and pain and stress, no matter what the curability of the illness it is applied on or whether it is in the later stages.

 End-of-Life Care: End-of-life care is one of the care approach of palliative that focuses more particularly on the dying patients. This is the care that aims at helping the patient to be comfortable and get the required dignity in the last weeks or days of life.

 Historical Perspectives:

 Early 20th Century: The idea of a palliative care was still in its infancy. Many priorities were on the curative care, and the terminal care were mainly palliative and often insuficient.

 1960s-1970s: The hospice movement developed as a response to long-standing problem by influencing Saunders’s development of the first modern hospice in London. This era have brought a change of attitude towards accepting comfort and quality of dying in life.

 1980s-Present: The U. S. witnessed the increasing awareness of palliative care and the development of hospice care services and the incorporation of palliative care in the healthcare facilities. Progress in the management of pain and other symptoms made them core to either palliative or end of life care.

 Legal Perspectives:

 Patient Self-Determination Act (1990): Mandated health care providers to explain for the patients, the patient’s rights when it comes to decisions regarding his or her treatment, including the use of a living will or a power of attorney for health care.

 Death with Dignity Laws: Today, some states such as Oregon, Washington and California have passed laws that let patients having terminal illness to receive help from their doctors for a controlled and dignified death.

 Sociocultural Perspectives:

 Cultural Variability: There are numerous perspectives, people have when it comes to death and dying depending with culture. In some cultures the importance is placed on ceremonies and family engagement while in others the stress is laid on procedures and sustaining life.

 Social Attitudes: More organizations are now acknowledging the importance of palliative and-sensitive care for the patient as they approach end of life. However, there are factors hindering the exercise such as; Stigma, Lack of awareness and Resource constraint.

 Settings for Palliative and End-of-Life Care:Settings for Palliative and End-of-Life Care:

 Palliative Care Settings:

 Hospitals: IPCT offer support to patients with severe illness and focuses on controlling symptoms of the diseases such as pain.

 Outpatient Clinics: Patients that do not require hospitalization are provided with ongoing care by specialized palliative care clinics.

 Home: Community palliative care support is done in the home setting to the clients and their families.

 End-of-Life Care Settings:

 Hospice Care: Specialized for terminal care and can be in the patient’s house or in a hospice house specially designed for it. Concerned with welfare as opposed to specific remedy.

 Hospital-Based Palliative Care: Offers palliative care in the hospital environment to those clients with terminal diseases.

 Principles and Components of Hospice Care:Principles and Components of Hospice Care:

 Holistic Care: Physical comforting, emotional, social and spiritual requirements needed to be met for the patients and their families.

 Pain and Symptom Management: Granting dis­tress from pain and other symptoms.

 Emotional and Spiritual Support: patient and families counselling and support services.

 Bereavement Support: Offering grief counselling and support to the families of the patient once the patient is gone.

 Barriers to Improving Care at the End of Life:Barriers to Improving Care at the End of Life:

 Lack of Access: One disadvantage associated with palliative and hospice care is that this type of services are scarce in some geographic regions.

 Financial Constraints: Expenses on terminal care are also overwhelming especially to the families of the patients.

 Cultural and Personal Beliefs: Masculine ideology of death and dying may impact on the acceptability and utilisation of palliative care services.

 Healthcare System Limitations: Haphazard care organization and even lack of can limit can limit the effective provision of holistic palliative care.

 Personal Experience and Attitudes Toward Death and Dying:Personal Experience and Attitudes Toward Death and Dying:

 People’s perception of death and dying is therefore crucial in influencing their attitudes towards end of life care. Perception on death can also determine the way a person can help the patients together with their families a key factor being the compassion, honour and culture.

 Skills for Communicating with Seriously Ill Patients and Their Families:Skills for Communicating with Seriously Ill Patients and Their Families:

 Active Listening: Meeting the desired needs of giving patients and family a voice.

 Empathy: Offering kindness, care and patience in the interactions with the client/patient.

 Clear Communication: How to talk about the prognosis, treatment plans and the goals of the care also in the case of dealing with the terminal illness?

 Providing Culturally and Spiritually Sensitive Care:Providing Culturally and Spiritually Sensitive Care:

 Cultural Competence: The appreciation of cultural sensitivity and learning the aspects of any culture regarding the issues of death and dying.

 Spiritual Support: Providing of support that they patient is comfortable with be it spiritual or religious support.

 Implementing Nursing Measures to Manage Physiologic Responses:Implementing Nursing Measures to Manage Physiologic Responses:

 Pain Management: Pain management by the use of drugs and other means apart from the use of drugs.

 Symptom Relief: Remedial of other symptoms including nausea, dyspnea, and constipation.

 Supporting Imminently Dying Patients and Their Families:Supporting Imminently Dying Patients and Their Families:

 Comfort Measures: Preserving the patient’s privacy and making the patient relaxed.

 Family Support: Being with families in caring, comforting and facilitating care for dying loved ones.

 Components of Uncomplicated Grief and Mourning:Components of Uncomplicated Grief and Mourning:

 Normal Grief Reactions: The emotional reactions are usually Inability to cry and express emotions such as; sadness, anger, guilt or acceptance.

 Supportive Measures: Counseling and giving directions as to how to deal with the situation after the death of a loved one.

 Through applying of these principles and practices, the healthcare professionals can improve the quality of the palliative and end-of-life care and give the patients and their families the right and proper support in the difficult situation.