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Acute respiratory failure 2 - nursing management. 16 September 2008
An audit of nursing observations on ward patients. 24 July 2008
Guidelines focus on improving patient safety in mental health. 28 November 2008
National Patient Safety Agency issue an alert on mental health resus. 2 December 2008
Should patients who are at the end of life be offered resuscitation? 23 January 2009
APPENDIX IV
The Principles of Palliative Care
Palliative care is governed by certain principles, which guide the care given. It:
Provides relief from pain and other distressing symptoms
Affirms life and regards death as a normal process
Intends neither to hasten or postpone death
Integrates the psychological and spiritual aspects of patient care
Offers a support system to help the family cope during the patient’s illness and in bereavement
Uses a team approach to address the needs of patients and their families, including counselling, if indicated
Will enhance quality of life and may positively influence the course of the illness
Is applicable early in the course of the illness, in conjunction with other therapies that may prolong life, such as chemotherapy or radiation therapy, and includes investigations needed to better understand and manage distressing clinical complications. (World Health Organization, 2004)
Other principles of palliative care promote:
Quality of life: palliative care tries to enhance this as much as is realistically possible
Patient choices: patient autonomy is respected and encouraged as much as possible
Open communication
Looking after the whole person which includes physical, emotional, psychological, spiritual and intellectual issues
Looking after the whole family because the patient is not an isolated unit but part of a whole social unit. Their disease, and its effects may have catastrophic influences on this social unit and its dynamics.
Involving support from the whole multi-disciplinary team (MDT): this includes professionals in the hospital and community such doctors, nurses, palliative care specialists, hospice services, dieticians, physiotherapists, occupational therapists, and chaplaincy. (Regnard and Kindlen, 2002)
Adapted from Palliative Care Resuscitation by Madeline Bass, published in 2006 by John Wiley and Sons: pp. 8, 13-14 and 113-115.
The subject of whether to use artificial hydration and nutrition in terminally ill patients, which could be included under the cloak of ‘active treatment’, has brought about different points of views. Rousseau (2000) states that many doctors and nurses feel food and fluid is always a basic need for human existence. However, although this is true, tube-feeding terminally ill patients (either via nasogastric, nasojejunostomy, gastrostomy or via parenteral routes, such as total parenteral nutrition - TPN) has not been found to enhance or prolong life. Remember, tube-feeding in no way resembles normal eating since it is a passive process that totally bypasses the sensory part gained from oral feeding: there is no smell, taste or texture of feeling food in the mouth. Tube-feeding can also have serious complications such as aspiration, nasal cartilage erosion, and tube displacement, which may require an uncomfortable, perhaps even painful, replacement.