North Carolina Licensing Boards Joint Statement on Pain Management in End-of-Life Care

Background and context: Almost two-thirds of the 7.6 million deaths every year from cancer worldwide occur in low-income and middle income countries, making cancer a leading cause of mortality in these settings. In Rwanda, we are focused on the development of the tools needed to perform social and health service delivery in addition to policy research in resource-limited settings. There is a real need for qualified staff members who are able to ask appropriate questions, to make relevant hypotheses, develop research protocols, and conduct effective studies to identify innovative approaches in social and health service delivery. Cancer patients undergoing end-of-life care suffer from physical pain, mental illness and psychological trauma. Aim: The aims of this project are to identify cancer patients at end-of-life care at the community level without appropriate support through a mobile clinic, to mobilize existing resources to introduce home based care at the community level with participation of community health workers and to sensitize the population in cancer prevention and supportive care of patient using African socio-cultural perspectives. Strategy/Tactics: This project, the first kind in Rwanda, bring at home the same services cancer patients receive at the hospital level except for access to chemotherapy or radiotherapy. And it's where all those services provided and patients' family are counseled and reduce the burden and challenges they used to have going to hospital. Program/Policy process: During this project patients are visited in their homes and are treated mostly with pain management and their complaints are listened to together with other issues related to cancer, then their families are also approached to clearly explain to them the case of the patient and how to well console him/her and support in their sickness, all these are done periodically with assessment of past visits. Outcomes: Before this project, many people used to die early due to lack of pain management, counseling and follow-up, and also patient families used to abandon them at home or at health facilities. With this current project people have already started to understand that cancer can be treated like other diseases and this awareness helps in the advocacy for pain treatment and availability of pain killers for cancer patients. What was learned: The lessons learned from this project is that home based end of life care for oncology is an important tool to care for oncology patients and to reduce the burdens they have such as pain and depression and also the burdens for their families such as loss of money in the cost of treatment. This program can be expanded to reach as many as possible patients and their families.

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End-of-life care for people with advanced dementia and pain: A qualitative study in Swedish nursing homes

10.21203/rs.2.16091/v3 ◽

2020 ◽

Author(s):

Emma Lundin ◽

Tove Godskesen

Keyword(s):

Pain Management ◽

Nursing Homes ◽

End Of Life ◽

End Of Life Care ◽

Terminal Illness ◽

Healthcare Personnel ◽

Life Care ◽

Advanced Dementia ◽

Structured Interviews ◽

Good Communication

Abstract Background: Of the Swedish people with advanced dementia, the majority die in nursing homes. Unresolved pain can occur in people with a terminal illness such as dementia. However, pain management in people with advanced dementia is often suboptimal and inadequate, with fewer palliative care interventions than offered to cancer patients. Although they are largely responsible for the care of these people, few studies have addressed the experiences of registered nurses in this respect. Therefore, the aim of this study was to describe the experiences of nurses in caring for people with advanced dementia and pain at the end of life.Methods: The study had a descriptive explorative design. Individual qualitative, semi-structured interviews were carried out with thirteen nurses from twelve nursing homes in Sweden. The results were analysed using thematic content analysis.Results: The nurses described communicative, relational and organisational challenges. One major issue involved difficulties in communicating with the person with advanced dementia, resulting in uncertain pain assessment. Other difficulties involved the differentiation of pain from anxiety, the balance of benefits and risks with morphine administration, and the creation of good relationships with healthcare personnel and the persons’ relatives. Relatives can greatly affect the assessment and management of pain, both because of their ability to interpret pain behaviour and by questioning the care given. Good pain management was facilitated by good communication and relationships with healthcare staff and relatives, extensive professional nursing experience, and already knowing the person with advanced dementia. Conclusions: This study highlights the need for nursing homes to employ specialist nurses who have been trained in the appropriate knowledge and skills to deal with the challenges of end-of-life care for people with advanced dementia and pain. Additionally, there should be resources and strategies available for providing information to family members and for involving them in the decision-making process, as they are often unfamiliar with the multitude of considerations involved in decisions such as whether to administer morphine or not.

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End-of-life care for people with advanced dementia and pain: A qualitative study in Swedish nursing homes

10.21203/rs.2.16091/v4 ◽

2020 ◽

Author(s):

Emma Lundin ◽

Tove Godskesen

Keyword(s):

Pain Management ◽

Nursing Homes ◽

End Of Life ◽

End Of Life Care ◽

Terminal Illness ◽

Healthcare Personnel ◽

Life Care ◽

Advanced Dementia ◽

Structured Interviews ◽

Good Communication

Abstract Background Of the Swedish people with advanced dementia, the majority die in nursing homes. Unresolved pain can occur in people with a terminal illness such as dementia. However, pain management in people with advanced dementia is often suboptimal and inadequate, with fewer palliative care interventions than offered to cancer patients. Although they are largely responsible for the care of these people, few studies have addressed the experiences of registered nurses in this respect. Therefore, the aim of this study was to describe the experiences of nurses in caring for people with advanced dementia and pain at the end of life.Methods The study had a descriptive explorative design. Individual qualitative, semi-structured interviews were carried out with thirteen nurses from twelve nursing homes in Sweden. The results were analysed using thematic content analysis.Results The nurses described communicative, relational and organisational challenges. One major issue involved difficulties in communicating with the person with advanced dementia, resulting in uncertain pain assessment. Other difficulties involved the differentiation of pain from anxiety, the balance of benefits and risks with morphine administration, and the creation of good relationships with healthcare personnel and the persons’ relatives. Relatives can greatly affect the assessment and management of pain, both because of their ability to interpret pain behaviour and by questioning the care given. Good pain management was facilitated by good communication and relationships with healthcare staff and relatives, extensive professional nursing experience, and already knowing the person with advanced dementia.Conclusions This study highlights the need for nursing homes to employ specialist nurses who have been trained in the appropriate knowledge and skills to deal with the challenges of end-of-life care for people with advanced dementia and pain. Additionally, there should be resources and strategies available for providing information to family members and for involving them in the decision-making process, as they are often unfamiliar with the multitude of considerations involved in decisions such as whether to administer morphine or not.

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