Question

1. Describe how you communicate with the family or carer of a client in palliative care about the client's quality of life ?

2. Describe how you communicated with the family or carer of a client in palliative care about the clients pain and comfort?

3. Describe how you communicate with a client in palliative care about their quality of life?

4. Describe how you communicate with the family ir carer of a client in palliative care about the clients pain and comfort

Answer 1

1. Maintanence of quality of life in palliative care is important and lack of guidance in the caregiving can cause problems. When a person is receiving palliative care there must be a coordinated team effort
between healthcare professionals, palliative care workers, the person, family members
and carers. In many instances, the palliative care worker spends as much time with
the carer as they do with the person.

The nurse should make sure that the caregiver or family should help the patient with ADLS ( activities of daily livings ) , Assistance with bathing does not capture bathing a person who is resisting a bath.Helping with medications does not adequately capture the hassles of medication administration, especially when the care recipient is receiving multiple medications several times a day, including injections, inhalers, eye drops, and crushed tablets.

Caregivers should refer family before taking any important decisions and often we see nurses and family do not agree to one point due to ones ( nurse ) understanding of technical knowledge of patient and ones understanding of personal knowledge of patient , but they should work together for the betterment of the patient . Nurses should help the family or caregiver with the patient condition and what are the possible complication to make them more prepeard and ready . The nurse should ask the family or caregiver to be paitient while attending the patient as human nature caregiver or family can feel exhausted or irritated at a point of time .

Caregiver should make a reocord of the daily routine and follow accordingly and it is not to be hampered .

Caregiver should look after their health and wellbeing parallel to the patients health.

A key responsibility for a palliative care worker is to build a good working relationship
with a person accessing the service’s unit of care, so information is willingly shared
when the person’s needs, preferences or condition changes.Supporting a person’s spiritual needs .

2. 4. Respect feelings
It is important to remember that as well as providing support to the person who
is facing death, the needs and feelings of family members and carers are crucial.
These people play an important part in the overall care of the person and also need
support – especially if this is their first experience of a palliative approach or of an
impending death. Family members and carers anticipating the loss of a significant
relationship often describe this period as like being on an emotional rollercoaster.
Many and varied emotions may be experienced. The anticipated loss of a loved one
may lead to feelings of guilt, anger, frustration, distress or family conflict. Do not
assume that a person’s family is always supportive. There may be conflicts within the
family; for example, regarding care.
Identify needs
People in a palliative environment have a range of emotional needs including the
need to:
X grieve
X hope
X express their feelings freely
X maintain their self-esteem and dignity
X come to terms with fear, uncertainty and impending loss.
Listen to feelings
An important part of a palliative care worker’s job is to listen.
Always let the person finish what they are saying before you respond. Never try to
change the subject, make a joke or respond with comments such as ‘It’s all for the
best’ or ‘At least they won’t suffer for long’. It is important to come to terms with your
own beliefs and attitudes regarding death and dying so you are able to provide calm
and rational support.

Effective communication with people accessing the service and other members of
the palliative care team is essential. The team should conduct regular meetings to
ensure everyone is aware of the person’s current situation and the care provided.

Recognise the type of pain a person may experience
X Information relating to person’s pain is detailed in the care plan and through the
instructions you receive from your supervisor. It is important for you to understand the
meanings of any medical words used in the care plan or by the supervisor.
X This will assist you to be prepared for the pain you may observe.
Monitor and identify the symptoms a person is experiencing
X Sometimes it is easy to make your own observations regarding a person’s pain;
for example, you may see the person holding a part of their body tightly, groaning
or constantly changing position in an effort to become comfortable. A person may
experience pain only at the end of the day or after they have taken medication.
X Always record these observations, especially as person may not always tell you if they
are in pain.
Ask the person to describe the pain
X Ask the person to describe the pain. To better understand the pain a person is
experiencing, ask them to describe the type of pain they are having, how bad it is, when
it starts, how long it lasts and where it is located. For example, ask the following:
− Where is the pain located?
− Does it spread from one area to another or is it in the one place?
− How does the pain feel; for example, is it throbbing, piercing, sharp, dull?
− Is the pain ongoing or does it stop and start?
− Does the pain occur when you are lying down or sitting up?
− Does the pain get worse when you are walking?
X If the person has difficulty communicating, use pictures or a scale where one indicates
slight pain and 10 indicates severe pain. You can use a line with numbers or words
attached, where the person moves a slide to the number or area matching the severity
of their pain. You may require the services of an interpreter.
X Some workplaces have brochures you can give to people, written in a variety of
languages, which describe the pain and what may be done to manage it. Be familiar
with the types of resources available to you.
Listen to what the person says about their pain
X Always listen carefully to how a person describes their pain. They may use words such
as intolerable, unbearable or annoying. Some people may deny they are in pain and
use words such as discomfort or uncomfortable. You must follow up immediately if a
person says they are in pain, by notifying your supervisor or another member of the
care team.
Identify any changes in a person’s pain
X Constantly monitor the person’s behaviour and what they tell you, so you can
determine if there are any changes in the type, location and severity of pain they are
experiencing.
X Ensure you document any changes and inform others as soon as there is a change.

