Introduction
Nursing is a profession explicitly associated with the care of the sick with the care of the sick either either in health institutions or sometimes the residents of the patients. In accomplishing most of their duties, nurses and other medical practitioners engage in helping the patient through a multiplicity of foci. This is because, patient care is not necessarily limited to the physical treatment of the patient but goes further to include the emotional and psychological aspects of man. Most ailments are exhibited with some forms of pain, a situation that is basically averted with the help and dedication of the medical practitioners. Palliative care encompasses the process of providing overall care for patients mainly in instances where an illness is presented with some kind of pain. This subject basically forms the basis of this discussion. The argument, as presented below is initiated by the provision of an over view of what palliative procedure mainly entails. This is achieved with respect to both acute and chronic pains and the roles that nurses play in managing chronic pain in patients. The paper goes further to outline the different approaches applied in conducting this procedure besides the challenges that have presented themselves in the field. In conclusion, the paper outlines a summary of what has been presented in the entire discussion
Palliative Care
Palliative Care refer to the section of healthcare service which is characterized by the provision of focused treatment mainly aimed at alleviating pain in victims besides saving them from any form of suffering. It involves the provision of drugs, therapy, and medicating to patients suffering from various conditions in a bid to alleviate the pain that accompanies the disease which affect them. The procedure, which is used by almost all healthcare institutions in the world, is applied to patients at any stage of their illness. This is clearly in contrast to the hospice method where care is mainly concentrated on the dying (Lynn 72).
Palliative care involves the participation of all kinds of medical practitioners ranging from physicians to social workers an aspect which ensures that all the aspects of a patients well being are taken care of. Despite the fact that this treatment is appropriate in relieving pain from illnesses regardless of the stage, the procedure is more rampant in cases where the disease had reached a complex phase and the patient has little or no hope of recovering from the complications (Wall 9).
The function of the procedure is in such a way that a medication is given to the patient and without necessarily treating the underlying ailment; it lessens the resultant pain and thus enhances the comfort of the patient. Such treatments include the use of morphine to reduce ache in a certain body part and the elimination of nausea resulting from chemotherapy just to mention a few (Casarett, Knebel & Helmers 4). Some of the ailments associated with this treatment include HIV/AIDS and cancer.
In essence, the goals of palliative care are diverse and generally aim at, improving the quality of life of the patient, eliminating or reducing the pain, restoring life, supporting patient’s family, enhancing both spiritual and psychological well being of the patient and helping individuals and their families accept death among other goals (Bruera, Kuehn, Miller, Selmser & Macmillan 7). According to, sue Lucas (pp 2) the treatment can be administered individuals of all ages, children and the elderly alike, provided that great care is taken on sensitive issues that come with age.
Nurse’s Role in the Management of Chronic Pain
Pain management for patient especially in palliative care involves the input of a wide range of professionals chief of which include nurses. Nurses are basically involved in the day to day care of the patients under palliative care and are in a special way present from the moment the patient commences treatment to the end. Nurses are essentially involved in providing a starting point for the treatment of patients suffering from chronic pain. They generally instigate treatment by examining the patients in knowing the kind of ailment they suffer from, the kinds of pain such conditions are associated with and the intensity of pain the individual is having (Dewar, 35). Nursing intervention is clearly imperative when it comes to deciding on the methods of treatment suitable for particular patients. Due to the disparities in the nature of patients say their ages; it is usually the burden of the nurses to determine which kinds of treatment method an individual can be offered.
Due to their vast knowledge in the field of medicine besides knowing the problems the problems that exists in the field of palliative care. Professional nurses are known of their involvement on various researches in the field of palliative care. In a bid to fill the gap that exists in this area of medicine, they have carried out massive investigates with more focus on how to better manage the conditions in patients.
Nurses in collaboration with special pain experts are highly involved in the actual pain management process in palliative care. Nurses under the care of psychologists, pharmacists, acupuncturists, surgeons and other medical practitioners provide direct care to patients or example by providing medication to the patients, injecting them with medicine and advising them on the right dosage when it comes to prescribed medicine.
The nurse is also responsible for monitoring the progress of treatment and effectiveness of medications prescribed by other specialists. In the event that the doctor’s treatments don’t work on the patients, the nurses have the role of advocating for better alternatives for the patients.
Pain Management Methods in Palliative Care
Algiatry or pain management as it is commonly known entails a variety of practices principally associated with palliative care. In medicine, this mission is so crucial to the management and elevation of pain for a number of patients and without it some patients would have to endure unnecessary pains and even pass on in pain. The procedure uses varied methods in achieving the same end depending on the conditioned the patient and the preference of the physician. Taking into consideration the fact that multiple aspects of patients’ health are dealt with in this process, the participation several doctors in helping one patient does not come as a surprise. . Medical practitioners such as occupational therapists and psychotherapist are just s few of the individuals that can be seen to be involved in one specific case. Methods used in achieving this are diverse and are generally categorized under the use of medication, procedures and physical methods (Strang et al 27).
Physical Techniques
The physical techniques in providing palliative care for patients include; Hypnosis and cognitive behavior treatment among others approaches.
According to Wall, hypnotherapy relates to the method of palliative care, characterized by the inducement of some conditioned mental state by a doctor into the patient. This is done with the view of dealing with some health issues pain included. In achieving this process, a physician engages the patient is a series of lengthy instructions and instills ideas into the patient’s mind, a process which results into an imaginative state on the part of the patient. In Hypnotherapy ideas are induced into a patient in the presence of certain conditions or environment relating to pain or relief. After a successful therapy, the doctor is psychologically able to relieve pain from the patient simply by introducing or removing the object of focus during the therapy session (Strang et al 27).
