HLST274 Global Health Care Management : Integration of Palliative Care

The evidence-based databases including CINAHL, Cochrane library, EMBASE, HAPI, MEDLINE and PubMed were systematically explored with the utilization of the above-mentioned search-terms through various permutations and combinations with the objective of retrieving the research studies and peer reviewed articles of interest (Walden_University, 2017). The focus of exploration attributed to the retrieval of systematic studies with the objective of acquiring evidence-based answers to the research question. The literature review focusses on the synthesis of the information of interest with the objective of acquiring the desirable outcomes by critical analysis of the retrieved information(Pautasso, 2013). A similar pattern of literature review approaches was followed in this systematic study for exploring the barriers to the administration of palliative interventions for home-based women in the United Kingdom. Accordingly, the findings of various research studies of interest could provide clues regarding the best practice interventions warranted for the enhancement of palliative outcomes of the terminally ill women patients. Search strategies acquired in finding answers to the proposed research questions followed a coherent and systematic convention while evaluating myriad studies available in the research literature. This was necessarily required for excluding the systematic studies that exhibited findings that were beyond the scope of our literature review. The qualitative and illuminative assessment approaches were utilized with the core objective of discussing the significance of educational, treatment, counseling, behavioural and life style strategies warranted for the systematic overcoming of palliative care challenges encountered by the home-based females in their residential premises (Reitmaier , et al., 2015). A blend of various search interventions attributing to "browsing", keywords exploration, scanning, forward citation, starting and chaining were employed for retrieving the desirable evidence-based outcomes. Browsing proves highly effective in acquiring the articles of interest while searching them in various databases attributing to PubMed, PubMed Central and Bookshelf (NCBI, 2013). The present study utilized browsing technique in searching the desirable articles through keywords in various evidence-based resources. For example, the blend of key terms attributing to “palliative barriers” and “healthcare” assisted in acquiring the articles related to treatment constraints encountered by the medical professionals during the administration of healthcare interventions. Furthermore, a more focussed browsing strategy utilizing the key terms including UK women, healthcare and palliative barriers assisted in the acquisition of studies documenting the palliative care barriers encountered by the physicians, nurses and paramedical professionals in administering holistic and person-centred healthcare interventions to the population of interest. Forward citation technique is a systematic intervention deployed for assessing the content related to qualitative as well as observational studies in the research literature (Kuper, et al., 2006). The present study also utilized this forward citation intervention for acquiring the peer reviewed articles that might anticipate the palliative care challenges encountered by the women candidates across the residential settings. The process of backward snowballing was sequentially deployed with the objective of exploring various references in the research literature that might prove helpful in answering the question of interest (Choong, et al., 2014). For example, systematic studies related to the palliative barriers were explored and retrieved with the effective utilization of snowballing technique. We recursively pursued various evidence-based references related to the subject of interest and incorporated them for evaluating the study results. The scanning of various bibliographic databases was carried out in the evidence-based research literature for extracting the solution to the research question (NCBI, 2013). We also utilized automatic indexing intervention while surpassing the stop-words in citations of interest and effectively matching them with the search terms. The citations that closely matched with the search terms were selected and their respective articles were included in the systematic-analysis. Concomitant utilization of keyword search approaches with various evidence-based interventions assisted in the effective filtering of articles (containing systematic studies of interest) for their consideration in the results section. Blend of search terms (i.e. keywords) and alternative search terms were concomitantly utilized in searching the content of interest in the selected evidence-based databases. Complex Boolean search operators were utilized for combining various search terms with the concomitant utilization of search field qualifiers in accordance with the Entrez conventions(NVCBI, 2007). This search strategy proved highly beneficial in extracting the information regarding “palliative care barriers for home-based women in UK” in the clinical literature. A limited landmark study of the research articles (based on search terms) was performed for affirming their relevance and authenticity in relation to the systematic resolution of the research question. Interestingly this strategy assisted in the exploration of an important peer reviewed article that substantially emphasized the health disparities affecting the life of terminally ill patients(Aziz, et al., 2012). These findings assisted in retrieving conclusions regarding the evidence-based factors accountable for the inappropriate administration of palliative care approaches to the population of interest. Resultantly the possible modifications in palliative care systems and clinical practice modalities were suggested based on the retrieved authentic findings. Similar systematic studies and peer reviewed articles were taken into consideration while searching them through various evidence-based approaches for deriving the study results. A total of 350 research articles were explored for their inclusion in the research intervention; however, 250 articles could not fulfil the inclusion criteria and were therefore excluded from analysis. Indeed 75 articles only resulted in abstracts and their complete description was not available in the evidence-based literature. Eventually 10 articles qualified the study parameters and were solely utilized for answering the projected research questions.

