Dialysis nurses for palliative care

The palliative approach offers significant and practical care throughout the treatment of the dialysis patient until death. Varied aspects of quality of life for patients can be improved. It is possible to relieve symptoms such as sleep disorders, pain, constipation and pruritus, which, according to the present survey, are common symptoms. The treatment of dying dialysis patients or the possibility and legitimization of discontinuing treatment are complex, controversial issues with ethical and legal implications. But these issues have not yet been adequately dealt with by the nephrological community. The nurses who encounter patients daily, who constantly deal with great suffering and who lack tools to help, can lead the practice in this field within the framework of inter-disciplinary team work. In light of the obvious need for progress in this area, appropriate training courses should be considered. The implementation of the palliative approach in dialysis units could be a challenge for all of us in the coming years.     

Education in palliative care

Palliative care education includes the domains of pain and nonpain symptom management, communications skills, ethics and law, psychosocial care, and health systems. Defining key attitudes, knowledge, and skill objectives, and matching these to appropriate learning formats, is essential in educational planning. Abundant educational resource material is available to support classroom and experiential palliative care training.     

Financing palliative care

Palliative care services are financed by a combination of revenue from a variety of sources: hospital, nursing home, hospice, and physician. Cost avoidance is calculated based on the patterns of care of the patients seen compared with control patients. Most programs also use grants and philanthropy as part of their "mix."     

Gastroenterological palliative care

On consideration of current medical and socio-economical factors, palliative care is becoming an increasingly important aspect of modern medicine in Germany. The German Society for Digestive and Metabolic Disorders (DGVS) has taken this into account by founding the working group "Palliative Gastroenterology". Patients with gastrointestinal malignancies or advanced non-malignant liver disease represent an important group that benefits from palliative care. Approximately 80 % of all palliative care patients suffer from gastrointestinal symptoms and endoscopic procedures performed by gastroenterologists play an important role in relieving symptoms such as obstruction. It is the object of this paper to evaluate the role of gastroenterologists in palliative medicine. It will give a brief definition, a historical review and the current legal background for palliative care in Germany and examine special aspects of ethics, decision making and research. Considering the current evidence on palliative endoscopic procedures this paper wants to establish the role of the gastroenterologist in palliative care far beyond the mere practicalities of endoscopy. The gastroenterologist is a crucial element of the interdisciplinary palliative care team and a partner to the patient in the process of decision-making. Finally, it is demonstrated how palliative care structures can be implemented in the setting of a university acute-care hospital.     

Family caregivers in palliative care

This article defines caregiving broadly to include the informal (ie, unpaid) care provided by family members that goes beyond customary and normative social support provided in social relationships. Family caregivers in particular play significant roles in the care of elders with advanced chronic disease and in the context of palliative and end-of-life care. These caregivers typically are involved in critical medical decisions, provide vital assistance with activities of daily living, and carry out most nonpharmacologic and pharmacologic treatment recommendations for community-based elders. This article describes family caregivers and the costs of care and introduces the stress process model to highlight essential caregiving experiences and needs in the context of palliative care. Common interventions used to support caregivers are highlighted, and the bereavement experience among caregivers is discussed.     

Guardianship and financial management legislation: what doctors in aged care need to know

Demographic and epidemiological changes have resulted in increasing numbers of elderly people, and in increasing numbers of elderly people suffering from various degrees of cognitive impairment, including dementia. It is well recognized that the presence of cognitive impairment may impact upon an older person's decision-making capacity, which has, in turn, been associated with increased acknowledgement of the need for greater accessibility to methods by which substitute decision-makers are appointed. To this end, legislation has been enacted throughout Australia to enable the appointment of substitute decision-makers in the form of guardians and financial managers. Medical practitioners are the largest group of health professional whose opinion is sought when appointments are being considered. Despite the significance of the legislation to the evaluation of elderly people with impaired cognition, many health professionals remain unaware of the provisions of the legislation and are unclear about what information will be required. The aims of this review are first, to provide health professionals with the legal context within which their evaluations of disability and capacity take place, by way of a review of the relevant guardianship and financial management legislation in each of the states and territories of Australia; and second, to discuss how these provisions relate to existing clinical practice, with suggested guidelines for the capacity assessment. The focus and quality of information that health professionals provide will be enhanced by them having a greater understanding of their role within the wider legal context by placing in their hands knowledge of the provisions of the relevant legislation.