Cognitive behavioral treatment on the other hand focuses on the reduction of depression and the provocation of relaxation within the patient. This mindfulness based treatment has proved effective in managing pain in patients and involves the view of persistent pain as a product of operant conditioning and the respondent. In using this approach, The doctor helps the patient through a learning process where the patient is conditioned to feel pain under some conditions and comfort in others. In avoiding pain, the patient is put in environments with the favorable conditions besides ensuring that environments associated with the pain in question are avoided
Medications
Medical practitioners in managing pain use various medications for the patients. Here patients mainly take drugs as prescribed by the doctor. The administration of this treatment mainly varies with the kind of condition causing g the pain besides the intensity of pain that an individual suffers from. For instance a combination of medicine called pain ladder has been recommended for use in the introduction of analgesia in pain management (Shelemay & Coakley 17). Non-steroidal anti-inflammatory drugs and narcotics respectively manage mild and severe pains. Some of the common medications used for managing pain for patients’ in health institutions include; antidepressants, Non steroidal anti inflammatory drugs, Opioid and antiepileptic drugs.
Non steroidal anti-inflammatory drugs are mainly used for the inducement of analgesia and provide remedies in a wide range of pains. Taken alone or together with other medications, the drugs have been proven to relieve chronic pains in patients. Some of these drugs are considered less effective besides producing side effects that are known to be fatal to the victims.
Antiepileptic drugs and antidepressants are in essence used for managing pains associated with stress and epileptic attacks. By acting through the patients’ nervous pathways, the drugs have been known to relieve a lot of chronic pains associated with the named conditions. They too have been known to have considerable side effects
With respect to Opioid, the drugs are mainly used for the inducement of different versions of analgesia in controlling pain. Depending on the severity of the condition, the medication can be provided on a long term, short term or intermediate basis (Ernst & Singh 350). Oral medication or injection methods are used to administer these drugs. Orally, the patients are given the medication through the nasal mucosa and the oral mucosa while the injections are administered using the intravenous methods, the rectal, method, and the intrathecal method among others (Shelemay & Coakley 17)
Procedural Methods
The procedural approach to pain management includes the use of pulse radiofrequency and entails an express introduction drugs into a patients system. The specific organ associated with pain may be directly injected in a bid to introduce the medication directly into the tissues this method is used for the management of chronic pain and involves procedures like nerve ablation. In some cases, special types of pumps are used in introducing the remedies into the spinal fluid
Challenges Associated with Palliative Care
Administering and maintaining palliative care for suffering patients is a procedure, which far from being necessary in enhancing comfort among patients, is quite sensitive and has thus not had a smooth sail since its introduction in the field of medicine. The different categories of medical practitioner and other experts input many efforts in ensuring that their patients get the best possible treatments. However, there exist a whole lot of challenges that deter proper patient care among the multi-disciplinary palliative teams in managing the pains within their areas of work. Some of these challenges include but does not limit to the following.
The re is lack of adequate staff in the palliative sector within hospitals. The rising cases of pain related complications coupled with the ever diminishing number of medical practitioners all through the globe has not in any way helped alleviate the challenges that medical care programs, palliative care included, face. In the United States, doctors who train under this program are hardly enough and thus cannot adequately meet the needs of the patients. The limited number of training programs associated with palliative care is grossly responsible for this; a situation which if not handled would in the future paralyze the system to unprecedented levels (Boughton 1). The fact that the patients need to be attended to by a wide array of experts also possess a lot of challenges with the view that a patient may not be able t o access all the experts as required. This may limit the effectiveness of the treatment and render other specialists input in vain.
Issues to do with end life moments are very sensitive and doctors, however specialized they are still face challenges in coming to term with them. The aspect of informing a patient of the fact that is life I coming to an end usually pose a grave challenge to the experts. In some cases, patients come with conflicting requirements in the form of death wish. Some of these demands conflict with the requirements of the medical world principles and rules. This kind of situation may pose the multi disciplinary team into a situation of dilemma. Putting them at cross road over whether to fulfill the patients’ wish or follow the rules of the medicine worlds to the later.
The fact that the team comes from difrent fields of operation in sometimes create confusion in the process of the teams dealing with the patients. Although a pharmacists and a nurse may have the same view in the treatment of the patient, the presence of different types experts say the religion leaders whose principles may differ from those of the patient may deteriorate the teams’ effort in managing the patients’ predicament.
The costly nature of the treatment coupled with the low-income levels of the families is a challenge mainly common within the third world countries. Patients who come in for treatment of diseases like cancer some time fail to receive this kind of care due to lack of funds on their part. Despite a team’s wish to handle the patients’ conditions, the lack of money and facilities on the part of both the patient and the hospital may deny the patient this crucial aspect of their treatment.
Conclusion
20th century saw an increased attention in the view of improving the value of life for all individuals in the society. The application of focused treatment just forms the tip of the iceberg in the myriad of ventures used in providing superior and quality life for all. Palliative care as discussed in this paper is a subject that requires a lot of attention due to the increasing cases of pain related complications among individuals. It is however unfortunate that uncountable challenge, some without direct solutions, presents themselves for the palliative care teams in charge for the patients
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