Does this description of a patient sound familiar to you?
“… a 91-year-old man diagnosed with moderate Alzheimer’s disease, hypertension, and benign prostatic hypertrophy whose change in mental status has prompted hospitalization from a long-term care facility…. This is his third admission in five months with similar symptoms; each time he was given IV fluids and sent back to the long term care facility within a few days.”
Figure. Photo © Photofusion Picture Library / Alamy Stock Photo.
With minor adjustments in age, gender, and the exact illnesses involved, this paragraph describes patients that I cared for on a regular basis in a large medical center. I always found such patients frustrating, and sad. I was frustrated because it seemed all we could do was “patch them up,” send them back to the nursing home, and wait for their inevitable return; and sad because there seemed so little quality of life to reach for.
In AJN’s September issue (“Palliative Care in the Acute Care Setting”), authors Jennifer L. Goldsborough and Marianne Matzo describe an option for this man and others with chronic, degenerative diseases who are never going to “get better”: palliative care.
The importance of setting goals.
Many clinicians think of palliative care as only for people with cancer. But the starting point of any palliative care plan is setting goals and figuring out how to achieve these in a way that is most comfortable and supportive for the patient. The palliative care perspective, then, provides those of us who work in acute care with a new approach to caring for medically complex patients who are often chronically uncomfortable. As the authors put it:
“Understanding the palliative care role aids nurses in including a palliative team for patients who have refractory symptoms, lack understanding of the disease trajectory, or struggle with decisions about the goals of care.”
This may be the situation of someone who is experiencing a progression of chronic illness, or alternately, a person who has just lived through a sudden and life-altering event.
Practical resources for nurses.
This article offers a wealth of practical information and resources for nurses in hospital and other acute care settings, including:
- What to do when the patient has no advance directive or health care power of attorney.
- A discussion of the hierarchy of surrogate decision makers.
- Assessing and documenting a patient’s decision-making capabilities.
- Palliative care steps your own clinical team can follow when there is no palliative care team in your facility.
But read the entire article, free until October 16.
I am a nurse by profession( specialist in pediatric nephrology) and a daughter to my 91 yr old father who has copd and advancing dementia. I have been voicing the need for exactly what you are writing about. I believe dementia needs to be treated the same as a cancer patient when all treatments fail. There is no treatment to stop the advancement of dementia. My dad suffers. He needs palliative care. How can we get this recognized as such and be able to get the correct treatment? Thank you so much for getting things going.