LEARNING OBJECTIVES
After studying this chapter, you should be able to:
• understand the relationship between chronic conditions and fatal burden in both Australia and New Zealand
• identify pain management and symptom control techniques for the person at end of life
• consider the issues in providing emergency care for the palliative patient
• describe the importance of psychosocial aspects of end of life care
• outline the importance of advanced care planning
• understand the nurse's role in end of life care.
Introduction
End of life care or palliative care is defined by Palliative Care Australia (2005) as ‘ the care provided for people of all ages who have a life limiting illness, with little or no prospect of cure, and for whom the primary treatment goal is quality of life’. On a global scale, chronic conditions including non-communicable diseases and communicable diseases accounted for 68 per cent and 23 per cent, respectively, of all deaths in 2012 (WHO, 2015).
Chronic conditions are attributed to be the cause of early death, significantly contributing to fatal burden worldwide. In Australia, chronic conditions accounted for the following mortality rates: cancer (35 per cent), cardiovascular disease (23 per cent), injuries (13 per cent), neurological conditions (6 per cent) and respiratory diseases (5 per cent) of the total burden. These five chronic condition groups were estimated to account for 82 per cent of all years of life lost (YLL) in 2010 (AIHW, 2015). Similarly in New Zealand, chronic conditions accounted for 63 per cent of fatal burden comprising of: cancers (17.5 per cent), vascular and blood disorders (17.5 per cent) followed by mental health disorders (11 per cent), musculoskeletal disorders (9 per cent) and injury (8 per cent) in 2006 (NZMOH, 2014).
Several national bodies exist which provide guidance and support to nurses working in the area of palliative care. In Australia, Palliative Care Australia (2015b) provides a range of resources, as does Hospice New Zealand (2015) in New Zealand. These bodies provide useful guidelines for best practice that are current and contextualised to country of origin, which can be especially useful for legal issues. The exact model of palliative care used differs due to services and resources available, local legislation, demographics and demand for services (AIHW, 2014).