www.chitraltimes.com

End of Life Care

By : Shaheen Abdul Muhammad

Palliation is a word unknown in Pakistan medical community, although most of the third world countries suffer from the same problem, but quite a few of them are trying to improve the life of very sick. I began my Nursing career in Pakistan, a developing country of South Asia. As a nursing student in a baccalaureate program in Pakistan, I was distressed by the problem of unavailability of proper nursing care for the patient at the end of life. This is despite the fact that over 80% of patients in Pakistan are diagnosed with cancer and other chronic diseases, palliation and pain relief remains the only practical option of cancer management. Apparently there is no institute or organization in Pakistan which is offering palliative care in an organized manner. Dr. Ashraf, (2006), stated, “The burden of palliative care in this country is huge because of advanced disease at presentation and low cure rate. There are no specialist palliative care physician and nurses nor there any government support for this.” Nurse researchers continue to facilitate change and make efforts to strengthen and improve end of life care .To improve end of life care, efforts have been focused on practicing nurses as well as elements that would support curricular change and strengthen nursing education for undergraduate students.

The World Health Organization (WHO) defines palliative care as: “the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and psychological, social, and spiritual problems, is paramount. The palliative care is achievement of the best quality of life for patients and their families…” (p11)

The need for improve nursing care for disease such as cancer, cardiovascular disease, and other chronic illness continuous to be associated with needless suffering. Pain and other symptoms are under managed. Many reports of different institute state that nurses are expected to have sufficient knowledge to care for patients during all life stages including dying. Researchers at The International Network of Cancer Treatment (INCT) (2006) developed a survey of end of life care, including the effectiveness of education regarding end of life care. The researchers concluded “nurses are distressed by unrelieved pain or other symptoms and their continued involvement in inadequate care of the dying strongly influences professional belief,” by way of no doubt, palliative care education is necessary and valuable to nurses for and, therefore, nursing students. In order to prepare nurses for practice, the integration of palliative care into nursing education curriculums is essential. Nurses play a critical role in the success of this initiative because those involved in the process of dying have a variety of physical, spiritual, emotional and social needs. The Association of Physicians of Pakistani Descent of North America (APPNA) Sukoon project will also advocate the introduction of hospice and palliative care in the medical college and nursing curriculum of Pakistan, thus filling the void of basic care in this domain. The News 12/19/2007 Islamabad, one of the doctor in press conference stated.

The idea is to raise public, medical establishment and governmental awareness of the vital importance of quality care not merely in life, but specifically for a comfortable and pain-free death, Taking care of the dying requires a special attitude on part of the care-givers, particularly the nurse.

In an effort to strengthen end of life nursing education across the nation developed open proposal to correct deficiencies in nursing education. At present many organizations nationally and internationally develop a core of expert nurse educators and to coordinate national education efforts in the end of care life. These curriculums contain different modules addressing critical aspects of the end of life care. Many foundations are conducting the training of nurse educator, which is an exemplary effort of nurses leading the revolution in improving end of life care. The INCTR emphasizes international collaboration and works to improve communication among the wide range of professionals and volunteers working to control cancer throughout the world...

Other efforts to facilitate the integration of palliative care into nursing curriculums are evolving. The aim of the Palliative access progamme in different settings is to improve the delivery of good quality palliative care in resource poor area. There are expert consulting advisory services of national and regional governments through clinical guidelines, workshops, and other means. These clinical guidelines for the symptoms of cancer are developed with listed purpose. To establish a standard of practice that leads to sound clinical judgment in managing acute and chronic symptoms and reassure nurses that by following these guidelines, they will be supported and not disciplined by the board for appropriate symptoms management.

Another effort to improve end of life care in nursing curriculums has been research and implementation of changes surrounding end of life content in nursing textbooks. In 1999 researchers identified incorrect and insufficient information on end of life care within the textbooks. A recent review by the authors of nursing in textbooks currently available on line revealed that several new books specific to end of life care have been published (in 2000 and 2001), and that few recently revised medical surgical nursing textbooks include end of life care in their table of contents. This indicates the recognition and efforts of nurse authors and publishers in response to needed improvement within nursing education.

Nurses provide end of life care to patients and their families than any other health care professional; therefore, quality end of life care depends on the availability of well prepared nursing professionals. Research has shown that practicing registered nurses do not feel they have received the education needed to provide quality care at the end of life. Effort are being made nationally by many nursing organizations and nursing professionals to establish standard curriculum and remove barriers to both practice and education that may inhibit nurses from practicing quality end of life care. Nursing education must be accountable and initiate curricular changes to assure students have knowledge and attitude needed to care of dying persons. The integration of palliative care and concepts into nursing education will improve the quality of care for dying patients and their families.