Results and Discussion

The findings of the systematic studies evidentially indicate environmental restriction as the most significant barrier to the palliative care interventions warranted for the women individuals (Loeb, et al., 2011). This restrictive environment reduces the healthcare accessibility of women affected with various terminal conditions. This further aggravates the state of their helplessness and guilt that facilitate the development of psychosocial disorders among the affected females. Resultantly, healthcare professionals face challenges in gaining the trust and confidence of the depressed women in relation to the recommended therapeutic interventions. The absence of any well-defined curriculum for educating the nurse professionals for dealing with the process of death and dying makes the healthcare assessment entirely cumbersome in the residential setting(Hebert, et al., 2011). Indeed, physicians and nurse professionals fail to understand the individualized requirements of the women patients and just continue acting as gatekeepers of the healthcare information (Hebert, et al., 2011). Resultantly, sensitive needs and treatment challenges of the treated patients remain unresolved, thereby leading to the pattern of dissatisfaction among the terminally ill women patients. The findings of this systematic study reveal that the effective resolution of the fears and apprehensions of the terminally ill women patients regarding the pain medications is highly required for the systematic improvement in pain management outcomes (Wilkie & Ezenwa, 2012). The absence of desirable knowledge and skills regarding pain assessment techniques among nurse professionals is primarily responsible for decreased quality of palliative care interventions warranting administration to the women patients in the United Kingdom. Healthcare professionals need to prioritize the systematic administration of pain management interventions with the core objective of maintaining the quality of life and wellness outcomes of the treated women patients. Pain influences the terminally ill women patients in multiple dimensions. Therefore, the acquisition of thorough knowledge regarding these multiple dimensions among healthcare professionals is highly warranted for the improvement in behavioural and cognitive outcomes of the women patients. Evidence-based findings reveal the greater attention of healthcare professionals to painful episodes of the hospitalized patients as compared to the women patients attaining treatment in their residential confinements (Wilkie & Ezenwa, 2012). Resultantly, home-based women patients tend to develop debilitating co-morbid states that evidentially increase the criticality of their life-threatening diseases and associated clinical manifestations.

The results of the systematic analysis reveal the absence of advance care planning by the healthcare professionals while administering palliative interventions to the women patients. Indeed, the advanced care planning requires the thorough evaluation of the wishes, conventions, beliefs and desires of the terminally ill women patients to facilitate the process of their death and bereavement in accordance with their cultural and social requirements (Lund, et al., 2015). Advance care interventions require the administration in the manner to safeguard the dignity and physical comfort of the treated women patients. The physicians, nurses and other multidisciplinary medical professionals need to understand and ascertain that the preferences and choices of the patient’s family members should not be negotiated at any point of time during the process of treatment administration (Lund, et al., 2015). The advance care approaches need to ensure the requirement of preserving the existential perspectives of the women patients in relation to their end-of-life stage and associated self-loss. They must identify death perspectives in relation individual choices and preferences of women patients and facilitate the process of prospective decision-making between patients, their family members as well as medical professionals. The choices of the patients about the proposed medical interventions need consideration by the nurse professionals for reducing the predisposition of the treated patients in terms of developing loss of self-esteem, potential and capacity. Advance care strategies in the palliative care systems should take into consideration the rights of the family members of the treated women patients in terms of implementing their preferences regarding medical decisions. Healthcare professionals need to provide ample scope for the intervention of the legal guardians of the treated women patients for their spiritual remediation following the course of palliative healthcare administration. The palliative healthcare practitioners need to understand the requirement of taking decisions in the best interests of women-patients during the state of their incapacity and disability at any point of time during the treatment interventions.

