The Concept of Palliative and Hospice Care through End-of-Life Nursing Care
Palliative care is care given to patients or individuals that have some type of serious illnesses so that they can feel comfortable and better. The focus of palliative care is to address the symptoms by preventing or treating them as well as eliminating the side effects of diseases and medication. Palliative care goes beyond the physical challenges of the patient, but addresses them emotionally, socially, and spiritually. When these aspects of their lives are addressed, the patients have an enhanced quality of life that makes them feel better (Lustbader, Mudra, Romano, Lukoski, Chang, Mittelberger, & Cooper, 2017) . Palliative care may begin at the onset of the disease or at a time that the disease has been diagnosed in an individual, and extends through the treatment, in the process of follow up- and at the end of life. Palliative care is offered to people that suffer from various illness (Hui & Bruera, 2016) . Both palliative and hospice care are intended to offer comfort to the patient. The difference is that palliative care begins at the time of diagnosis, which can happen concurrently with the treatment process. Hospice care begins after treatment of the disease has been stopped and when it evident that the person has entered the end-of-life stage and there are no chances of survival from the illness. This paper will address palliative and hospice care on elderly person diagnosed with cancer and heart diseases. Individuals receiving palliative and hospice care have reached a terminal stage. They may not be cured and are confronting an end-of-life moment.
The care setting that is chosen is a medical center that admits elderly patients specifically who are in need of care. Elderly populations were chosen to be investigated in terms of their response to palliative and hospice care. The elderly persons are at an end of life situation and have complex needs that could only be addressed by the interprofessional team. Lung cancer and heart diseases have been the major cause of deaths in various populations across the world over the last two decades. Statistics collected from local hospices in entire California further indicated that patients that have been diagnosing with lung cancer and heart diseases formed the majority of all patients that were servicing hospice care (Harrison Denning, Crowther, & Adnan, 2018) . The impact of palliative and hospice care on elderly patients that have been diagnosed with lung cancer and heart disease can be determined to extend our understanding and for better recommendations on quality care. In most cases, palliative care patients have one or more chronic diseases and such would be elderly patients suffering from lung cancer and heart disease at the same time. End of life care is focused on these elderly patients to address biomedical, emotional and spiritual aspects of their lives.
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The Basis of Choosing the Population, Setting, and Disease
Hospice and palliative care work best for older patients than anyone else does, of course for children too. Hospice will reduce medical costs and promote fulfillment for patients that are at critical conditions as well as their families. The elderly persons need a lot of care because both physically and emotionally they are deprived, and are not strong enough because their immune system is also deteriorating as they advance in age. The medical center setting was selected where elderly patients could receive palliative care instead of being taken care of at home (Dy, Kiley, Ast, Lupu, Norton, McMillan, & Casarett, 2015) . Most elderly patients in the hospice-care group prefer to medical centers for their end-of-life care, because they trust that the t would be the best place to receive help other than home. A hospital setting was the most significant because many elderly persons could be attended to at once, compared to walking to their homes. Lung cancer and heart diseases have proven to be the most acute diseases that heighten morbidity and mortality rates globally (Sanso, Galiana, Oliver, Pascual, Sinclair, & Benito, 2015) . It is the essence of investigating whether palliative and hospice care could reduce these rates and achieve short hospital stays for elderly patients.
Physiological, Psychological, Spiritual, and Social Aspects of Elderly Persons that Need Hospice and Palliative Care
The physiological needs that associated with elderly persons are the desire to ease from pain. Most of such paints fear pain and they may negatively affected, particularly on occasions of shortness of breath and feeling that they are being choked. Psychological needs that have to be addressed in these elderly population that need palliative and hospice care include anxiety, uncertainty and feeling of loneliness. Loneliness could also be a social need. The major needs that are social in nature would include the need to be visited by friends and relatives, and not to feel neglected (Hue & Bruera, 2016) . Their spiritual needs should be addressed, whereby they will be made ready to meet their make. This is because at the end of the day, he or she must be accountable for how they lived their life. The idea should be to have a holistic approach when attending to the elderly persons.
