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A shortage of healthcare providers trained in palliative care can harm patient well-being

Specialist palliative-care nurses ensure that patients receive timely, appropriate treatment, but there is a lack of trained professionals, says Pregamol Rutchanagul, dean of the Faculty of Nursing at Thammasat University in Thailand. “We need palliative care more and more.”

Thailand is among the fastest ageing countries in the world, according to the World Health Organisation, with more than one in 10 considered to be elderly. With an ageing population comes the need for palliative care.

“Palliative care involves continuity of care that focuses on the quality of life of people who have severe and even life-threatening illnesses,” Rutchanagul says. “And the focus is not just the patients themselves, it’s also related to the family’s quality of life as well.”

While many healthcare professionals must navigate this challenge with their patients and families, few receive training in palliative care. Such training encompasses “holistic care”, Rutchanagul says. “It covers patients’ physical symptoms but also their psychological, emotional and spiritual health.”

Palliative care is one of the main focuses of Thammasat University’s Faculty of Nursing to address this shortage of trained professionals. Palliative-care nurses are taught to assess patients’ symptoms to determine if they require this specialised care as well as recognise the signs of common disease progressions and co-infections. “Palliative-care nurses should have the skill of early detection for patients with life-threatening illnesses,” Rutchanagul explains.

This is particularly true when it comes to illnesses that cause a lot of pain. “Nurses should be trained to identify those” and administer pain-management medications, she says. Palliative-care nurses also need to understand a patient's family dynamics and engage with the patient in a culturally sensitive way. “They need to understand the beliefs of the patient and their family to support their spiritual health.”?

Many patients who require palliative care, especially if they are at the end of their lives, prefer to be at home than in a hospital. “Hospitals are often crowded – patients like to be at home with their loved ones, and that is a big gap right now in palliative-care nursing,” Rutchanagul says. “When we try to move patients from hospitals to a home-based setting, we don’t have enough well-trained staff in the community.” To address this, Thammasat University offers palliative-care training in undergraduate and postgraduate courses, as well as further education for practising professionals.

Its research is also working to improve patient care, Rutchanagul says. “We have many process-of-care innovations,” she explains. These include a bed-turning protocol to ensure patient comfort and avoid bed sores. “We also research what is effective in home-based care.”?

Going forward, Rutchanagul says that the university will continue to train current and future healthcare providers in this important area, as well as undertake research to improve patients’ quality of life. “We also will push to understand more policy research and use that kind of research to make recommendations to the policymakers to close some of the gaps in palliative care,” she says.?