The findings of this systematic study advocate the requirement of administering evidence-based interactional approaches for effectively treating the communicative and cognitive incapacity of the terminally ill women patients(Lund, et al., 2015). The home confined women patients fail to understand, identify and evaluate the credibility and advantages of the administered palliative approaches in the context of attaining wellness outcomes (Sommerbakk, et al., 2016). This leads to their deactivation and reduction in social competence that makes them more vulnerable towards acquiring health adversities under the influence of their terminal conditions in the home setting. The absence of leadership qualities in the healthcare professionals reduces the extent of their positive influence on the treated women patients during the administration of healthcare approaches. Therefore, healthcare professionals need to develop effective leadership qualities with the objective of developing face-to-face contact with the home-based terminally-ill patients in the context of gaining their confidence on the palliative interventions. Healthcare professionals need to develop adequate expertise, resources, facilities and structure for effectively influencing the cultural change in the terminally ill women patients (Sommerbakk, et al., 2016). The change in cultural perspectives is warranted particularly at those stages where the cultural influences deteriorate the desire of patients in terms of enhancing their quality of life and wellness outcomes under the influence of their debilitating clinical conditions. Indeed, in today’s scenario, the healthcare organizations across the United Kingdom lack a clear mandate, legislation and policy for the enhancement and stabilization of the state of health and wellness of the terminally ill women patients. Therefore, the periodic organization of educational sessions, meetings and conventions is highly necessary for gaining the understanding and insight of the healthcare challenges experienced by the terminally ill patients for their effective mitigation (Sommerbakk, et al., 2016). The healthcare professionals refrain from undertaking the systematic evaluation of the adverse general condition of the terminally ill women patients in their home care settings and resultantly, they just focus on the administration of conservative approaches for effectively controlling the symptomatologic-manifestations (Sommerbakk, et al., 2016). The healthcare professionals therefore, need to change their vision and patient perspectives while administering palliative care approaches and acquire the practice of holistic and person-centred approaches for relieving the somatic and psychosocial symptoms of the terminally ill patients in their home care settings.

The findings of the systematic study reveal that in real time palliative-scenarios in the home care setting, it becomes very challenging for the healthcare professionals in dealing with the state of denial, anger. Bargaining, depression and acceptance of the treated women patients (Hebert, et al., 2011). Highly frustrated terminally ill patients tend to exhibit the state of normalcy and straightforwardly deny their debilitating health status. They refrain from utilizing the medication interventions and acquire the state of major depression and associated clinical manifestations. The healthcare professionals find it extremely difficult to mitigate the psychosocial adversities experienced by the patients during their end-stage of life that further disrupts their disease manifestations. Women patients eventually experience the state of aggression that further aggravates their mental complications and reduces their quality of life in the home care setting(Hebert, et al., 2011). Patients attempt to negotiate for increasing their life-span in lieu of a reformed quality of life and acquire the illusion of attaining wellness outcomes through the administration of modified treatment approaches. Resultantly, the lack of accomplishment of these irrational objectives deteriorates the somatic and psychosocial condition of the terminally ill patients that further reduces their life expectancy in a real time scenario (Hebert, et al., 2011). Healthcare professionals often do not consider the deployment of motivational strategies for mitigating the state of psychosocial isolation experienced by the terminally ill women patients. The fear and sorrow of death and dying disconnects the terminally ill patients from their surroundings and they refrain themselves from exhibiting the state of affection with their family members (Hebert, et al., 2011). They remain predisposed towards the acquisition of panic attacks and neuropathic as well as spiritual pain that the healthcare professionals must mitigate for stabilizing the wellness outcomes of the terminally ill women candidates. The establishment of the state of acceptance and preparedness for death among the women patients is a very tough process and in real time scenarios, healthcare professionals lack adequate skills in preparing the patients for the process of death and dying. Indeed, nurse professionals must gain cultural competence in the context of understanding the beliefs and conventions of the treated women patients for preparing them towards the experience of a peaceful death process (Hebert, et al., 2011).

