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Assumptions And Principles Underlying Standards For Care Of The Terminally Ill
Assumptions And Principles Underlying Standards For Care of The Terminally Ill Assumptions And Principles Underlying Standards For Care of The Terminally Ill Introduction There is agreement that patients with life-threatening illnesses, including progressive malignancies, need appropriate therapy and treatment throughout the course of illness. At one stage, therapy is directed toward assessment and intervention in order to control and/or to cure such illness and alleviate associated symptoms. For some persons, however, the time comes when cure and remission are beyond current medical expertise. It is then that the intervention must shift to what is now often termed "palliative treatment," which is designed to control pain in the broadest sense and provide personal support for patients and family during the terminal phase of illness. In general, palliative care requires limited use of apparatus and technology, extensive personal care, and an ordering of the physical and social environment to be therapeutic in itself. There are, as it were, two complementary systems of treatment which may often overlap: One system is concerned with eliminating a curable disease and the other with relieving the symptoms resulting from the relentless progress of an incurable illness. There must be openness, interchange, and overlap between the two systems so that the patient receives continuous appropriate care. The patient should not be subjected to aggressive treatment that offers no hope of being effective in curing or controlling the disease and may only cause further distress. Obviously, the clinician must be on the alert for any shifts that may occur in the course of a terminal illness, which make the patient again a candidate for active treatment. Patients suffer not only from inappropriate active care, but also from inept terminal care. This is well documented by studies that only confirm what dying patients and their families know at first hand. These principles have been prepared as an aid to those who have initiated or are planning programs for the terminally ill in delineating standards of care. GENERAL ASSUMPTIONS AND PRINCIPLES The care of the dying is a process involving needs of the patient, family, and caregivers. The interaction of these three groups of individuals must constantly be assessed with the aim being the best possible care of the patient. This cannot be accomplished, however, if the needs of the family and/or caregiver are negated. 2. The problems of the patient-family facing terminal illness include a wide variety of issues: psychological, legal, social, spiritual, economic, and interpersonal. Care requires collaboration of many disciplines working as an integrated clinical team, meeting for frequent discussions, and with commonness of purpose. 3. Dying tends to produce a feeling of isolation. All that counteracts unwanted isolation should be encouraged; social events and shared work, inclusive of all involved, should be arranged so that meaningful relations can be sustained and developed. 4. It has been the tradition to train caregivers not to become emotionally involved, but in terminal illness the patient and family need to experience the personal concern of those taking care of them. Profound involvement without loss of objectivity should be allowed and fostered, realizing this may present certain risks to the caregiver. 5. Health care services customarily lack coordination. The organization structure must provide links with existing health care professionals in the community. 6. A supportive physical environment contributes to the sense of well being of patients, of family, and of caregivers. The environment should provide adequate space, furnishings that put people at ease, the reassuring presence of personal belongings, and symbols of life cycles. PATIENT-ORIENTED ASSUMPTIONS AN...This is ONLY a preview of the article. If you would like to view the entire document, you must subscribe to Electronic References. Please register below now! Get This Full Article After Registration
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