Introduction
The experience of grief, loss, or bereavement can be debilitating. According to the Australian Center for Grief and Bereavement (2018), an individual’s experience of grief in the spiritual, emotional, cognitive, and physical domains varies depending on cultural influences, belief systems, and gender. The aging population in Australia, like many other developed countries, has increased significantly. In the last fifty years, the number of people aged 65 and over has tripled, with estimates placing the number at 3.4 million in 2014 (Parker et al., 2018). Approximately 80% of the people who lost their lives between 2010 and 2011 and were over 65 years of age used care services in the eight years preceding their death (Parker et al., 2018). It is evident that the provision of care services is essential in the Australian context. Social factors play a critical role in determining the efficiency with which healthcare professionals provide palliative care to individuals with terminal diagnoses.
Palliative Care
Advances in medical treatments for chronic conditions mean that a larger number of people with the aforementioned illnesses, and are in need of palliative care services. Patients receive palliative care for varying durations depending on the identified needs. Palliative care is defined as a set of holistic care services that help individuals nearing the end of their life to live as comfortably as possible for a long period (Australian Government, 2018). The World Health Organization defines it as a care process that “supports the physical, emotional, social, and spiritual needs” of an individual diagnosed with a life-threatening illness, their carers, and family (Gravier et al., 2019). It is a care approach that enhances the quality of life of patients as they face the challenges associated with terminal conditions. The individual’s experiences are improved through the relief and prevention of suffering through early identification, rigorous assessment, and the management of physical and psychological discomfort (Parker et al., 2018). The services are provided to individuals of any age suffering from incurable conditions.
The uptake of palliative care in Australia remains quite low. Despite the presence of evidence highlighting the benefits and efficacy of palliative care, only 50.5% of individuals who lost their lives between 2015 and 2016 received palliative care services (Gravier et al., 2019). It is often the case that family members, neighbours, and friends may take up the role of a palliative carer for a variety of reasons. The ability to strike a balance between caring for an individual in need and personal responsibilities is an additional burden (Miller et al., 2021).
In the Australian context, palliative care services are divided into specific categories. Level one palliative care is defined as services by the primary care physician and other health personnel and often involves conversations regarding the goals of care, prognostication, and advanced care planning (Miller et al., 2021). Patients at this level of care are often referred for specialist care for services such as the administration of medication, the provision of equipment, and counselling. The second and third levels of care are characterized by the provision of specialist palliative care services for individuals with complex needs (Miller et al., 2021). The system is designed to ensure that patients receive quality services whenever they are needed.
The Australian palliative care delivery system has specific unique traits. For instance, palliative care programs are designed to offer patients relief from pain and other distressing symptoms while affirming that life and death are normal processes (Australian Institute of Health and Welfare, 2022). The services offered are not intended to postpone or hasten death, and they incorporate important spiritual and psychological elements in the delivery of care. Australia’s palliative care programs are designed to enable patients to live as actively as possible. They also provide support systems that help families to cope with the patient’s illness and eventual death (Australian Institute of Health and Welfare, 2022). It should be noted that the Australian health system prioritizes the application of a multidisciplinary approach to address emergent needs.
Loss, Grief, and Bereavement
Bereavement is a universal experience that ultimately impacts all people at some point in their life (Aoun et al., 2020). Grief refers to the distress that occurs as a result of the loss of a loved one (Zordan et al., 2019). It is vital that all providers of palliative care have the skills necessary to assess where the patients and family members under their care require bereavement support. Support for individuals experiencing grief can be provided as professional and informal services.
There are a variety of symptoms that indicate the presence of grief in affected individuals. Emotional features of grief include depression, guilt, anxiety, loneliness, and the loss of interest in pleasurable activities (Palliative Care Knowledge Network, 2021). Cognitive symptoms include a sense of hopelessness and denial, while behavioural symptoms include agitation and social withdrawal (Palliative Care Knowledge Network, 2021). Psychological symptoms include disturbances in sleep, loss of appetite, and increased susceptibility to diseases.
There are a variety of factors that protect people from bereavement. They include the presence of a responsive healthcare system that facilitates the reduction of distress before death and the presence of resilient and optimistic personality traits among grieving individuals (Palliative Care Knowledge Network, 2021). Other protective factors include secure relationships among family members and the presence of support from the community. Care services have an immensely positive impact on bereavement. Evidence indicates that a high degree of emotional and social support results in the modification of bereavement distress. In addition, the provision of palliative care services at home improves the overall well-being of caregivers (Palliative Care Knowledge Network, 2021). It is vital to ensure that patients in need access the services they require to alleviate the suffering associated with death.
