Palliative care in South Korea

Most Koreans would prefer to withdraw from medically futile life-sustaining treatment, but many Koreans still receive futile treatment even after their conditions are diagnosed as terminal. Korean law does not allow doctors to remove life-sustaining treatment, regardless of the patient‘s condition or desires or those of family members. The limited hospice palliative care that is offered often demands a high degree of family responsibility; the caregivers of terminal patients are usually immediate family members or private caregivers hired by the family. For these reasons, Korean family members of terminally ill patients experience heavy physical, emotional, and social stresses, much more so than families in the West.

Rehabilitation and palliative care

This chapter applies the concept of physical activity to palliative care across settings. A physical activity program for each patient should be presented at the time of diagnosis and extend to end-of-life care. Even when it is not possible to cure or reverse a disease process, or to restore a previous level of functioning and independence, a rehabilitative approach to nursing care adds quality to the experience of living until life’s completion. The language of rehabilitation nursing is a language shared with those who practice palliative care. Feelings of self-confidence, independence, hope, human dignity, and autonomy are all influenced by an individually tailored program of rehabilitation.

Palliative care of cancer survivors

Being told you are cancer-free does not mean you are free of the consequences of the disease. Seventy-six percent of cancer survivors are over age 60 years and have coexisting medical conditions that complicate posttreatment recovery to maximum health. Childhood cancer survivors also carry a heavy burden of medical and psychological problems resulting from their experience with cancer. Cancer diagnosis and treatment affects the family as well as the patient. Improvements are needed in the coordination of care for cancer survivors to assure optimal quality of life.

Elderly patients

This chapter is organized into two main sections. The first section provides an overview of special concerns of older patients at the end of life. The second section focuses on the assessment and management of common symptoms experienced by this population at the end of life.

Spiritual assessment

This chapter reviews models for spiritual assessment, presents general guidelines on how to conduct a spiritual assessment, and discusses what the nurse ought to do with data from a spiritual assessment. These topics are prefaced by arguments supporting the need for spiritual assessments, descriptions of what spirituality “looks like” among the terminally ill, and risk factors for those who are likely to experience spiritual distress.

Planning for the actual death

The care of patients and families near to death and afterward is an important nursing function—arguably one of the most important things nurses do. At the end of life, nurses and other healthcare professionals often only have one chance to “get it right.” Assessment and aggressive management of symptoms must remain a priority, especially as death approaches. Goals of care inevitably change in rhythm with patient and family needs and wishes. Care of the body after death, including normalizing and interpreting postmortem changes and honoring rituals and individual requests, is critically important in communicating to family members and close others that the person who died was indeed important and valued.

Withdrawal of life-sustaining therapies

Withdrawal of mechanical ventilation (MV), discontinuation of dialysis, and deactivation of cardiac devices are procedures that occur with relative frequency. The benefits of these therapies, when initiated, are to replace failing organs, extend life, and improve quality of life by relieving symptom distress associated with organ failure. When the burdens exceed the benefits, or when the patient is near death or unresponsive, decisions may be made to cease these therapies. In some cases, such as implantable cardioverter defibrillator (ICD) deactivation, no distress is anticipated. In others, such as discontinuing dialysis or withdrawing MV, measures to palliate anticipated distress must be applied. A peaceful death after cessation of life-prolonging therapies can be provided.

Sexuality

Healthcare practitioners should assume a leading role in the assessment and remediation of potential or identified alterations in sexual functioning. Not all couples will be concerned about their sexual health at this point of their life together. However, people may find that being physically close to the one they love is life-affirming and comforting. Assessment of sexual health should occur for all patients to determine whether these needs and hopes include maintenance of their sexual health. The healthcare practitioner’s offer of information and support can make a significant difference in a couple’s ability to adjust to the changes in sexual health during end-of-life care.

Artificial nutrition and hydration

Decreased appetite or inability to tolerate or enjoy food and fluids is often a hallmark of the terminal phase of an illness. Discussions and decisions regarding initiating or withholding artificial nutrition and hydration at the end of life are guided by goals of care, evaluation of benefits and burden, ethical and cultural considerations, and the beliefs and wishes of the patient and family. Patients have the right to refuse hydration and nutrition, whether parenteral or oral. Nurses are responsible for promoting patient autonomy, providing education regarding benefits and burdens of interventions in order, promoting informed decision making, and delivering quality care with the rest of the are team.

Nausea and vomiting

Nausea and vomiting are symptoms commonly experienced in advanced disease, especially the cancer population. Clear understanding of the different concepts surrounding nausea and vomiting is essential and will aid in screening, preventing, assessing, and treating symptoms as well as improve understanding of the incidence and severity of patient distress. The cause of nausea and vomiting is often multifactorial and requires a thorough assessment and understanding of the emetic pathway and neurotransmitters involved in order to aid treatment decisions. Pharmacologic and nonpharmacologic interventions should be used to manage the distressful symptoms of nausea and vomiting. Nurses play a vital role in helping patients and family members manage and cope with nausea and vomiting.