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Introduction of Biography And Narrative In Palliative, Supportive And End Of Life Care Assignment
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1.1. Introduction
Palliative care is referred to as exclusive medical care for those people living with some critical illness such as heart failure or cancer. The aim of the study is to assess the utilisation of narrative methods in palliative care. The patients in "palliative care" obtain medical care for the symptoms along with the treatment that tends to cure the critical illness. The study critically focuses on multiple aspects of palliative care based on the utilisation of narrative methods. In the study, mainly the cancer patients in palliative care are focused to assess the study facts. Palliative care is demonstrated as person-centred care where the carers are immensely valued and obtain the care they require.
1.2. Rationale
In palliative care, national health systems and policies are not included and the other issue with palliative care is often non-existent and limited. As opined by Roikjær et al. (2019), palliative care is an extremely useful approach that develops the life quality of patients and their families who are experiencing issues with life-threatening illnesses. However, many issues arise with the approach of palliative care where certain facts must be considered. Access to the population in "opioid pain relief" is not enough and fails to fulfil any international conventions on accessing important medicines (Green et al. 2018). Other than the issues of palliative care, the people who are suffering from the symptoms of serious pain and difficulty are in the requirement of palliative care.
Palliative care and pain management
(Source: Tarberg et al. (2019)
The survey conducted by WHO concerning communicable diseases was conducted among 194 member states in 2019. The outcome is that 68 per cent of the countries are funded for palliative care and approximately 40 per cent of the countries have reported that services require half of the patients are in need (Who, 2022). There are other barriers or issues associated with palliative care including lack of awareness among policymakers, cultural and social barriers, and misconceptions of palliative care. One of the most significant issues in palliative care is communication lack between the team of healthcare where lack of knowledge regarding the policies and practices is the main reason for the emergence of the issue.
1.3. Definitions
Narrative technique in the healthcare system comprises identities and histories and the methods are carefully structured processes and prompts that elicit stories in patterns that positively affect healing and healthcare. As mentioned by Tarberg et al. (2019), palliative care helps in relieving the pain of patients and addressing spiritual and emotional concerns and those of the caregivers. Palliative care develops the life process and quality during the illness. The approach of palliative care focuses on the relief and prevention of suffering through treating and assessing pain and other psychological, spiritual or physical issues (Gardiner et al. 2018). Palliative care in “end of life care" comprises caring for people in the last stage of life which is difficult to assume. It mainly focuses on and assists people to love and possibly die with respect and dignity. Palliative care works on main five principles
- It does not postpones or hasten deaths
- It gives relief from painful and distressing symptoms.
- It claims to die as a normal method and affirms the subjectivity of life.
- It integrates the spiritual and psychological aspects of care.
- Palliative care through a narrative approach presents a support system to assist patients to live as actively as probable until death.
1.4. Approach used in the assignment
In this study, the narrative approach is utilised to assess the facts of palliative care where dignity therapy and narrative-based medicine are utilised. I have observed that the approach of dignity therapy is utilised in managing distress in patients having brain tumours. In the study, Dr Claire has mentioned that Dignity therapy is an intervention approach to minimise the level of psychological distress and develops the quality of life quality (Youtube, 2022). I have comprehended that the approach of dignity therapy was made by Dr Harvey Chochinov whose intention was to eliminate the existential stress of ill families and patients. The narrative-based medicine has been introduced in the lecture which states that the providers of healthcare strive in getting an in-depth comprehension of emotions and experiences that are likely to have impacted the health of every patient (Youtube, 2022). I believe that the patients of palliative care can be well treated with narrative-based medicine and can gain a better approach to life.
2. Narrative method in palliative care
2.1. Overview of the range of processes and understanding for distinct purposes
Palliative care utilises the team approach to aid the caregivers and patients including addressing the practical needs and giving counselling on bereavement. Biography and narrative are referred to as the umbrella term that comprises different activities and techniques. For instance: oral history, narrative medicine and many more. As opined by Datla et al. (2019), the narrative and biography approach in healthcare is utilised which centres on meanings that people explain in experiencing and obtaining the insight into lives complexity. The approaches and processes in palliative care in healthcare are enormously important and have the aim of assisting the patient and everyone impacted by the illness to accomplish the best life quality that is family and patient-centred.
The biographical approach in healthcare and palliative care gives older people chances to talk about their experiences. The biographical approach generally tends to focus on processes for interpreting and generating stories of the lives of individuals (Bloomer and Walshe, 2020). In the videos, the stories of people and doctors are portrayed regarding palliative care. On the other hand, the narrative approach utilises the language and words in palliative care with the motive to open minds to new experiences and interpretations from the storyteller's perspectives. As cited by Ross et al. (2020), narrative techniques or approaches assist in providing a new manner to assist the individual in reshaping the negative experiences including the techniques of narrative therapy. Both the approaches have different perspectives and different purposes to focus on. In palliative care, the processes or approaches share the personal comprehension of living with the illness that is life-threatening and illness place in the life of an individual.