Pain management
A person’s pain management may involve:
X non-opioids, such as paracetamol or aspirin, which are delivered orally (by
mouth), unless this causes ongoing nausea and vomiting or the person has
difficulty swallowing
X opioids, such as Panadeine Forte, orally for moderate high-level pain
X opioids, such as codeine or morphine, orally for high-level pain
X regular analgesic medication (for example, every four hours) to prevent pain
returning
X drugs, such as anti-depressants, to help the client remain calm or steroids to
reduce any swelling.

X Carers/support workers may apply hot and cold packs and/or aromatherapy
(the carer’s role in administering alternative therapies will vary depending on the
training requirements of the therapy).
X A physiotherapist may assess and treat musculoskeletal disorders; however,
clients may be assisted with ongoing exercises by carers/support workers.
X Carers/support workers may use music therapy; that is, play the client’s favourite
music as a means to calm them.
X Carers/support workers may give clients a daily hand massage with essential
oils.
X A diversional therapist may run a daily meditation session for clients.

Care plan of a patient with

Diagnosis:
Early stage dementia, significant hearing loss, reduced blood supply to the heart
caused by coronary artery disease, prone to deep-vein thrombosis (DVT) in
legs, uses a four-wheeled walking frame following surgery for fractured hip. Has
developed a pressure area post-surgery, with necrotic tissue, on right leg. The foot
is also heavily infected .

People should not receive pain relief until cause is determined
Appropriate response
X One of the aims of a palliative approach is to provide relief and comfort to the
person when a cure is no longer possible. It is an important responsibility for the
whole palliative care team to understand and implement strategies to promote
comfort as a response to pain after an assessment of the person has been
conducted.
Person to refer to for clarification
X Nurse, palliative care team leader or supervisor
The person may become addicted to pain-relief medication
Appropriate response
X Drug addiction is often associated with people misusing drugs. However,
addiction is not an issue when opioids are used correctly to relieve pain. I will
organise for the doctor to come to see you later today to discuss any concerns
you may have.
Person to refer to for clarification
X Doctor
Strong analgesics may shorten a person’s life
Appropriate response
X I’ll explain your concerns about the safety and effectiveness of strong analgesics
to your doctor and get back to you.
Person to refer to for clarification
X Doctor
Pain management alone is not palliative care
Appropriate response
X Yes, pain management alone is not palliative care. Palliative care enhances the
person’s quality of life by treating pain and physical, psychological, social and
spiritual problems in a holistic manner.
Person to refer to for clarification
X Nurse, palliative care team leader or supervisor
The person is too drowsy to communicate with family members
Appropriate response
X Yes, some pain-relief medication may cause the person to feel very tired and
they may not be able to communicate with you. They may even fall asleep.
Person to refer to for clarification
X Nurse, palliative care team leader or supervisor

These are to be followed by the caregiver and refer according for betterment of the patient .

Nurse should communicate everything with the caregiver and the family .

3. The importance of awareness of the patient about his or her health care by the caregiver or family is equally necessary . The patient should be knowing the necessary rights of the patient so that it cannot be misused by caregiver or family .

Based on the WHO definition, the primary objective of palliative care (PC) is to improve the quality of life (QoL) of the patients facing life threatening illness by means of a multidisciplinary approach. The assessment of QoL in patients under PC is an important process for the identification of patient’s overall conditions including psycho-social, spiritual issues as well as the evaluation of the services provided to the patient.The primary goal of palliative care is the achievement of the best possible quality of life for the patients and their families and role extends to support on bereavement, if necessary. The term ‘care’ underpinned by the concept of total pain, defined as including not only physical symptoms but also mental distress and social or spiritual problems .

the patient must be aware of primary aim of palliative medicine is to prevent, treat the symptoms of patients with non-curable diseases as total care and to improve the quality of life (QoL) of the patient and their families.

The evaluation of QoL of patients should be known by patient in Palliative Care is an important procedure in the identification of a patient’s overall condition as well as in the evaluation of the quality of service provided [6]. In patient’s perspective, the following aspects such as physical abilities, personal autonomy, emotional state, socializing, spirituality, cognition, health care provision and preparation for death are important factors of quality of life in people with a life-limiting illness receiving palliative care and to be considered during the assessment of quality of life in these patient cohort.