Philosophy of Hospice and Palliative Nursing Care in an Interprofessional Practice Environment
Hospice and palliative care entail an interprofessional collaborative strategy in engaging with patients as well as their family as well as nurses by giving patient-focused and customized pain relief empathy, care and general reduction of symptom acuteness. In most occasions, elderly patients have one or more chronic diseases, and a collaborative active approach that encourages interprofessional practice framework will be the most effective (Harrison Denning, Crowther, & Adnan, 2018) . The collaborative care encompasses attributes of comfort care or end-of-life care. The goal is to enhance the quality of life for both the patient suffering, family, as well as family and non-family caregivers. Hospice and palliative care ensure optimal results particularly for the individuals receiving the care and the family, which is depended on the experience and ability of the team members (Dy et al., 2015). The team members must demonstrate an understanding of each of their roles and responsibilities, and be willing to coordinate and communicate within the interprofessional team. This sharing of responsibilities and everyone being involved in the decision-making process. The palliative care setting should be one that supports a holistic and personalized collaborative strategy to patient care and management to fulfill every need of the patient.
Historical, Landmark, Ethical and Legal Events Shape and Formed my Current Health Care Practice
The painful experiences of elderly persons in their end-of-stage situation have shaped my health care practice is several ways. In the past, most focus on offering palliative and hospice care has been to relieve physical pain from the patients. Pain often prevents the practitioners and caregivers from taking notice of the psychological, social and spiritual needs of the patients (Lustbader et al., 2017) . Holistic palliative care would entail addressing these needs entirely together and not focusing on one and neglecting the other. In addition, I have come to appreciate the place of loved ones at this point in life. There is a connection with the patient for not only the family members but also even the practitioners giving care (Dy et al., 2015). Therefore, regardless of our feelings, we should not allow our emotions hinder from providing security by being around our patients. There is a need for ensuring that the medical team is coordinated, especially for patients suffering from cancer and other serious chronic illnesses.
Gaps Identified for Chosen Population, Setting and Physical Aspect of Dying
One of the gaps is in the patients receiving palliative care because of old age and cancer. 75 percent of most individuals dying from cancer are above 65 years of age (Harrison Denning, Crowther, & Adnan, 2018) . Most medical practitioners and caregivers are not keen at observing the clinical guidelines on pain control. Educational interventions can help in ensuring that much knowledge and perspectives of medical staff are obtained concerning the pain as experienced by the patients and their families. Nurses should encourage patients to fill pain diaries, doctors utilize explicit approaches to make sure that pain is examined daily, and that drug dosages are expanded appropriately (Sanso et al., 2015) . Of course, physical pain will sometimes be linked to the spiritual needs of the patient because they will be worried they are done and are unprepared for it. It is a challenge to address spiritual needs because they are personal but significant to several people at the end of life. In addition, many practitioners neglect this aspect since they are not certain whether the patient will appreciate it or otherwise. Spiritual support should be sought as it has been confirmed to influence individual coping and their quality of life.
Growth Related to Awareness of Nurse’s role as a Palliative or Hospice Care Nurse
Nurses should boost their communication skills since most of their services depend on effective communication. The nurses should be keen to record fundamental consultations to benefit the patients. Most of the caregivers and practitioners will rely on the information that has been documented on the patient (Sanso et al., 2015) . A better knowledge of the situation of the patient, without exposing them to psychological problems of recalling information about themselves is helpful. Proper records and good communication can ease clarification of patient needs and enhance their satisfaction.
References
Dy, S. M., Kiley, K. B., Ast, K., Lupu, D., Norton, S. A., McMillan, S. C., . & Casarett, D. J. (2015). Measuring what matters: top-ranked quality indicators for hospice and palliative care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association. Journal of pain and symptom management , 49 (4), 773- 781.
Harrison Dening, K., Crowther, J., & Adnan, S. (2018). An Admiral Nursing and hospice partnership in end-of-life care: Innovative practice. Dementia , 1471301218806427.
Hui, D., & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature reviews Clinical oncology , 13 (3), 159.
Lustbader, D., Mudra, M., Romano, C., Lukoski, E., Chang, A., Mittelberger, J., & Cooper, D. (2017). The impact of a home-based palliative care program in an accountable care organization. Journal of palliative medicine , 20 (1), 23-28.
Sansó, N., Galiana, L., Oliver, A., Pascual, A., Sinclair, S., & Benito, E. (2015). Palliative care professionals' inner life: exploring the relationships among awareness, self-care, and compassion satisfaction and fatigue, burnout, and coping with death . Journal of Pain and Symptom Management , 50 (2), 200-207.
