Continuous Quality Improvement and Patient Satisfaction in Palliative Care

The assignment explores the therapeutic relationship between nurses and patients, particularly in palliative care settings. The proposal highlights the importance of building trust, empathy, and genuineness through active listening and patient-centered communication. It also emphasizes the role of hospitals in supporting nurse well-being and providing training for end-of-life care. The proposal suggests that a cost-efficient approach to in-house training can improve patient outcomes and reduce healthcare costs.

Continuous Quality Improvement and Patient Satisfaction 1
Continuous Quality Improvement and Patient Satisfaction
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Continuous Quality Improvement and Patient Satisfaction 2
Continuous Quality Improvement and Patient Satisfaction
Purpose of the programme-In healthcare, continuous quality improvement is required.
Better quality will give better patient satisfaction and speedy recovery of the patient. Quality
improvement projects and studies are aimed at making positive changes in the health care
processes. (van Spreuwel et al 2015)
In quality improvement projects it is important to establish three main aspects 1 ) What is the
goal of the project? 2) how will we come to know that the goal has been reached 3) What is
to be done to reach the goal.
Target Population- Here we will discuss providing better end life palliative care to the
terminally ill patients. There are many approaches which we required to follow to achieve our
goal of better end life palliative care.
Nursing Theories For Better Approach
Humanistic Nursing Theory – This includes application to hospice and palliative care.
Physically palliative approach is followed to manage pain and physical discomfort in most of
the situations. Pain being the most important complaint in the palliative approach to
treatment. As the discomfort increases the need for palliative approach increases. It becomes
very important where treatment is painful .Old age people become prone to life-threatening
disease or their suffering increases due to the natural ageing process. In many countries,
palliative services are provided at home only.( Wu, H. L., & Volker, D. L. (2012). Mostly
people by the end stage of their life prefer to spend their time at home. The palliative
approach helps patient’s family to cope with the terminal illness of the patient. Palliative care
leads to hospice care which includes focusing on comfort and quality of life. A personalised
action plan is required for every patient for comfort and care. In this, it has been found that

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the survival expectancy is increased by 6 months. In this, the main focus is on pain control
which troubles the patient most. Pain control is done by analgesics and comfort measures
which can be achieved at home. (Brysiewicz, P., & Campbell, L. (2016).
It is important to develop an integrated care pathway for the dying patient. This is for the
patients whose diagnosis is known and loss of life is inevitable. In this symptoms are closely
monitored and palliative approach is followed accordingly. In few cases, older people denied
access to palliative care. In these cases, their admission in hospital and nursing home
becomes very important. Specialised palliative care is required in many patients.
Proper symptom control is impossible in older adults without proper communication. An
accurate assessment of patient’s health requires effective communication. Communication is
the centre of all treatment. Communication will deliver a great amount of palliative care to
the older adults. In the society conversation about death is often very awkward and difficult.
Among the health care professionals, there is a requirement of improvement of techniques to
overcome these obstacles. In last two decades, there is awareness of the importance of
communication skills. The palliative practice involves communication between nurses with
officials , patients and also their relatives. By effective communication, a comfort level with
the patient is developed by which patient conveys his pain, fear , shares anxiety. Listening is
a very important mode of communication. It requires nursing skills and attention. By this
nurses can access the situation and problems of the patient. By being a good listener nurses
can provide care at all levels of recovery.( Guimarães, et al 2016).
.

