There are a myriad of symptoms experienced by patients nearing the end of life that can be treated adequately. Effective symptom management in palliative care relies, in part, on the professionalism and altruism of the medical team’s members, especially the nursing staff. Research shows that 20 to 50 percent of the whole of the elderly community suffers painful symptoms that are recurrent or persistent. As palliative care becomes the focus of a patient’s treatment, the severity of pain and other symptoms increases significantly. At this point in treatment, the role of symptom management in palliative care is to provide consistent and thorough assessment, management of medications and other medical procedures, and monitoring for compliance to pain management policy and procedure.
Upon admission to a long-term care facility or an in-home palliative care program, the patient, regardless of his cognitive status, is screened for pain. In many cases, when a patient is suffering from a significantly painful disease, like cancer, experienced nurses can begin pain management quickly. In other cases, the evaluation for pain is more complex. Nurses look at the patient’s history, ask the patient to vocalize the source and intensity of his pain; the nurse also looks for bodily symptoms, like facial grimacing. If the patient is unable to adequately express himself, family members are asked to speak on behalf of the patient.
Symptom management in palliative care focuses on patients being assessed frequently for pain, digestive dysfunction, and cognitive function. The nurse may ask the patient if the “quality” of the pain has changed. For example, a pain that began as “aching” may progress to “shooting.” In this type of case, the pain needs to be addressed by changing or increasing pain management medication, helping the patient to change his sitting or lying position, or prescribing calming physical therapy, like yoga. New pains reported by the patient that are considered to be acute and serious in nature are reported to the attending physician immediately.
The overall objective of symptom management in palliative care is to comfort the patient and help him to participate in activities of daily living. The appropriately managed patient who is measurably cognizant should be relaxed, able to communicate to family and medical staff about his disease and spiritual beliefs pertaining to death, and show less apathy and more gratification in his day-by-day routine. He should feel comfortable expressing and bringing attention to new symptoms and working with the medical team to formulate a care plan that is emphatically personal and flexible. A patient who is more progressed in the disease process and cannot communicate effectively is assessed physically in accordance to protocol based on ideal symptom management in palliative care. In this case, family members are strongly encouraged to become involved, as they can offer valuable information regarding the patient’s intensity and location of chronic pain that was present before palliative care began.