2.2. Illustration of narrative method
In this study, a narrative approach to palliative care is used as it provides more benefit to the healthcare system. The narrative approach or therapy is goal-directed and patient-centred. It is extremely useful to utilise the personal experiences dealing with the families or terminal illnesses are given that this therapy type is based on the experience of the individual in his or her situation. As opined by Scott et al. (2020), the main motive of this therapy is to assist the individual to develop the self sensor and their connection with themselves. The narrative approach and therapy assist in separating the problematic experience, a single person has away from their recognition.
The intervention of this narrative therapy technique can support families and patients in their development spiritually. The narrative approach or technique assists them in reclaiming life and what it means at the moment in period regardless of the advanced stage of their career. Narrative therapy or technique assists the individual suffering from trauma, anxiety and pain to change their attitude towards the "end of life" by primarily transforming the language of their own experience while at the life end (Kilbertus et al. 2018). For instance, I have experienced trauma and nervousness while doing any professional work. I struggled to fall asleep and realised I had panic attacks. I used to fear that I was disappointing my parents in real life and I was ashamed due to fear and anxiety. But narrative therapy works for me when I have the opportunity to rewrite the story. It works extremely well and I feel relaxed in looking at my past experiences and getting rid of them.
2.3. Evaluate the purpose and meaning of social processes
Social processes are mentioned in the social interaction form that emerges repeatedly. The people in these manners interact and form social relationships with each other. As mentioned by Disalvo et al. (2021), the purpose of social relationships works for the benefit and solidarity of the society which includes accommodation, assimilation, cooperation and acculturation. Social processes and relationships are mentioned as the repetitive behaviour forms which are commonly searched in social life. The interaction socially generally emerges in the accommodation form.
Issues with the end of life often emerge including internal conflicts with religion and spirituality. Often families or patients decide to revisit their trust if they are far away from it. Implementing the news of interventions of narrative therapy and diagnosis creates a meaningful terminal illness and end of experiences of life (Dunleavy et al. 2018). The new intervention type after a certain experience of trauma assists in bringing a new pattern of life when they have a sense of peace. Narrative therapy provides immense benefit to the patients of palliative care by making a shared story at the end of a closed one's life. It assists in curtailing the maladaptive coping phenomenon post-death during loss and grief.
Narrative intervermtion within palliative care setting
(source: Kendall et al. 2018)
Narrative therapy assists in changing the attitude and behaviour which assist the cancer patients to view their diseases and how they recognise "outside the disease", "depression lessens" and "ongoing anxiety" over time. As opined by Kendall et al. (2018), life quality, esteem and overall mental health development as a result of narrative therapy. I believe that narrative therapy is extremely beneficial in palliative care that one must look upon. I have evaluated the recordings and understand that the narrative approach or therapy provides a unique technique to approach the pain from the point of view of the patient. The approach claims that patients are empowered by listening to two different perspectives of their self-story with double listening facilitation by the therapists (Wierstra et al. 2022). I believe that narrative therapy has assisted the patients to have better-regulated emotions and assisted their overall psychological well being.
Strengths and weaknesses of the narrative method
|
Narrative method
|
Strength
|
Weaknesses
|
|
? Change the issue
? It's about changing the problem not the individual
|
? Little Scientific research
? No absolute truth in life
? Unique needs are different from each other
? Limitation of trauma leads restrict the intellectual, cognitive and language skills
|
Table 1: Strength and weaknesses of narrative method
(Source: Wierstra et al. 2022)
2.4. Issues with the narrative method
Many scientists and critics assume that narrative therapy often possesses some ethical issues. The validity of the story is not checked and thorough as one can make the story to let others feel relaxed and empowered. It can be an issue that people can fail to memorise the past event and experiences and retell it to overcome the barriers or issues. According to the view of Santarpia et al. (2021), the representation of the story may be fake and offensive which may lead to more depression. The issues with narrative therapy are more prevailing and significant. However, in palliative care, the narrative approach and therapy have proved to be beneficial most of the time.
3. Conclusion
Based on the above study, it can be comprehended that Palliative care develops life and its quality for a better and healthier future. Families and patients that are suffering from life-threatening diseases often consult with palliative care to get a better life and resolve their issues thoroughly. Dignity therapy and narrative-based medicine are extremely essential in the treatment of patients experiencing life-threatening diseases.
I agree with the statement that narrative care assists in the development of one's life for a better cause. I feel that the patients and families may make a meaningful life and empower themselves with joy and happiness. It leaves them feeling more relaxed and free with an enriched sense of happiness and the most vulnerable period in life. I think that the narrative method has the limitation that no assumptions are true. However, in my opinion, the narrative method with a false story can make somebody's life better.