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The nurse should be an experience and expert in communication and palliative approach of
treatment so that she can deal with the situation. The nurse and patient need to understand the
goals of care. At times in older adults, the decision-making ability is hampered. In this case,
the nurse has to keep a clear communication. She needs to keep patient’s relative about
patient’s condition. For the patient’s family circumstances change on a day to day basis
depending on the patient’s health. Like in the case of older adult the family may need to
discuss something which is very difficult and emotive. Open and sensitive communication
works in the best way. It also depends on an appropriate situation. This applies to nurse,
patient and family members. Communication in nursing practice comes naturally. It's not
simple, it is always difficult to communicate with some terminally ill. It required education
and experience.
In palliative care, a nurse should be able to carry out tough conversations with the patients
family. These conversations include patient’s current health , the progression of a disease and
anticipated death. The information provided should be honest and it should be provided in a
way that the family members should be able to understand the situation. Palliative care nurses
need to be knowledgeable and they should carry enough experience in nursing to deliver
sensitive information in a proper manner
The qualities of this relationship consist of active listening . In this, the nurse has to listen
patiently what the patient is saying. It is important that the patient trusts the nurse , only then
effective communication will happen. The nurse has to respond to the patient in the same
manner addressing the concerns. The patient and nurse should have genuineness and empathy
towards each other.

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Along with listening , speaking with the patient also becomes important .Conversations
should be held in appropriate condition. Each patient has its own way to discuss the problem.
After the nurse has listened to all the problems she can talk to the patient.
As the medicines have already played their role. It is a stage where a patient wants to say
want he actually feels and at the time someone who has knowledge and presence of mind is
required. The communication area has been surprisingly ignored but since two decades there
has been significant focus on it.
Watson’s theory -According to Watson’s theory nursing is all about promoting health ,
preventing illness , caring for sick and restoration of health. Caring is a very integral part of
nursing. It is important to engage yourself in genuine care by learning through various
experiences with the patients. This will come with years of practice and dedication. Caring is
an art which has to be studied but more than this it is an attitude in life which nurses should
flow for the patients and also the people around them. It is a there duty to create a healing
environment. Researchers have proved that if a patient is given adequate care and timely
medication it can even have miraculous results. For terminally ill patients care is the most
important thing they required. This may add few more months or years in their lives. Caring
is the most important aspect of the nursing profession.As we know that in old age many
patients suffer from lack of care. A proper caring institution can give relief to old age patient
in many aspects Caring is the term always associated with nursing. The nurse's behaviour
should be holistic and the actions should aim at creating and maintaining an environment
which will support healing. To support the nursing profession the nurses need to engage
themselves in a broad range of activities when enacting professional roles. There should be a
deeper understanding of the term care.( Riegel, B., Jaarsma, T., & Strömberg, A. (2012).
There are multiple levels of care. Caring comes with professional experience. It may have a

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different meaning for different nurses. The concept of care depends on different factors. It
depends on the amount of professional experience, the level of nursing education,
professional values and how and where the nursing skills and concepts are being applied. The
caring concept is central to the nursing practice. It requires a great amount of discipline and
dedication to follow. There should be intentional and conscious caring. This will bring out
the best of the nursing practices from you. Being a nurse means you have to be fully present
in that moment and take proper care of the patient. It is all about having a trusting, helping
and caring relationship with the patient. This should not be limited to the patient but also
should be extended towards the other staff and most important the caregivers of the patient.
This gives a positive feeling in the patient and the caregivers.( Sitzman, K., & Watson, J.
(2013)
Nursing has a very strong impact on our society .Nurses can use their research knowledge
and skills to answer questions related to nursing diagnosis also they can prepare care plans
for patients. It includes learning about drugs and diseases. Obtaining information from the
patient which is a very crucial practice for nurses which will help them in their further
research. Through patient interaction, they can investigate new topics pertaining to their
interest. All this will promote the professional development. There are certain laws related to
nursing. Over 100 years ago these laws were made to ensure the safe nursing practice.
Therapeutic Approach in Nursing- A large amount of literature exists in nurse and client
therapeutic relationship. This relation is also called helping relationship . In this, the patient
depends on the nurse for all the help and care required. Hence therapeutic has been
considered as the fundamental of nursing. A patient who gives better outcome when the
relationship is based on therapeutics. Patient and people around them need to feel and
understand the need of therapeutic relationship. The therapeutic relation has been challenged

