Comment: Taking care
Michèle Salamagne
pp 4-4
This issue presents all the different aspects involved in tending patients in the advanced stage of a serious illness. It is obvious that we all need to work together. What carer can possibly be qualified to prescribe treatments to relieve problems of salivation or pruritus, for instance? To integrate criteria for a clinical evaluation suitable for palliative care purposes? To help set up a computerised programme and cope with the difficulties of monitoring patients around the clock in their homes?
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Treatment of drooling
Viv Lucas and Louise Schofield
pp 5-7
Drooling is a problem often ignored or regarded as trivial. However, its impact upon a patient’s confidence and well-being may be considerable. The term ‘drooling’ appears to be used interchangeably with sialorrhoea in much literature, although their actual meaning is different. Sialorrhoea refers to an increase in salivary flow which can be either persistent or episodic, managed by the patient increasing their rate of swallowing. People who drool produce normal amounts of saliva, but due to neuromuscular dysfunction or another cause, it accumulates and spills out of the mouth.
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The management of pruritus in palliative care patients
Andrew Thorns and Polly Edmonds
pp 9-12
Pruritus is a skin sensation leading to a desire to scratch. It is distinct from touch and pain in nature, persistence and localisation. Its prevalence in palliative care is about 5%, although it is more common in patients with end-stage HIV. Patients with end-stage renal failure have a prevalence as high as 70% and those with cholestasis, 80%. In this article we shall review the causes, pathophysiology, methods of assessment and treatments available, concentrating on treatments applicable to palliative care patients.
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A link between medical staff and the world at large
Nicole Landry-Dattée
pp 14-17
The voluntary worker has to come to grips with disciplines bordering on the religious, political, sociological, philosophical and psychological – among others. They must also have a wide range of interests, including leisure, sport, politics, charity work and healthcare. This catholic range of responsibilities can cause problems and controversy both for organisations and individuals. In order to understand precisely the role of the voluntary worker in any organisation, we must ask a few questions.
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Patient self-assessment or carer assessment: are these the only options?
Cheryl Nekolaichuk
pp 18-20
Despite the common occurrence of debilitating symptoms, most palliative patients will not undergo any form of systematic symptom assessment before they die. Two major issues impede the use of routine symptom assessments: first, the lack of simple, reliable bedside assessment tools, and second, the selection of an appropriate ‘gold standard’ against which to measure. Traditionally, either the patient or a third party (usually a carer) has been used as the gold standard. Despite this trend, clinicians rarely base their treatment decisions on a single factor.
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Out-of-hours palliative care – bridging the gap
Keri Thomas
pp 22-25
Out-of-hours palliative care in the community is becoming increasingly recognised as a major issue in the provision of good quality management of patients at home. No matter how much anticipatory palliative care is provided there will always be crises. Often these will occur in the 75% of the week that takes place outside normal working hours.
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Implementing a patient administration system
Graham Young
pp 26-28
Like it or not, information technology now plays an increasingly important role in the effective management of hospices and directly impacts the care and well-being of the patients and their families. This article examines the experience of St John’s Hospice, London, in selecting and implementing a computerised palliative care system. It highlights the critical success factors of such a project; above all, the importance of gaining everyone’s involvement, including the administration staff, the nurses, doctors, social workers and the suppliers.
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The role of bereavement counselling in hospice work
Monika Mu¨ller
pp 29-32
Hospice is a treatment and care concept geared especially to meet the needs of both dying people and their relatives and friends. It is crucial that hospices develop and offer whatever they can to meet the very personal way in which everyone affected by a process of dying experiences grief. All known services, homes or inpatient palliative care units dedicated to hospice work provide bereavement counselling to family members of the dying. However, does this make them a place where people can really work openly through their grief?
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