Palliative Care: Origins, Principles, and Delivery in Practice

This paper explores the historical development, core principles, and practical implementation of palliative care. It delves into the origins of palliative care, tracing its evolution from early forms of care for the sick and dying to the modern, holistic approach. The paper examines the key principles that guide palliative care, emphasizing patient-centered care, pain management, and respect for individual dignity. It then analyzes the practical delivery of palliative care, focusing on the roles of healthcare professionals, community nurses, and dedicated palliative care teams. The paper also discusses the importance of guidelines and legislation in ensuring quality palliative care services.

Palliative care
INTRODUCTION.....................................................................................................................................1
1.1 Understanding of the origins and development of palliative care...............................................1
1.2 Understanding of the principles of palliative care....................................................................2
1.3 Understanding of the delivery of palliative care in practice........................................................3
CONCLUSION.........................................................................................................................................4
REFERENCES..........................................................................................................................................4

INTRODUCTION
Modern day palliative care involves a holistic approach to enhance the quality of life of an
individual battling illness. The aim of the care is neither to enhance or compromise the term
of the illness but to ease the process of treating the illness be it physical, and psychosocial
or spiritual. It is focused on patient care and adapts to the needs of an individual, their
illness, and their habits by offering them a constant support mechanism and diffuses any
clinical complications at the same time. Through this body of work a detailed assessment of
the history and modern day provision of palliative care is discussed.
1.1 Understanding of the origins and development of palliative care
The historical perspective of management of illness included treatment practices and
masking the discomfort to make the illness a bearable experience. During the migration and
exploration phase in history, travellers with dire illness were catered in the homes of the
foreign lands. Especially the exploration towards the European and Middle East countries
where a maximum percentage of pilgrims were headed, the geriatric and sick persons were
housed by the locals and taken in for care. (Ciemins et al, 2015)
Earlier times the palliative care centres around the terminally sick and dying people and
medical records from different parts of Europe and UK trace this trend back to the 18th
century where the orders of medical care were given by religious authorities. By the wake of
early 19th century separate institutions were developed that were dedicated to the service
of the dying. In France, an institution for the social and dying was materialized in mid 19ty
century. The success f the same lead to the formation of more such institutions focussing
not just on the dying but also sick people in need for institutionalised care. In United States,
Rose Hawthorn Lathrop played a major role in forming the cancer care services institution
across the country.( Bishop, 2015) This model inspired the cancer care hospice in London in
1967, the St Christopher’s hospice that lead to the revolutionary plunging in the arena of
research and education. (Truman, 1995)
This was the start of the provision of palliative care in foreign lands that has now evolved
into its present form. The Hospice Movement from the 1970s picked up the momentum and
incorporated the care system with the cure system. (Lack, 1979) The compassionate service
towards the sick lead to the joined collaboration of the multidisciplinary teams of health and
social care services.
According to WHO, various study models of different demographic areas has been analysed.
There have been a considerable development in the increase in numbers of palliative care
centres in the United States, Australia, Japan, UK, European Union, and Peru with over 4.86-
681.20 providers are available per 1,000,000 population. (Alliance, and World Health
Organization, 2014) An estimated increase in the need of palliative care was also assessed
and the focused areas were China, India, Russia, South Africa, and South America. With the
continuous efforts in the right direction this feat can be achieved. (Lynch et al, 2013)
1.2 Understanding of the principles of palliative care

