Stepping into Palliative Care

Jo Cooper

• Publisher: CRC Press
• Year: 2017
• Print ISBN: 9781138448384
• eBook ISBN: 9781315344942
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

The second edition of this highly successful text has been greatly expanded and updated, and is now available in two companion volumes. Stepping into Palliative Care 2 focuses on symptom management, emergencies, bereavement and spirituality. This practical guide with numerous examples, illustrations and thorough references, includes boxes, tables, figures, self-assessment questions, points for reflection and case studies to aid comprehension. The clear layout and straightforward approach is ideal for all those working in community care, including nurses, nursing students, doctors and social workers, and those already involved to some extent in palliative care.

Chapter 1

Assessment in palliative care

Mary Brooks

Pre-reading exercise 1.1

Time: 10 minutes

Consider in what ways an assessment process can be helpful to:

• you
• other team members
• the patient.

What is assessment?

Assessment is a continuous, ongoing process, beginning even before the professional and patient identify problematic issues. Once the provisional care plan has been agreed, assessment continues throughout to ensure interventions and treatment are adjusted to meet the patient’s and family’s needs. However, there is usually a point when the professional, patient and family sit down and systematically draw together information required to decide on the exact nature of the problem and how best to move forward.¹ The primary aim of assessment is three-fold:

1. Information – gather accurate information (listening to their story) about the:
   • person
   • family
   • illness
   • associated problems.
2. Identify – factors associated with the illness.
3. Coping strategies – explore strengths and weaknesses and the person’s ability to cope with, and play a pivotal role in the management of, the illness and identified problems.¹

To be effective, assessment involves two-way communications,² enabling patient and family to express

• hopes
• fears
• expectations

and to receive information about the illness, interventions and treatment. This requires sensitivity and skill, which develops with experience and knowledge.

Why is assessment important?

Symptoms related to cancer do not take place in isolation. Cancer causes other problems. Therefore, throughout assessment the professional must consider the holistic needs of the patient and family covering the following aspects of the individual’s life:

• physical
• psychological
• social
• emotional
• economical
• spiritual.³

While including highly clinical aspects, the professionals’ role is primarily to facilitate self-help. It is acknowledged that the patient is the expert in his or her own care and needs⁴ and the professionals’ role is to facilitate that expertise, to identify problems, and offer appropriate interventions and treatment, to achieve the individual’s chosen goal. Consequently, in order to plan care it is necessary to have good information about the patient’s and family’s:

• inclinations
• strengths
• abilities
• problems
• difficulties.

Other agencies, professional and lay, may be involved with the patient and family. Therefore, it is essential to identify each, and the role each plays in the individual’s life. This avoids overlap, enhances coordination and effective interdisciplinary work and directs resources to the direct care of the individual.

The assessment questions are three-fold:

1. What can I do for the patient and family?
2. What can the patient and family do?
3. How can I help the patient and family maintain their independence?¹

What should assessment include?

Every individual has a story to tell. Encourage the patient and family member to tell his or her story:

• using their words
• in their own time.

This may be time consuming but it is time well spent. Without a holistic picture, intervention and treatment is ineffective. Only when you have decided what information is needed can you clarify:

• why you need it
• what you will do with it.

During assessment ask yourself:

• what decisions do the patient, family and I have to make?
• what information is needed to aid the decision-making process?¹

The process of assessment

Assessment should take place in a safe, confidential environment, with sensitivity towards issues of race, culture, gender, sexuality, religion and age. The way the assessment is conducted and information is collected, influences the rapport between the professional, patient and family, which in turn will affect the process of any interventions that follow.¹ Patients most likely to engage are those who feel the professional is warm, accepting, understanding, knowledgeable and genuinely wants to work with them.¹

Assessment provides an opportunity to gain insight into the illness and its impact on the individual’s and family’s life. If assessment is thorough and part of mutual openness and understanding, effective treatment and intervention can be made jointly on the basis of a shared understanding.

Assessment tools

While helpful in aiding diagnosis or symptom severity, assessment tools do not take the place of a willingness to listen and the ability to understand the patient and family. Assessment tools can aid the flow and structure and ensure specific information is obtained and or measured. However, it is important to explain if you are going to write notes or complete an assessment tool and to discuss the issue of confidentiality relating to information being shared.⁵

Assessment tools can be disadvantageous, creating a barrier between the patient and professional, taking the focus away from the patient’s identified needs or concerns. However, if they are completed with sensitivity, maintaining eye contact, this should not be intrusive to effective communication.

Primary factors of assessment

Assessment is:

• continuous
• ongoing
• detailed.

Eight primary factors can aid focus on points of assessment. By taking these points a picture of the person’s story develops that aids further intervention and assessment.

1. Ensure the setting is right:
   • initial contact – building trust and a therapeutic relationship
   • introduction – friendly, war...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Foreword
• Setting the scene
• Cautionary note
• List of contributors
• Acknowledgements
• Dedication
• 1 Assessment in palliative care
• 2 Introduction to pain management
• 3 Symptom management: a framework
• 4 Continuous subcutaneous infusion
• 5 Mouth care
• 6 Lymphoedema
• 7 Wound care
• 8 Emergencies in palliative care
• 9 The last few days of life
• 10 Terminal restlessness
• 11 Breaking bad news
• 12 Hearing the pain of the carer
• 13 Spirituality and palliative care
• 14 Bereavement
• 15 Complementary therapies: a therapeutic model for palliative care
• 16 The special needs of the neurological patient
• Useful contacts
• Index