A holistic approach to terminal care

Abstract

A time comes in the care of patients with progressive and incurable illness, when further attempts to cure become inappropriate. The role of those caring for such patients then changes and concentrates on ensuring that the remainder of their life is free from physical and mental distress and that they are surrounded by support and human concern. The dissertation purports to review current understanding of what constitutes good terminal care. After the introduction an explanation of some key words and phrases of hospice terminology is given. The hospice movement, primarily in the U.K. and subsequently the world over, has done much to recognise, nurture and raise awareness of the needs of the dying. It has pioneered advances which have become synonymous with the principles and practice of good care. In 1989, the Committee of Ministers of the Council of Europe adopted Recommendation No. R(89) 13 "On the Organisation of Multi-disciplinary Care for Cancer Patients (Appendix ii). This recommendation was adopted because the ministers were aware of the high incidence of cancer amongst the peoples of Europe. They recognised the complex needs arising from this and considered that effective multi disciplinary team work among health professionals was vitally important as a means of delivering a high standard of care to cancer sufferers. The recommendation issued guidelines to the National Health Authorities of member states with regard, among other things, to the importance of training in communication skills for doctors, nurses and therapists working with cancer patients; to the need of psychological support and involvement of the family at all stages of the progression and treatment of the disease; to the importance of training in palliative skills and techniques for doctors and nurses; to the active promotion of the hospice philosophy of continuing care for terminally ill patients; to the need for adequate staffing levels and to the level of stress affecting care staff working in this area. These guidelines correspond with what is discussed in the theoretical framework and with the needs and problems highlighted in the survey. The theoretical framework of the dissertation follows the explanation of terminology and comprises some common attitudes to death and dying, a brief history of the hospice movement and a review of some aspects of terminal care covered by an already huge literature on the subject. The review includes a description of the principles and practice of good terminal care with regard to the three categories of people involved, that is, the patient, family members and the care staff. It considers the implications for social work and outlines possible components of a comprehensive service of care for the dying. The aims of the survey are then stated. It may be important to note here that the scope of the survey is not to provide conclusive or definitive solutions to the wide professional, social, financial and health issues which are fundamental to the provision of terminal care. The scope is rather, to pinpoint patients needs and problems currently being faced by persons engaged in the day to day care of such patients and to outline possible components of a service of care, which gives practical application to life affirming values and addresses the needs of patient, family and carer. The background study leading up to the survey follows, together with an explanation of my own position vis-a-vis the subject. The instrument of research used to carry out the survey is then described. The research hypothesis completes the outline of the methodology of the dissertation. Results of the questionnaire and interviews are then analysed and presented together with tables. A summary of these leads to the conclusion and some recommendations arising from the issues discussed. The dissertation has been prepared with a deep sense of awe in the presence of human suffering and human courage; yet ...... "How little the real sufferings of illness are known and understood. How little does anyone in good health fancy him or herself into the life of a sick person." (Nightingale, 1946).