The palliative care is “an approach that improves the quality of life of patients and their
families facing the problems associated with life threatening illness, through prevention and
relied of suffering by the means of early identification and impeccable assessment and
treatment of pain and other problems, physical, psychosocial and spiritual”(WHO 2016) This
approach is primarily based on management of the outcomes of the illness that causes
discomfort and disruption in day to day activities. It involves different methodologies of
psychological and spiritual management and not just the physical management of the sick
individual. This enhances the dignity of the person’s life and adapts to the needs and
demands of the ailing person preserving their autonomy.
The palliative care must be suitable for all age groups and specially people with similar
illnesses who share common needs. Effective pain management and empathetic
communication are the qualities that are capable in providing support to individuals
suffering from debilitating illnesses. (Downing, 2012) The team of trained professionals in
the palliative care must therefore acquire the necessary skills for a good quality service.
These services must be based on some common principles on which the structure of
palliative care rests. These basic principles are
• Managing the pain of the individual and providing adequate relief.
• Respecting the dignity of the individual and not demeaning them due to their state of
illness. (Detering et al, 2010)
• Providing quality of life than offer means to enhance the longevity of the person or hasten
their death.
• Integration of various aspects of mental health including psychological and spiritual.
• Maintaining the physical vitality of the individual and motivating active lifestyle that best
suits them.
• Providing a support to channelize the grief and negative emotions of the individual and
their family which is associated with their limiting state of life and individual’s health.
• Positively challenging the course of illness and motivating the individual.
• Provision of service at the demand and need of individual rather than depending upon the
mere diagnosis of the illness, that is, the freedom of choice for opting the care rather than
making it a matter or compulsion or exclusion. (MacArtney et al, 2016)
These principles form the basis of the palliative care, and positively coordinate to the
provision of medical services and benefit the individual on a more holistic scale. The
providers must train their staff according to this framework formed by the guiding principles
ensuring good quality services.
1.3 Understanding of the delivery of palliative care in practice
The palliative care provision is an evolutionary process as it becomes more comprehensive
and patient centred with time. It helps individuals lead a better quality life by providing
psychological, emotional, and social support. Palliative care is provision of care for sick
people, end of life care, and individuals with a personal need for the same. In UK, end of life
care is the responsibility of the National Health Service (NHS) and is being delivered at home
or in a care home under the medical guidance of the local GP. Community nurses and close
family and friends may be involved in the delivery of the same too. By doing so, the life is
made pain free and holistically enriched even though the illness cannot be cured.

The providers may be individual practitioners specialising in palliative care, health care
professionals with the aid of community nurses or a dedicated team comprising of
professionals focused on palliative care. They provide the services for the duration of need
with dignity and respect while keeping the family and other carers in mind too. (Stajduhar et
al, 2013.) The online services of Find Me Help by the NHS make the process of finding the
suitable care provider easy.
The legislative boundaries are set by the National Institute for Health and Care Excellence
(NICE) in 2015 on the care of adults in their last days. (Ruegger et al, 2015) These guidelines
serve as a framework for the provision of the kinds of service that needs to be given to
individuals with only 2-3 days to live and how. These guidelines include recommendations
on
• Recognition of the end of life symptoms of an ailing individual- the individual’s clinical
assessment must be made along with the assessment of psychological, emotional and social
aspects for a firm diagnosis. Along with functional changes such as mobility dependence,
decreasing performance and social isolation must also be taken into account. (MacArtney et
al, 2016) This final diagnosis is made with help of multi-professional team and must be
informed to the individual and their family.
• Assistance of clinical hydration- if the individual is conscious oral route must be preferred
for the intake of water. And if the individual is unable to consume water orally, intravenous
route must be considered in order to prevent dehydration.
• Communication among the professionals and reaching consensus after decision making-
the consent must be acquired by the patient or their family members of the patient is
mentally compromised. The communication channel must be established between the user
and provider to provide accurate information about their prognosis and listen to their
apprehensions and fears. The provider must be empathetic, confident and respectful when
reaching out to the individual or his family. (Wright et al, 2014)
• List of symptoms and their pharmacological management- the medications must be
prescribed by a health professional keeping in mind the condition of the individual and most
effective medicines must be administered via acceptable routes that help treating the
symptoms.
• Non-pharmacological management of the symptoms- nearing the end days after thorough
revision of medicines has been done, there are non pharmacological methods that can help
managing the symptoms such as change in position to help relieve pain or help in breathing.
These guidelines are based on inputs by healthcare, social care and public health
professionals. The NHS and Department of Health and Social Care are the key organisations
that take the responsibility of forming these guidelines. These go through a rigorous process
of research, analysis and interpretation finally forming the design of the guidelines. These
are updated regularly according to the needs of the individual over the course of time.
CONCLUSION
A good quality palliative service is the aim of professionals to provide the people a chance to
live their end of days with dignity and respect. When the principles and guidelines are

followed the services become more patient centred and the providers are legally bound to
provide the same. The history and development of the palliative care inspires the
professionals to better the existing services and make them even more efficient.
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