Oral history often helps the people in trauma to come out from the fear and anxiety and live healthy with narrative therapy or approach. It is also obtained from the overall study that early palliative care delivery minimises the unnecessary hospital admissions and utilisation of health services. Palliative care comprises a broad range of services that have equally significant roles to play comprising nursing, physicians, and supporting workers in support of the family and patients.
References
Journals
Bloomer, M.J. and Walshe, C., 2020. ‘It’s not what they were expecting’: A systematic review and narrative synthesis of the role and experience of the hospital palliative care volunteer. Palliative medicine, 34(5), pp.589-604.
Datla, S., Verberkt, C.A., Hoye, A., Janssen, D.J. and Johnson, M.J., 2019. Multi-disciplinary palliative care is effective in people with symptomatic heart failure: a systematic review and narrative synthesis. Palliative medicine, 33(8), pp.1003-1016.
Disalvo, D., Agar, M., Caplan, G., Murtagh, F.E., Luckett, T., Heneka, N., Hickman, L., Kinchin, I., Trethewie, S., Sheehan, C. and Urban, K., 2021. Virtual models of care for people with palliative care needs living in their own home: A systematic meta-review and narrative synthesis. Palliative Medicine, 35(8), pp.1385-1406.
Dunleavy, L., Walshe, C., Oriani, A. and Preston, N., 2018. Using the ‘Social Marketing Mix Framework’to explore recruitment barriers and facilitators in palliative care randomised controlled trials? A narrative synthesis review. Palliative Medicine, 32(5), pp.990-1009.
Gardiner, C., Ryan, T. and Gott, M., 2018. What is the cost of palliative care in the UK? A systematic review. BMJ supportive & palliative care, 8(3), pp.250-257.
Green, E., Knight, S., Gott, M., Barclay, S. and White, P., 2018. Patients’ and carers’ perspectives of palliative care in general practice: a systematic review with narrative synthesis. Palliative Medicine, 32(4), pp.838-850.
Kendall, M., Cowey, E., Mead, G., Barber, M., McAlpine, C., Stott, D.J., Boyd, K. and Murray, S.A., 2018. Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study. Cmaj, 190(9), pp.E238-E246.
Kilbertus, F., Ajjawi, R. and Archibald, D.B., 2018. “You’re not trying to save somebody from death”: learning as “becoming” in palliative care. Academic Medicine, 93(6), pp.929-936.
Roikjær, S.G., Missel, M., Bergenholtz, H.M., Schønau, M.N. and Timm, H.U., 2019. The use of personal narratives in hospital-based palliative care interventions: an integrative literature review. Palliative Medicine, 33(10), pp.1255-1271.
Ross, L., Danforth, C.M., Eppstein, M.J., Clarfeld, L.A., Durieux, B.N., Gramling, C.J., Hirsch, L., Rizzo, D.M. and Gramling, R., 2020. Story arcs in serious illness: natural language processing features of palliative care conversations. Patient education and counseling, 103(4), pp.826-832.
Santarpia, A., Ricci, T., Meuche, G., Gamberini, N. and Destandau, M., 2021. The narrative effects of shamanic mythology in palliative care. Journal of Humanistic Psychology, 61(1), pp.73-103.
Scott, M., Shaver, N., Lapenskie, J., Isenberg, S.R., Saunders, S., Hsu, A.T. and Tanuseputro, P., 2020. Does inpatient palliative care consultation impact outcomes following hospital discharge? A narrative systematic review. Palliative medicine, 34(1), pp.5-15.
Tarberg, A.S., Kvangarsnes, M., Hole, T., Thronæs, M., Madssen, T.S. and Landstad, B.J., 2019. Silent voices: Family caregivers' narratives of involvement in palliative care. Nursing open, 6(4), pp.1446-1454.
Wierstra, I.R., Liefbroer, A.I., Post, L., Tromp, T. and Körver, J., 2022. Addressing spiritual needs in palliative care: proposal for a narrative and interfaith spiritual care intervention for chaplaincy. Journal of Health Care Chaplaincy, pp.1-14.
Websites
Who, 2022. About Palliative care. Available from; https://www.who.int/news-room/fact-sheets/detail/palliative-care [Accessed on: 6th May, 2022]
Youtube, 2022. About Dignity therapy. Available from: https://www.youtube.com/watch?v=OTDZ89yReiI [Accessed on: 6th May, 2022]
Youtube, 2022. About Honouring the stories of illness | Dr. Rita Charon | TEDxAtlanta. Available from: https://www.youtube.com/watch?v=24kHX2HtU3o [Accessed on: 6th May, 2022]
