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A Palliative Nurse Practitioner (PNPR) is an advanced practice registered nurse (Forchuk, 2015). PNPR is trained to assess patient needs, diagnose disease, interpret diagnostic results and provide palliative medicine to treat illness with complex pain and symptoms. Additionally, PNPR will anticipate and meet the needs of the patient and family facing terminal illness and bereavement (Forchuk, 2015).
Peplau Theory is an interpersonal relation theory (Peplau, 2017). This is the theory that will be used to examine the challenge facing Challenge Facing Palliative Care Practitioners by looking at how enhancing interpersonal relationships between the nurses and the patients can help enhance health outcomes (Peplau, 2017).
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Peplau’s Theory Views a Palliative Nursing Practitioner as a professional that establishes therapeutic relationship with patients. Peplau’s theory consist in 3 phases which are orientation, working and termination stages (Peplau, 2017). During the orientation phase, the patient, family and nurse work together to recognize, clarify, and define existing problem. The working phase includes deliver and application of interventions, and services of care to treat, explore and change a situation. Finally, the termination phase includes resolution and successful completion of all the other two stages on finalization of care (Townsend, 2015).
This theory is significant in palliative care because it will allow me to determine the needs of my patients and their families through the use of the orientation, working concepts. In doing so, I can serve as a resource person, a counselor and surrogate. In addition, I can provide individualized care that will meet the needs of my patients and their families. But most importantly, this theory is significant to palliative care because it will help me to transition patients and their families through end of life care by applying the concepts of the termination phase (Townsend, 2015 p. 40) , (Forchuk, 2015).
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Today’s society struggles with the subject of death. We live in a decade where modern technology and treatments are prolonging life and the concept of natural death is seeming a vague illusion and almost an impossible concept to accept and face. We are dragged into the philosophy that there is nothing worse than letting our loves ones go and we hold them tight without acknowledging and respecting their wishes. Palliative Care Nurse Practitioners (PNPR) play an important role on assessing patient and family needs. They focus on providing patient-centered care to relieve symptoms and stress of a serious illness. The goal of PNPC is to improve quality of life for both the patient and the family (Townsend, 2015). Unfortunately, palliative care carries a negative stigma associated with death. Because of this there is fear and avoidance of palliative care because it is usually associated with precipitation of death (Meleis, 2014).
On the other hand, conflicting approaches to patient care can lead to conflicts among providers which can result in a decrease of the overall quality of care (Townsend, 2015). Fortunately, the application of Peplau’s theory promotes a stronger therapeutic relationship which will allow the PNPRs to be a better advocate to patients and families. Another challenge, somehow unique to PNPR, is ensuring that the family is supportive and honors the patient’s wishes during what can be a difficult time. Again, the relationship created through the use of this theory can provide the PNPR with the tools to help families transition through the grieving process (Peplau, 2017).
Finally, overcoming the stigma of what is palliative care and the barriers of cultural perceptions of surrounding end of life is a challenge often face by PNPRs.
However, through education and strong therapeutic relationships built using Peplau’s theory, PNPRs can successfully overcome these challenges (Manley, 2016).
The scope of practice restriction could include lacking of the authorization to order lab tests and diagnostic testing necessary when providing care. As a result PNPR must consult primary care providers or hospitalist which can lead to delay of patient care.
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Society tend to confuse Hospice and palliative care, but they are two distinct entities. For instance, Palliative care is intended to alleviate symptoms and improve quality of life, and is appropriate for all patients with serious illness, not just those who are at the end of life. While, hospice care is end-of-life care (Shuler, 2013).
Unfortunately due to the stigma, palliative care is only a treatment of choice when curative or life-prolonging treatments are ineffective or undesired. Because of this, there is a rapidly decline on patient’s health because symptoms of disease are not properly treated. According to World Health Organization (WHO), people with a terminal or advance disease benefit physically and mentally from palliative care treatments (Potter, 2013).
At times, the lack of knowledge of palliative care can actually result in the prevention of natural death. For instance, terminal ill patients and their families will opt to continue aggressive treatments which are usually focused on treating the underling diseases. Unfortunately, they won’t have a meaningful impact on their chronic or advances conditions. As a result, these patients will struggle with symptoms and side effects of therapies, pain, rapid decline and many times undergo uncomfortable and painful treatments (Forchuk, 2015).
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Some of the Ways in which Peplau’s Theory can be used to address the societal perception of palliative care is by improving interpersonal relationship with patients. Better interpersonal relationships will lead to high quality health services because it improves the delivery of holistic care (Manley, 2016).
In the same manner, through the process of orientation and working phase, PNPR can educate and inform patients and families regarding palliative care treatments and options at the time of terminal diagnosis or when there is not meaningful hope of recovery (Peplau, 2017).
The importance of promoting awareness and shared decision-making between patients and their families about end of life care lends to the equally important acknowledgment, and honoring of patients’ last wishes (Shuler, 2013).
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The application of Peplau’s theory promotes effective communication and education among patient and family regarding comfort measurements, and palliative medicine during or at the end of life care. Furthermore, strong patient-nurse relationship increases patient participation in care and autonomy because allow patients to have more control over their care by improving their understanding of treatment options and matching their goals. It also supports family caregivers and provides practical support and referrals (Potter, 2013).
The termination phase of Peplau’s theory has significant impact when providing palliative care because once the design patient centered care has been applied during the working phase, it is on the termination phase that PNPC can finalized continuity of care by improve patients ‘s level of comfort , pain and suffering until their last moment of care. When finalizing these intervention on the termination phase, PNPR can ensure that patient has dignified, respected and peaceful death (Meleis, 2014).
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In conclusion, Peplau’s Theory is relevant in the explanation of what palliative nursing care entails. A Palliative Nursing Practitioner as per Peplau’s Theory is a professional that establishes therapeutic relationship with patients. The quality of patient care is determined by the type of relationship that a Palliative Nursing Practitioner has with patient. Restrictions on practice should be eliminated to improve interpersonal relationship with patients (Peplau, 2017).
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