Palliative care from a nurse’s perspective

Palliative Care is a comprehensive approach to treating serious illness that focuses on the physical, psychological and spiritual needs of a person. The support and care is aimed at providing the best quality of life available by relieving suffering and controlling pain and symptoms.

The care is usually provided by an interdisciplinary team to people living with a life-threatening or severe advanced illness expected to progress to dying, and their families. There are a number of considerations that must be taken into account when caring for someone, no matter what condition or disease they may have.

Incontinence can be a factor which may add to their suffering. Both bowel and bladder symptoms may be related to their condition and incontinence can increase as the disease progresses.

Pain relief such as analgesics can mean aperients or laxatives may be necessary for bowel evacuation. A bowel management program is important as medication such as morphine or their derivatives can cause constipation. There are different aperients or laxatives that can be used to help with constipation and these are listed in the Intouch Direct product catalogue.

It is important to have a bowel routine such as toileting fifteen to twenty minutes after a meal, especially after breakfast, as the colo-rectal reflex is at its greatest. Oral intake of 1.5–2 litres of fluid a day is particularly important for keeping bowels healthy.

A comprehensive continence assessment by a doctor, continence nurse advisor or continence specialist is essential when a patient experiences continence issues or problems.

Odour control can also be a problem and can be distressing for the person suffering from urinary or faecal incontinence. Several products including deodorisers or neutralisers are available. Products for faecal soiling or incontinence can be used to keep people clean and comfortable and maintain their dignity.

Continence pads or pull-up pants for urine incontinence can also be useful if the patient has urine leakage. A wide range of bed protection including bed sheets, quilt and mattress protectors along with chair pads and floor mats are also available, most of these products are washable.

Skin breakdown is common in palliative patients. Excoriation can occur if the patient has incontinence when skin becomes frail and the disease progresses. Barrier creams, cleansing and healing creams are available to maintain skin integrity and prevent breakdown. Wound breakdown can also be a concern and there are many wound healing products for specific areas of wound care. Skin protection garments are also available to protect frail skin and provide comfort.

Personal and oral hygiene are vital for good health care and personal comfort. Bed baths and shampoo caps are helpful for people who are bed bound and provide a safe and easy way to maintain hygiene and self-esteem.

Food supplements are an important part of nutritional wellbeing for someone who can’t take solid food, has difficulty swallowing or with decreased appetite. There are a number of good supplementary and complementary products available which are high in energy and protein to help maintain weight and nutrition.

Palliative Care Australia has developed the National Palliative Care Service Directory to assist the community and health professionals’ access information about palliative care services, primary care services for care at the end of life and a range of other services offering support to people with life limiting illness.

Good palliative care and understanding of the disease process can make a significant difference to the patient, their family and carers.

Acknowledgements and useful web-sites:
Palliative Care Australia
Caring Connections
Department of Health and Ageing