The grief and bereavement support offered by healthcare professionals has a significantly positive impact on the well-being of individuals dealing with loss. It is estimated that 10% of bereaved individuals are at risk of developing complex grief issues, and the number is expected to rise to 20% as a result of the complications caused by the COVID-19 pandemic (Palliative Care Australia, 2020). Approximately 2.4 million people have lost their lives as a result of the Pandemic, with each death affecting approximately nine people (Lee et al., 2021). Individuals receiving palliative care services also require social support, which refers to the perception of being cared for in a mutually supportive network of friends, family, and colleagues (Breen, 2021). There is a need to address the needs of palliative care patients in light of the prevailing conditions.
The mental distress caused by grief and bereavement is often pronounced for palliative patients. The current restriction of visitation, close contact, and the practice of rituals with individuals nearing death have made it difficult for families to cope. The current pandemic has highlighted the importance of advanced care planning for end-of-life management. Such activities are essential in view of the fact that they prepare affected individuals and their families to deal with death and cope with its aftermath. Advanced planning helps people know what to expect, how to deal with grief, and avoid making difficult decisions during times of crisis.
Bereavement and grief have a significant impact on the well-being of affected individuals. In a comparative study conducted by Aoun et al. (2020), between 20 and 30% of the surveyed participants reported that their quality of life worsened as a result of grief, with 5.6% of individuals in Australia noting that their mental health suffered the most. The researchers also note that between 46 and 49% of individuals who did not receive support experienced worsening symptoms compared to 18% of those who were aided in their loss (Aoun et al., 2020). In response to the aforementioned findings, organizations such as the Intentional Compassion Framework provide school communities and palliative care service providers with new and innovative ways of conceptualizing death (Kennedy, 2022). The presented evidence points to the importance of the role nurses can play in helping individuals affected by loss.
The Health Professional’s Role
Health professionals play a critical role in the provision of palliative care. It is essential to form partnerships between formal and informal networks to facilitate the delivery of quality services. The sources of bereavement support in palliative care can be classified as community support, informal support, and professional support (Aoun et al., 2018). Informal support is provided by friends, family, financial advisors, and funeral directors, community support is provided by general practitioners and community leaders, and professional support is provided by trained counsellors.
The ability to identify grief in the palliative care context is important. It is vital that healthcare professionals such as nurses are able to recognize pathologic grief and refer affected individuals for specialized care in good time (Hay et al., 2019). This is important in view of the fact that individuals suffering from problematic grief seldom seek help. Nurses must also be wary of the impact of traumatic loss on the well-being of children, who are often affected differently in the palliative context (Cheluvappa & Selvendran, 2022). It is vital to understand the mechanisms children use to process the experience of being diagnosed with a terminal illness and the impact on developmental abilities (Hay et al., 2019). It is essential to tailor palliative services to meet the needs of caregivers and bereaved families.
It is critical that healthcare professionals address their personal beliefs about death and dying when offering palliative care services to patients. Despite its inevitability, western societies are ill-equipped to address death (Gravier et al., 2019). The over-medicalization of care has separated people from the experience of dying, thus facilitating the stigmatization of death.
Challenges
There are some challenges associated with grief and palliative care in Australia. The provision of palliative care is associated with emotional and physical exhaustion. It is estimated that between 6 and 8% of caregivers experience persistent distress, referred to as Prolonged Grief Disorder (PGD) (Breen et al., 2020). The disorder is linked to an increased risk of suicide, sleep disturbances, and a lowered quality of life. In a study conducted by Zordan et al. (2019) in palliative care service centres in Melbourne Australia, 5% of palliative caregivers were noted to have PGD. The researchers propose that all caregivers must be screened for the possibility of developing PGD as a means of alleviating suffering. The provision of palliative healthcare services in Australia is inconsistent, especially in rural and remote areas. Geographical and logistical challenges make the delivery of service in remote areas complex and expensive (Wenham et al., 2020). It is essential to implement evidence-based strategies to ensure end-of-life care is available to all patients in need.
The aforementioned challenges can be overcome by implementing the Palliative and End of Life Model of Care. It incorporates a holistic management and assessment plan where patient needs are exhaustively assessed. In addition, it prioritizes the maintenance of communication with the patient’s family to initiate advance care planning strategies (Wenham et al., 2020). Finally, the Palliative and End of Life Model of Care optimizes the management of symptoms and facilitates the provision of the equipment necessary to offer essential services.
Conclusion
The experience of grief, loss, or bereavement is often debilitating for individuals and families undergoing palliative care. The increase in the elderly population, coupled with advances in medical treatments for chronic conditions, means that a larger number of people are in need of palliative care services. The grief and bereavement support offered by healthcare professionals has a significantly positive impact on the well-being of individuals dealing with loss in the context of palliative care. Healthcare professionals should prioritize the provision of services that take into account the effects of the social context an individual and their family is in as they deal with terminal diagnoses.
References
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