The medical elements may include
2.9 Integrated Team In Palliative Care
2.9.1 Specific Roles Of the Integrated Team Members
• Role of the Medical Practitioners
Medical practitioners are involved with diagnosis, prognosis, symptom
prevention, design of treatment plan, education and communication with staff, patient, and family regarding status and response to treatment.
Consulting physicians are responsible to primary medical providers and should work as part of the team. Specialists may include psychiatrists, ophthalmologists, neurologists, dermatologists, oncologists, gynecologists, orthopedists, or
providers of any other specialist service (Kutzen, 2003:448).
• Role of The Palliative Nurse
The primary role of the nurse is to assist the patient in coping with the effects of advancing HIV disease. This includes attention to some of the most personal and intimate aspects of physical care, pain and symptom assessment and management, personal care such as bathing, control of odor, care of pressure areas, mouth care, bowel and bladder care, as well as patient and family education on anticipated care needs.
Research findings in New South Wales, Australia, (Taylor, Glass et ai, 1997: 253), revealed that palliative nursing is also about:
Dealing with death, which is an inescapable part of palliative nursing.
Making connections with patients and their families, thereby ensuring that a special bond exists between the nurses themselves and their patients.
Making realistic contracts with dying people and attempting to fulfill them, for example, making a contractual arrangement with a patient in not letting him suffer.
Acting as an advocate by communicating with other people on the patient's behalf.
Building interpersonal relationships by taking time to build the relationship, by developing trust and rapport, and through bonding and getting close.
Facilitating support through the engagement of the family in the care and support of their loved one.
Being involved in issues, such as what was going to happen to the dying patient, dealing with feeling personally responsible for covering all the work that needed to be done.
• Role of Pharmacists
Pharmacists assist medical practitioners with adjusting the doses of medication to reduce side effects, provide new information to the team, and educate patients and families about medication plans. They can thus form an integral part of the multi-disciplinary team (Kutzen, 2003:451).
• Role of Physiotherapists
The role of the physiotherapist is to provide physical assessment, education for patients and caregivers, and assistance in helping patients to stabilize gait and be mobile. As patients are living longer with HIV, more patients are living with neuromuscular deficits for longer periods of time. The role of the physiotherapist is more to maximize the patient's physical agility as a result of diminishing
physical health rather than to improve function (Kutzen, 2003:451).
• Role of Religious Workers
Illness is a major life event that can cause people to question themselves, their purpose and meaning in life. Palliative care has long recognized that, in addition to physical and psychological symptoms, patients with advanced illness will suffer existential distress as well.
Existential distress deals with questions regarding the meaning of life, the fear of death, and the realization that they will be separated from their loved ones.
These issues take on greater importance in HIV/AIDS because of the stigma and judgment that still accompany people living with this disease. Spirituality plays a
critical role in helping people to cope with their suffering, becausethe relationship with a transcendent being can give meaning and purpose to people's lives, to their joys and to their sufferings (Puchalski, 2003: 290).
The concept of spirituality is often poorly understood within health care. It is still viewed as being closely linked with religion and should therefore be addressed by chaplains. Palliative nursing care in the 21stcentury means embracing body, mind and spirit and is not limited to religious practices only. Health professionals therefore need to become more involved with the existential issues of living with a chronic illness. Research in the United States in 1997 (Wilkinson, 2000:4) revealed that 40% of respondents expected their doctor to discuss spiritual issues with them if they were seriously ill. Nurses spend moretime with the terminally ill patients than most. They should, therefore, be involved in speaking the language of spirituality as part of their communication during episodes of care.
• Role of Psychologist
Psychological care is concerned with the psychological well being of the patient and their family and the provision of general emotional care and support. It is concerned with enabling the individual to express thoughts, feelings and
concerns relating to illness, assessing individual needs and resources for coping, and ensuring that appropriate psychological support is available. A range of planned and informal interventions may be used, for example, communication skills to elicit concerns and to provide supportive care, counseling to facilitate reflection upon the illness experience, and specific psychological interventions to relieve anxiety or depression. Psychological care and supportshould be
available at all times (Payne & Haines, 2002: 242).
• Role of the Social Worker
The goal of social work in palliative care is to help the patient and family deal with the personal and social problems of illness, disability and impending death, and to provide survivor skill-building and support. Social Workers assess many important areas of need for both patient and family, and help the family develop realistic plans for the present and the future. The strengths and challenges of each family unit are assessed and referrals made to available resources (Kutzen, 2003:449).
Social workers also assess cultural and socio-cultural factors unique to the patient and family, such as traditional medicine or alternate healing practices in the home.
Social workers assist when there is dysfunction within the family, for example, drug and alcohol abuse are common within HIV care.
One of the most important roles of social workers is advocacy on behalf of the patient and family (Kutzen, 2003:449).
• Role of Nutritionist
Nutritionists work with patients in all stages of the HIV disease, but are most needed in the terminal stages as both weight loss and malnutrition increase as the HIV disease progresses. Nutritionists can provide nutritional counseling and advise on nutritional supplements and appetite stimulants when this is needed.
Nutritionists can be valuable team members in discussions of the pros and cons of end-of-Iife nutrition and hydration (Kutzen, 2003:450).
Each team member has particular expertise in his/her own field. However, all members share the responsibility for advocacy, enabling, support, truthfulness and mediation to prevent crises, minimize suffering and ensure that the patient and family remain the focus of care (Kutzen, 2003:447).