Palliative care is an important aspect of healthcare, which seeks to improve the health-
related quality of life of individuals with incurable diseases. Accordingly, the intervention
includes symptom control and support for psychological and emotional wellbeing. Palliative care
is an area of personal interest since I work with geriatric patients in a long-term care facility.
Understanding palliative care would enable me to serve patients better and ensure they enjoy a
high quality of life despite their debilitating health conditions. Additionally, it would ensure
sufficient utilization of palliative care since many healthcare professionals wrongly associate it
with end-of-life care.
The long-term care facility is located in Jamaica, Queens, New York. Accordingly, it is
an urban inpatient setting. Among the geriatric population, the most common illnesses are
hypertension and diabetes. The disease of interest for this discourse is pulmonary arterial
hypertension (PAH). This form of hypertension develops when the arteries in the lungs become
thick and narrow, thus blocking the flow of blood through the lungs. The disease is characterized
by symptoms such as increased shortness of breath, chest pain, fatigue, edema, and heart
palpitations (American Lung Association, n.d.). The symptoms are similar to those of other lung
diseases such as chronic obstructive pulmonary disease and asthma. PAH does not have a cure.
At end-stage PAH, a patient lacks therapeutic alternatives. Additionally, the features of the right
ventricle, both hemodynamic and echocardiographic, indicate that the heart is starting to fail
(Farber et al., 2016). Therefore, treatment revolves around controlling symptoms and improving
the patient’s quality of life. According to Khirfan et al. (2018), PAH patients have poor long-
term survival, with 50 percent mortality at 7 years. This is despite the existence of
pharmacological therapies that help manage PAH patients. The medication delays the disease’s
progression rather than curing it. In a significant percentage of PAH patients, the disease will
progress and culminate in right heart failure and death (Khirfan et al., 2018). Additionally, some
of the medications used to treat patients with PAH cause adverse effects that affect the health-
related quality of life of the patients. These factors make PAH patients perfect candidates for
palliative care to accompany PAH-specific pharmacotherapy.
Palliative care demands the use of an interdisciplinary team to cater to the wide range of
demands of patients. The different team members offer their expertise, thus ensuring the
successful management of symptoms and appropriate socioemotional support. The general
practitioner caters to the patient’s day-to-day health care issues. The physician also liaises with
the palliative care specialist to ensure coordination of care and for help with complex medical
needs. Additionally, they provide referrals to therapists in case the patient or caregiver suffers
from emotional distress. The palliative care specialist is the second key member of the team
since they recommend treatment for symptoms such as pain, nausea, and shortness of breath. The
specialist also assists in decision-making about care and treatment options. A counsellor or
psychologist is also an important member of the palliative care team since patients struggle with
mental and emotional issues. The counsellor helps palliative patients and their caregivers open
up about their feelings and worries. The former then teaches the latter coping strategies to deal
with the distress and introduces them to meditation exercises to help them ease physical and
emotional pain. Besides the counselor, the team also includes a pastoral carer. The carer helps
patients deal with spiritual matters and help them find meaning amid their health complications.
In some cases, they offer religious rituals to help the patient feel at ease. Social workers are also
an integral component of the palliative care team. They assess the social support that a patient
needs and make necessary arrangements through referrals for financial care, meal services, and
aged care services. Additionally, they communicate with the patient’s family members to inform
them about their state and to formulate care goals. For older patients who are in the end stage of
PAH, an occupational therapist joins the team. The occupational therapist helps patients manage
various aspects of their daily activities such as walking and bathing. Additionally, they help
patients acquire necessary physical aids to help them maintain a desirable quality of life. Nurses,
such as myself, connect the team ecosystem, helping whenever needed by any of the team
members. This includes providing telephone support to patients.
Symptom management for PAH involves invasive interventions and non-invasive
medical therapy. Invasive interventions include atrial septosomy, right ventricular assist devices,
and pulmonary artery denervation. The invasive procedures seek to alleviate the harm caused by
the disease to the cardiac and pulmonary systems. In the case of atrial septosomy, a hole is made
between the left and right atria, thus allowing for the decompression of the right side of the heart.
According to Khirfan et al., (2018), the intervention may improve symptoms and survival rates
in patients. The placement of a right ventricular assist device, on the other hand, increases
pulmonary blood flow and decreases pressure in the right atrium. Non-invasive symptom
management involves pain control, PAH-specific pharmacotherapy, and management of
shortness of breath and nausea. The palliative care team can manage a patient’s pain using both
opioid and non-opioid-based medication. Fatigue may be improved by medication to boost
energy while anorexia could be managed by administering medication to increase appetite. PAH
medication is important in symptom management. Vasodilators relax blood vessels thus
improving blood flow, guanylate cyclase stimulators lower pressure within pulmonary arteries,
while endothelin receptor antagonists reverse the damage caused by endothelin (Pulmonary
Hypertension Association, n.d.). In patients with stages III and IV of the disease, lung
transplantation is recommended (Farber et al., 2016). However, management of symptoms
continues as the patient awaits transplantation.
Palliative care extends beyond caring for the patient. The patient’s family suffers from
distress, therefore making it necessary to provide care to them too. Healthcare organizations
provide such comprehensive care through interdisciplinary palliative care teams. For family
members socioemotional support is necessary. Therefore, counsellors, pastoral carers, and social
workers play a key role in caring for the patient’s family. The professionals help the family come
to terms with the condition of the patient and recommend various coping strategies. In palliative
care, healthcare professionals should strive for cultural competence (Mazanec & Panke, 2015).
This would ensure that they consider the patient’s and family’s belief system when formulating a
plan of care. The rationale behind this is to ensure that care is responsive to the patient’s culture.
Cultural competence also helps avoid legal and ethical issues. An example of the latter is a case
where one of my coworkers was confronted by a patient’s family for including meditation in the
plan of care. The family argued that pastoral care conformed to their beliefs but meditation did
not. Despite knowing the benefits of meditation to the patient, my coworker had to remove
meditation from the plan of care. It is important not to go against the wishes of patients and their
families. Since the problem in the scenario was cultural competence, the organization provided
support by enrolling all personnel in cultural competence classes. Additionally, the in-house
counselor provides mental and emotional support for staff, thus making such scenarios bearable.
For healthcare professionals willing to work in palliative care, one should be a natural
caregiver. They will encounter patients in severe pain regularly. Therefore, compassion and
empathy are key. It is easy to burn out and experience compassion fatigue while working in
palliative care. Therefore, I recommend emotional coping strategies such as mindfulness and
meditation to ensure one does not lose sight of why they work in palliative care.
American Lung Association (n.d.). Pulmonary arterial hypertension symptoms and diagnosis.
Farber, H., Sitbon, O., Crespo, M., & Frost, A. (2016). Dealing with end-stage pulmonary
arterial hypertension. Advances in Pulmonary Hypertension, 15(1), 45-50.
Khirfan, G., Tonelli, A. R., Ramsey, J., & Sahay, S. (2018). Palliative care in pulmonary arterial
hypertension: an underutilised treatment. European Respiratory Review, 27(150).
Mazanec, P., & Panke, J. T. (2015). Cultural considerations in palliative care. In Spiritual,
Religious, and Cultural Aspects of Care. Oxford University Press.
Pulmonary Hypertension Association (n.d.). Treatments.