Question

1. What should you do if a person changes their end-of-life requests? Create a step-by-step outline of what you should do that could be used to train other care workers.

2. When a person who is accessing services informs you that they wish to die at home, what action should you take?

3. What are three things that you should document when a person is reporting that they have pain?

4. Research one of the pain management/comfort promotion techniques mentioned in this section to learn more about it. How might this help people in palliative care? How can it be applied and is a specialist practitioner/health professional required? Where can you learn more and/or find a qualified practitioner?

5. Explain three observations that you would make to see if the pain relief is effective or not effective.

Answer 1

End-of-life-requests

This is term which comes under the end of life care in case of Terminal illness.Terminal illnesses are which doesnot have a complete cure only symptomatic treatments.

End of life requests should be carried out by discussing with the consulting doctor and also with the family members.

According to the nature of the request ,a consent may be required from the family members and the patient.

The Requests can be

• A spiritual
• A will
• Acceptance of treatment
• Treatment methods, etc

The Action taken for the person who wish to die at home

If there is written DNR (Do not Resuscitate)order from the consultant that should be mentioned in the file of the patient.Also get a consent from the family members that they want to take back to home.But the Indian rules don't allow a person to keep in DNR.It says every treatment and resuscitation should be given till his/her death confirmed.

Things that should be document if a person have pain

• Nature of Pain/Intensity (Pain Scale)
• Location of Pain
• Duration of Pain

These things will help to determine what treatment is required immediately.

Pain management/comfort promotion technique and help people in palliative care.

Pain management/comfort postions are one of the palliative care managements.ie. the treatment we are giving at the end stage of life.These techniques are used to reduce their symptoms and to give more comfort.

Oncology/cancer patients we can take as an example that these will have untolerable pain.So inorder to promote comfort , we can intiate pain management medicines and other diverting therapies. For pain administering opiod drugs and also psychological supports.These facilities are available as palliative care centres for rehabilitation of the patients.

Three observations that you would make to see if the pain relief is effective

• By using pain scale scoring 1 to 10
• Vital signs recording.eg the heart rate will be high when severe pain.
• Doing daily activities by their own.