A practical guide to palliative care

Palliative care is specialist medical treatment provided to persons suffering from a serious disease. When a person is in acute pain, palliative care focuses on providing relief from stress and symptoms. Palliative care aims to improve quality of life for both the patient and the patient's family. The curative approach includes cure-oriented medicinal treatments designed to treat and remove illness. Palliative care models provide active total care to people with diseases that do not respond to curative treatment. This paradigm is primarily used in adult patients at the end of their lives. Enhanced cultural competency is a cultural practice that is concerned with improving the end of life care in adult patients. Enhanced cultural competency is a cultural practice that is concerned with improving the end of life care and identifies the importance of hospice care practices along with psychiatric practices. Close family relatives who are directly involved in taking care of the patient and home care nurses should be present during a family conference.

Religion is where a person belongs to a community which has shared rituals and values, and it offers mutual support to an individual. Spirituality is where a person lives a life with a sense of connection to something that is bigger and involves searching for the meaning of life. An example of the instructive advance directive is “living will”. Living will instructive advance directive is involved controlling certain future health care decisions when an individual is unable to make choices and decisions by themselves. It does describe the type of medical treatment that an individual receives in given situations (Old & Swagerty, 2007). A person who can be named as a durable power of attorney is a person who is legally authorized to carry out legal matters such as financial matters, and the person should be deemed competent in carrying out the legal matters.

Competency is where one can do a certain task well enough and with proficiency. The person should have the competent skills and proficiency required to achieve a given task. Capacity, on the other hand, is the ability to carry out a given duty. It also involves the possession of the skills that are required to do a given task. Hospice care has a goal of ensuring that every end time in a person counts before he or she dies. Additionally, its goal is to ensure that the person is well attended to and receives the appropriate care at home. Besides, its aims at ensuring that the ill person is well emotionally and spiritually the last months of life. Hospice care directs at ensuring that care and support are given to the critically sick person. Bowlby theorist provides the stages of grief which are shock and numbness, yearning and searching despair and disorganization and recognition and recovery.

Worksheet 2

Characteristic of a person who has weeks to months to dies include having fever, confusion, and sleeping. With confusion, the person has problems in identifying people around him or her. The amount of sleeping also increases with an increased fever. When a person has weeks to days for a living, he or she will depict signs of coolness where the feet, hands, and arms become increasing cool to touch, and the color of the skin also changes. The cognitive changes also deteriorate. A person who is about to die becomes uncommunicative, difficulties in controlling urinary functions and also the urinary decreases (Old & Swagerty, 2007). There are also changes in breathing system characterized with shallow breath and also periods of no breathing. Examples of non-cancerous diagnoses include adenomas which are tumors that start in the epithelial tissue of a gland that covers organs. They grow in liver and thyroid. Fibromas are also a no cancerous tissue that grows in any organ and thus becomes fatal. Hemangiomas involve the buildup of blood vessels in the skin or the terminal organs. Lipomas are also on the cancerous diagnosis that grows from fat cells. Osteochondromas are also non-cancerous which grows on the born.

The early stage of the syndrome of imminent death is described by loose of interest and ability to eat and drink, increased sleeping and cognitive changes. The mid-stage is characterized by more deterioration in the mental status and death rattle as a result of the pooled oral sections which are not cleared as there is a loss of reflex to swallow (Old & Swagerty, 2007). On the other hand, the last stage is characterized by altered respiratory patterns which could be slow or fast and extreme coolness. Atropine is one of the drugs that could be used to treat death rattle. The mechanics of this drug is that it ultimately binds to the receptors with Ach. The drug has 7-helical amino acid structure along with antagonistic and agonistic with receptors. The chE antagonist and M-antagonist work together. Phenomena that are seen in near-death awareness include a feeling of levitation and detachment from the body. Benzodiazepine is an effective drug choice in the management of terminal delirium. Normal grieving is emotional, and it is characterized by the inability to concentrate and retain information along with the lack of interest or motivation. On the other hand, complicated grieving is marked by bitterness for the loss and felling that life is meaningless and that has no purpose.

Worksheet 3

Through learning this course, I am able to understand the role of Palliative care in end of life for adult patients. I was able to know that the goal of palliative care is to relieve the suffering of a patient and family through having a comprehensive assessment of the psychosocial, physical and spiritual symptoms factors. In approaching death, the symptoms that a person indicates require a more aggressive attention. Support has to be given to the dying patients, and palliative care should focus on the bereavement of the family after the person dies. The course provided the curative and palliative models which are significant in palliative care. More importantly, the goals of hospice care as provided by the course are fundamental in caring for the critically ill patients. Furthermore, I was able to know and understand the characteristic of a person who is about to die along with characteristics of the syndrome of imminent death. The course is critical for me to enhance my career practice particularly in the area of palliative care. It will enable me to effectively handle a dying person and accord the person the required attention. In the management of the end of life practice, I will develop the require competency skills that will enable me to adequately deliver my duties in the palliative care such as management of death rattle and terminal delirium. The book A Practical Guide to palliative care by Old and Swagerty has comprehensively explained the factors relating to palliative care. Indeed, the book provides an in-depth analysis of palliative care practices and informs on the factors that are involved in end to life for the adults. The course should incorporate the palliative care practice into sponsored clinical trials to make the student to be familiar with the end of life practices. This will make the student acquire the required skills and enhance the competency level. Besides, the course should make provisions for clinical and research training practices in the surgical oncology and medical care for both pediatric and adult patients.


Old, J. L., & Swagerty, D. (Eds.). (2007). A practical guide to palliative care. Lippincott Williams & Wilkins.

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