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A nurse-led service to provide palliative care in the community

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Margaret McGovern, RN.

Senior Nurse, Jersey Hospice Care

This nurse-led, nurse-managed service works in partnership with GP colleagues and other members of the multidisciplinary team to ensure optimum palliative care for patients and their families. Close consultation and communication with colleagues in the oncology, occupational therapy and physiotherapy departments at the general hospital are vital to providing a complete service. The patients referred to the home-care team have their symptoms and needs assessed and a 24-hour on-call service is provided.

This nurse-led, nurse-managed service works in partnership with GP colleagues and other members of the multidisciplinary team to ensure optimum palliative care for patients and their families. Close consultation and communication with colleagues in the oncology, occupational therapy and physiotherapy departments at the general hospital are vital to providing a complete service. The patients referred to the home-care team have their symptoms and needs assessed and a 24-hour on-call service is provided.

The patient's pain is evaluated using a body chart (Figure 1). This allows the individual to focus on specific areas. Patients are encouraged to use descriptive adjectives, such as dull, stabbing or burning to describe their pain, which helps the nurse to identify the type of pain. This process empowers the patient, allowing them to take responsibility for reporting and recording their symptoms accurately. The patient is thus fully involved in working towards a successful resolution of his or her pain.

A joint decision
The nurse should be honest at all times. Patients don't expect miracles, but should be treated with honesty, respect and kindness. It takes time and understanding to allay patients' concerns about analgesia. Many patients have misunderstandings, for example, about the use of opiates. They often regard them as 'addictive' and a 'last resort'. When assessing pain it is important to think laterally - does the patient need adjuvant therapy? Is an anti-inflammatory required for bone pain? Or for nerve pain, would tricyclics or steroids be appropriate?

Medication needs to be continually re-evaluated and adjusted accordingly. The hospice care team has devised a 'Treatment Guideline for Cancer Pain' model for this purpose (Figure 2).

Cancer care in Jersey is complicated by the lack of a radiotherapy unit. Patients must therefore travel to the UK (usually Southampton) if this treatment is considered necessary. This can present a dilemma for people with a limited life expectancy.

They have to consider separation from their family, friends and the familiar support services, for perhaps several weeks. This has to be balanced against the hoped-for success of radiotherapy treatment. The nurses working on the team support the patient's decision, whatever it might be.

The case study above illustrates how the patient, the GP, hospital staff and the hospice care team jointly manage pain and symptom control.

Conclusion
Managing patients with a terminal illness requires more than just effective pain control, incorporating emotional and spiritual elements. As nurses, we must be aware that alleviating pain, though essential, is but one facet of effective palliative care. The patient should always be respected as an individual, who, though often acutely unwell, is, above all else, a unique human being.

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