In real time scenarios, the healthcare professionals face numerous challenges while administering social care to the terminally ill women patients (Dhiliwal & Muckaden, 2015). The lack of societal norms, policies and conventions (regarding the level of care and interaction required for the terminally ill patients) warrants the requirement of configuring community-based palliative interventions particularly for women patients in home-based settings for the systematic enhancement of their wellness outcomes. Community-based approaches advocate the organization of support programs and evidence-based palliative care systems with the objective of administering coping interventions for the terminally ill women patients (Dhiliwal & Muckaden, 2015). The administration of evidence-based coping strategies assists the treated patients in terms of resolving their interpersonal conflicts for the effective enhancement of their psychosocial, mental and wellness outcomes. The psychosocial burden experienced by the family members of terminally ill women patients proves to be the biggest hindrance in the systematic enhancement of their healthcare outcomes. This negative burden demotivates the family members and they aspire for not providing the required healthcare support to their terminally ill women patients because of the economic and psychological constraints (Dhiliwal & Muckaden, 2015). Therefore, healthcare professionals need to counsel the family members of the treated patients while elevating their knowledge and insight regarding the prognosis of the life-threatening conditions. They must consistently share information regarding the proposed healthcare strategies with the family members (of the patient) and facilitate their spiritual enhancement and integrity towards their terminally ill patient. Healthcare professionals sometimes experience challenges in utilizing the home based palliative care approaches for the systematic transformation of the terminally ill patients towards the acquisition of hospice care as per the treatment requirements (Dhiliwal & Muckaden, 2015). Therefore, palliative caretakers require the effective engagement of family practitioners while extending care and treatment to terminally ill patients in their homes for improving treatment outcomes. The findings of this systematic study reveal that the facilitation of the state of good health in terminally ill women patients is practically not feasible; however, stabilization of their symptoms to an optimum extent is possible with the administration of evidence-based palliative approaches. The greatest objective of undertaking palliative care approaches attributes the elevation of patient’s level of satisfaction in relation to the treatment outcomes. The terminally ill women patients tend to lose every hope of living and contentment and therefore, the healthcare professionals experience psychosocial barriers while convincing them towards acquiring an improved quality of life across the community environment. Physicians need to exhibit regard for the death options chosen by the terminally ill patients and should not enforce the administration of life-saving interventions against the will and desire of the patient during the end-stage of her life, in accordance with the advance care directives. Healthcare professionals must configure evidence-based healthcare goals for the terminally ill patients and attempt to positively influence their end-of-life care decisions in the home-based setting (Halpern, et al., 2013). Healthcare professionals must prioritize the facilitation of the comfort level of the terminally ill women patients over the enhancement of their life expectancy. They must attempt to systematically empathize with the treated patients with the objectives of systematically accomplishing their healthcare goals in the home care setting.

The biggest barrier encountered in the facilitation of quality of life of terminally ill women patients in the United Kingdom attributes to the aggressive invasive treatment interventions (Nevadunsky, et al., 2014). The patients affected with gynecologic malignancies need extended family support and remedial interventions for effectively resisting the disastrous effects of the chemotherapy interventions administered for treating the metastatic status of the women patients. The elevated cost incurred in treating the life-threatening malignancies in women candidates consistently their psychosocial health and the increasing financial burden predisposes them towards the development of suicidal ideation and associated debilitating outcomes (Nevadunsky, et al., 2014). Medical professionals sometimes develop negative attitudes against the dying patients and focus solely on the administration of conservative approaches warranted for reducing the progression of the terminal condition (Nevadunsky, et al., 2014). This indicates the requirement of organizing educational sessions for the treating healthcare professionals with the objective of changing their treatment approaches and thought processes for the terminally ill patients. The administration of multidisciplinary treatment interventions for women candidates is highly necessary for the administration of concurrent care in the home-based environment (Nevadunsky, et al., 2014). Healthcare professionals require implementing optimal treatment protocols and must effectively collaborate among themselves by exploring the best available palliative approaches for the radical improvement in patient outcomes. Palliative care experts require a thorough understanding of the patient characteristics while administering healthcare interventions warranted for improving the treatment outcomes of the terminally ill women patients. The exploration of living standard, quality of life and the pattern of committed relationship of the female patients is highly required for the effective customization of healthcare interventions in accordance with the disease manifestations and associated treatment requirements. Women patients pertaining to the ethnically backward background require additional attention and palliative care efforts for enhancing their wellness outcomes. The terminally ill women patients of various age groups also need uninterrupted accessibility to healthcare services during medical emergencies (Nevadunsky, et al., 2014). The administration of palliative interventions while ignoring the urgent care requirements of the terminally ill women patients decrease their level of compliance and trust on the available remedial approaches. The clinical findings in (Duska, 2016) indicate the high predisposition of health adversities experienced by the terminally ill women affected with the pattern of epithelial ovarian cancer. These health adversities exhibit minimum improvement despite the administration of palliative approaches during the advance stage of ovarian cancer. Therefore, healthcare professionals need to integrate palliative remedial strategies (at an early stage) with the conservative treatment methodology warranted for treating the progression of ovarian cancer. Medical practitioners rarely practice integrated palliative care (IPC) approaches while extending care and treatment to the women patients who have acquired the pattern of cancers and associated debilitating manifestations(Beek, et al., 2016). Therefore, the effective administration of IPC techniques in the home care setting proves to be a dynamic remedy warranted for increasing the life expectancy as well as quality of life of the treated women candidates. The administration of IPC intervention in the home care setting improves the continuity of care and systematically facilitates the "dying-process" in collaboration with the caregivers as well as the patient’s family members (Beek, et al., 2016).

