PALLIATIVE CARE

Palliative care according to WHO is "active care of the diseases that have no cure response, and aims to increase the quality of life of patients and their families"

The main aim in palliative is care to relieve suffering and greatly improve the quality of life of these patients.

Nurses must provide palliative care to patients both at hospital and at home, these, have a high need and demand for health care with the involvement of all levels of care in the health system.

Nursing must meet a number of objectives with these patients:

- Comprehensive care accessible

- Teamwork

- No discrimination based on age, sex ...

- Actions based on the best available evidence

- Open communication

- Assistance to the patient and the family

Staff should be trained to communicate "bad news" in the best way possible and as clearly, for that there are different models such as: technical, paternalistic, accommodating and deliberative, the latter being the most recommended.

Nursing will use theoretical strategy to communicate bad news BUCKMAN, which are six stages traversed by order not advance if you have not passed the previous.

The reactions that occur in the family to receive this kind of news are: feeling of disorientation, feeling threatened by the loss of a family member, disorder, grief.... Being the set of all what will condition the situation of the patient.

Once released to the patient his diagnosis will begin to meet the stages of grief according to Dr. "kueler-ross"; these phases contemplate:

- Negation

- Anger / rage

- Negotiation / agreement

- Depression

- Acceptance

Patients receiving palliative care:

- Neoplastic pathologies

- Pathologies chronic, progressive and infectious

- Neurological degenerative pathologies

Nursing care of the terminally ill symptoms:

- PAIN: Subjective and changing experience which is valued by the “Eva´s Scale"

- ORAL CAVITY DISORDERS

- INTESTINAL RATE CHANGES

- NAUSEA AND VOMITING

- CONFUSION

- INSOMNIA

- ANXIETY

- DEPRESSION

- PRESSURE ULCERS

- Incontinence / URINARY RETENTION

- AGONY

To alleviate many of the symptoms associated with terminal illness nursing will use subcutaneous routes to do the less pain added to the patient, contemplating the scale of the WHO analgesia.

In conclusion I would emphasize that the situation terminal and death are part of life's natural way, the nurse should perform the necessary care for the patient to leave considering the patient holistically. It should convey the patient and family that he can decide where to die so respecting patient rights.

VIDEO "LEARNING TO FAREWELL"

                             Vanessa Palomares Garcia

BIBLIOGRAPHY:

- F. Diaz Garcia. Bad news in medicine: recommendations to make a virtue of necessity. Intensive Med [serial on the Internet]. 2006 Dec [cited 2013 Apr 07], 30 (9): 452-459. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0210-56912006000900006&lng=es

- Http://escuela.med.puc.cl/publ/arsmedica/ArsMedica8/Art01.html "GERONTOLOGIA MORE TO HUMAN"

- Criteria for inclusion of a patient with stage dementia syndrome in hospice care. Arriola Manchola, E*.; González Larreina, R**.; Ibarzabal Aramberri, X***. y Buiza Bueno, C****.* Médico geriatra. Unidad de Memoria y Alzheimer (UMA). Matia Fundazioa. ** Médico geriatra. Unidad de Cuidados Paliativos. (UCP). Matia Fundazioa. *** Médico internista. Magister en Bioética. Comisión de Ética Asistencial. Matia Fundazioa. **** Psicólogo. Unidad de Memoria y Alzheimer (UMA). Matia Fundazioa.

- SciELO. "NEW PERSPECTIVES IN PALLIATIVE CARE." Leo Pessini * and Luciana. BERTACHINI. Acta Bioethica Interfaces 2006, 12 (2) Revised May 2012.