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as there is a shift in evidence-based practice and focus on measurable outcomes. The
therapeutic relation is rarely discussed. (Hamric, A. B. Et al 2013). The therapeutic relation
has many qualities such as respect, empathy . The literature has focussed on the key elements
of the therapeutic relationship. Like the quality of the relationship , the sequencing process ,
the impending process and lastly the outcome. The qualities of this relationship consist of
active listening . In this, the nurse has to listen patiently what the patient is saying. It is
important that the patient trusts the nurse , only then effective communication will happen.
The nurse has to respond to the patient in the same manner addressing the concerns. The
patient and nurse should have genuineness and empathy towards each other. Some
relationship goes through a series of phases .
As the patient responds well to the therapeutic relationship he/she recovers and responds well
to treatment. Hence helps in early discharge from hospital and reducing the cost of the
treatment. By using literature in many hospitals the retention rate of nurses , their health ,
satisfaction and their reaction to towards the patient has improved. The institutes that support
the well-being of nurses must make efforts to reduce their work-related stress. Organisation
must help and assist nurses in gathering knowledge over the therapeutic relationship.
Institutes should support their nurses and their findings so that they can participate in the
therapeutic relationship. however, Institutes should not only promote communication
between nurse and the patient but communication between nurses and the nurses and all
levels of management is also required. Nurse information is accessible by everyone. It creates
a supportive environment and hence helping everyone by therapeutic relationship. It is the
duty of the senior management to an environment that supports creativity , risk taking, new

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ideas so that nurses can implement their skill in a better way.( .( Lusk, J. M., & Fater, K.
(2013, April).
Benefits Of the Programme- A palliative care where we reduce the pain of the patient whois
suffering by terminal illness. Palliative approach provide comfort to the patient. No one wish
to die a painful death. Palliative approach helps in peaceful death of the patient This is
adopted mainly in life-threatening diseases where the cure is not possible. The palliative
approach is utilised to improve the life of the patient from the pain and suffering related to
the disease. This also helps and supports the life of the patient who is having a natural death.
The life-threatening disease can be encountered at any stage of life. Different type of
palliative care is required for different age groups .Hence an age-related palliative approach is
required .The palliative approach is based on individual needs , it differs in different age and
medical condition. The palliative approach helps to comfort the individual suffering from the
disease. Physically palliative approach is followed to manage pain and physical discomfort in
most of the situations. Pain being the most important complaint in the palliative approach to
treatment.. As the discomfort increases the need for palliative approach increases. It becomes
very important where treatment is painful.
Nursing based care and in time quality decision, based on clinical expertise. The aim is to
provide better, healthy and safe care to the patients with most new techniques available. To
practice, nursing knowledge of the nurse along with multiple studies needs to be utilised.
These all are part of nursing education.( Aadal, L., et al 2013).

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Budget Justification-The project is cost effective as in-house training can be imparted to the
nurses. It requires patient and caring approach by them to achieve the goals. In this, there is
no involvement of any special technical setup and better end life care can be achieved.
At times the therapeutic relationship might act as a very efficient tool and patient response to
it very well. However, in many cases, the patient might take a good amount of time to
understand the approach of the therapeutic relationship and respond to it. To appreciate the
effects of therapeutic relationship we must look for its outcome
Researchers have shown that therapeutic relation improves the quality of the life of the
patient . Moreover, they are able to communicate in a better way and therefore sharing their
concerns which are very important. The therapeutic relationship also helps in reducing cost.
Basis of evaluation- The project can be evaluated on the basis that it will provide
comfortable end life days to the patient. Also it is cost efficient and in house training to
hospital nurses and staff can be provided for better palliative care of patient.
Requesting your feedback on below questions
1.Do you believe the proposal would be approved if formally proposed?
Yes , as the proposal seems to be complete in all aspects. In provides better quality care to the
patient who are terminally ill, Also the proposal is cost efficient. Hence it can be accepted
keeping in mind that it will bring overall positive effect on the institution.

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2.What are some strengths and weaknesses of the proposal?
Strengths- The project is extremely cost efficient.
Weakness- The hospital staff need to be trained for end life care. As in these cases
emergencies are more frequent hence it is required for proper training and knowledge to take
quick bedside decisions.

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