Conclusion:

The presented research intervention identified and evaluated the systematic studies available in evidence-based research literature for the effective exploration of barriers encountered by healthcare professionals while administering palliative care interventions to the home-based women patients in the United Kingdom. The study attempted to investigate the remedial interventions warranting deployment in the healthcare sector for overcoming the palliative care barriers for the women patients. The research findings also suggested the best practice care models and modifications in the existing palliative care systems for the enhancement of the quality of life and wellness outcomes of the terminally ill women candidates in the home care setting. The biggest obstacle in administering palliative care approaches to the terminally ill women patients’ attributes to the lack of palliative care knowledge among the healthcare professionals. Healthcare professionals need to advocate the following the guidelines stipulated by the National Institute for Health and Care Excellence for effectively mitigating the treatment challenges and accomplishing the individualized requirements of the terminally ill women patients. Indeed, the configuration of an effective therapeutic relationship with the treated patients is highly required by the healthcare professionals for evaluating the fears and concerns of the patients in relation to the recommended therapeutic interventions. Healthcare professionals need to effectively empathise with the terminally ill patients for understanding their beliefs, perceptions, cultural conventions and apprehensions in relation to the palliative care as well as other treatment approaches. Effective understanding of these attributes assists in customizing palliative-care strategies (for the terminally ill women patients) in the home care setting. The absence of public awareness regarding the palliative treatment approaches is another big hurdle encountered by the healthcare professionals while serving the terminally ill female patients. Therefore, the organization of education sessions and campaigns is highly warranted with the objective of improving the knowledge base as well as an acceptance level of the common masses in relation to the effectiveness and authenticity of palliative approaches in the home-based setting. The analysis remained limited in terms of the selected systematic studies utilized for answering the research questions. The weakness of this research study attributes to the selection of qualitative (systematic) studies executed for investigating various concepts and conventions regarding the palliative model of healthcare interventions. The limited analysis of palliative care data leads to the configuration of questionable findings requiring further investigation through the execution of prospective research interventions on a larger scale.

The systematic analysis advocates the requirement of undertaking environmental modification for improving healthcare outcomes of the terminally ill patients. The terminally ill women patients treated in a restrictive environment fail to respond appropriately to the administered treatment and develop psychosocial manifestations. The study findings evidentially reveal the requirement of improving the level of trust and confidence of the terminally ill patients on the proposed palliative as well as treatment interventions. Healthcare professionals should therefore, refrain from merely becoming the gatekeepers to healthcare information and attempt to enhance the level of awareness of terminally ill patients regarding advantages of palliative remedial approaches. The preliminary objective of palliative approaches attributes to the enhancement of the level of satisfaction of the terminally ill patients in relation to the administered therapeutic approaches and treatment interventions. The nurse professionals as well as physicians need to acquire knowledge and skills regarding pain assessment of the terminally ill women patients and must undertake evidence-based measures for effectively controlling the pattern of their psychosocial, somatic and spiritual pain. Identification of multiple pain dimensions is highly necessary for the healthcare professionals for reducing the predisposition of the terminally ill patients in relation to the acquisition of adverse cognitive and behavioural outcomes. Healthcare nurse professionals must practice advance care directives while configuring healthcare goals for the women patients affected with life threatening conditions. Advance care strategies focus on the safeguarding of dignity and respect of the treated patients while concomitantly reducing their physical and mental discomfort. These techniques assist in improving the level of self-esteem and confidence of the terminally ill women candidates. The perspectives and beliefs of the terminally ill patients require consideration by healthcare professionals while giving due weight-age to their healthcare choices in the home-based setting. The culturally appropriate, holistic, person-centred and community-based palliative care strategies require integration with the conventional treatment modalities for effectively controlling the adversities experienced by the terminally ill women patients under the influence of their debilitating symptomatology. Physicians and nurses must evaluate the adverse general condition of the treated patients and accordingly customize their treatment interventions for the systematic enhancement of their wellness outcomes. The implementation of palliative care strategies on a wide scale requires the collaborative efforts by the multidisciplinary healthcare professionals with the objective of substantially reducing the intensity of the sufferings by the terminally ill patients while providing them various healthcare options for improving their quality of life. The streamlining of the end-of-life stages of terminally ill patients is the greatest barrier requiring evidence-based mitigation for comforting their lives across the community environment. The improvement in the life-expectancy and reduction in adverse symptomatology of the terminally ill women patients requires the evidence-based deployment of integrated palliative strategies by the healthcare professionals.

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