Establishing a Therapeutic Relationship in Palliative Care
Added on 2019-10-18
6 Pages2960 Words145 ViewsType: 145
Healthcare and Research
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Therapeutic Relationships FrameworkIntroductionA palliative care is an approach which reduces the stress and pain due to suffering from terminal disease. 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 indifferent age and medical condition. The palliative approach helps to comfort the individual suffering from the disease.A therapeutic relationship is a relation between nurse and the patient. This relation is based on mutual respect and trust. It is a helping relationship in which the nurse should be sensitive to self and others . Providing physical, emotional, spiritual support to the patient and their family.To be a successful nurse excellent communication skills are important. This helps in building an interpersonal relationship with patient and family. The nurse is able to take better care of the patient if she able to communicate properly with the patient. This also helps in building a relationship among the staff of the institute. More the communication by the nurse their is fewer chances of error. Also, he helps in creating a trust and positive environment. Good communication skills help in building a therapeutic relationship. Communication is very important in nursing. All the aspects of nursing like prevention. Treatment , rehabilitation, health promotion closely depend on communication. The development of interpersonal relation with the patient is done by communication only. Communication involves an exchange of thoughts and information. The therapeutic practice involves communication between nurses with officials , patients and also their relatives. By effective communication, a comfort level withthe patient is developed by which patient conveys his pain, fear , shares anxiety. All this helps inbetter recovery of the patient. The nurse can collect this information and in return can transfer other information for rehabilitation and health promotion of the patient. By effective communication, an understanding with the patient is developed. It requires great nursing skills to understand the patient’s concern . It is a reflection of knowledge and effective skills. Communication and interpersonal relationship should be studied by the nurses to progress further. There are few principles which should be taken care. Communication shows accurate and easy nursing work providing satisfaction to the patient as well as their relative. If communication skills are not proper then it becomes difficult to separate professional and personal life.In this problems transfer from one side to another. A two-way communication is
always important to the patient . If the patient is able to relate to your words he will surely share his concerns with you. Communication cannot be kept unidirectional. Special attention is needed to be given by the care givers while using medical terminologies, Patient might hear something which is not appropriate for him. This will cause nervousness and anxiety in the patients. Patient might not be able to understand the meaning of the medical terminology which gives them great mental stress and communication become more and more difficultCommunication can be also non-verbal. It is done by facial expressions, gestures. Each patient has its own separate characteristic. Few patients might be comfortable with non-verbal communication but few may prefer verbal communication.Listening is a very important mode of communication. It requires nursing skills and attention. Bythis nurses can access the situation and problems of the patient. By being a good listener nursescan provide care at all levels of recovery.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.The most important core of nursing practice is known as the therapeutic relationship. Its key role comes during palliative care. In this a person and its family members require support. This requires great sensitivity .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 role of the palliative nurse is extremely stressful . It is important for the nurse to focus on self-care along with the care of patient and family members. (Watanabe SM, Nekolaichuk C, Beaumont C-2011)Physically palliative approach is followed to manage pain and physical discomfort in most of thesituations. 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. Mostlypeople by the end stage of their life prefer to spend their time at home. The palliative approachhelps 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 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. The GNP (gerontological nurse practitioner ) can be utilised for palliative care. When a patient is in hospital or home , a GNP can educate and train the family members and staff regarding palliative care. GNP is very much required to provide psychological support to patient’s family. A GNP can guide the family to use hospice care services. GNP can explain the family the progression of the disease and what are the challenges they have to face in coming days. So that the family can be psychologically prepared for the upcoming challenges. GNP also clarifies the goals of end life care of the patient with the family member. NP’s help in medical treatment to achieve their goals.GNP can help the family in a spiritual , psychosocial and emotional way.( American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons-2009)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. At times it requires great planning before you start a topic. 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, their is a requirement of improvement of techniques to overcome these obstacles. In last two decades, their is awareness of the importance of communication skills.( R Twycross and A Wilcock-2008) Good communication in end life patient involves the ability to both give and receive information. It is important for the nurse to make the patient understand his/her condition. Also to prepare the family for the near future events which will occur. However, In the case of old adults, it is sudden death. Thos may come as a shock to the family. It is the duty of the nurse to explain the correct situation of patient’s health to the family so that they can deal with any sudden emergency. Communication helps in various aspects. Not only patient shares its fear and concern with the nurse but the family members also share their grief, fear and concern. 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
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