Most of us have the desire to end our days in the comfort of our own homes, but the reality is that more often than not, we will spend our last days in hospital or in a nursing home on palliative care. Palliative care in this sense means having a team to care for the terminally ill patient and their medical needs by keeping them as comfortable and content as possible, but without any medical intervention or specific treatment of the terminal condition they have. In other words, the only medical intervention provided is purely for comfort and pain relief.
Sadly, many people needing terminal care have many issues that require specific medical intervention to care for them. It may be an IVI for pain medication, oxygen to help them breathe easier, or wounds that need to be dressed. This type of care necessitates the need for qualified medical personnel, and in many cases is the reason why they stay in hospitals until the very end. Some people are truly too sick be at home, especially when they are undergoing chemotherapy and radiation treatments for cancer. Often they may need procedures like blood transfusions, CT scans, or X-rays; all of which need to be done from a hospital facility.
Sometimes it is possible to have much of this care in the comfort of your own home. A Registered Nurse can be arranged to come in at regular intervals for the medical procedures prescribed by the doctor, leaving the routine daily care up to Personal Support Workers who have experience and training in palliative care.
The key to good palliative care is the clear understanding that teamwork is required. In a typical scenario, family members, doctors, nurses, personal support workers, and caregivers are all closely involved. In some cases, there are specialized teams such as oncology nurses, physiotherapists and dieticians who can also be called in to make up the team. Often when one is sent home to die with peace and dignity, the family can find it very difficult to accept all these strange faces coming and going. Good palliative care involves the family being part of this process. Often they themselves are trying to deal with the grieving process and are reluctant to have strangers in the home.
Tensions and emotions can run high, and one needs to remember that the purpose of palliative care is to provide a calm and comforting environment for the terminal patient. With this in mind, families need to put their own feelings aside and allow the medical team to work with them in order to provide the desired environment and care for their loved ones.
While many families feel they can provide the care themselves, the reality is that this is a time consuming and emotionally exhausting 24 hour, seven days a week job. Family members still need to go to work and fulfill their own family obligations. It is unusual to find that there are sufficient family members able to sit around the clock who have the experience with death and dying to meet the challenges that arise. It is even more unlikely that they will have the expertise to nurse their loved ones in these final days. A good palliative team will be able to coordinate the necessary care while still providing the emotional support for the patient and the family. Thus the palliative team is there not only for the patient, but also for the family struggling to cope with the news that their loved one is dying.
It is understandable that the family, and possibly even the patient, wish to be left alone at a time like this. In the end the goal that we all aspire to is to create a harmonious and comforting environment, coupled with the right medical care to allow the terminally ill patient to die in peace, with the dignity he or she deserves while being surrounded by a loving family.
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