By Howard Oliver

Palliative care is an interdisciplinary specialty resource that aims to
relieve suffering and improve the quality of care and life for clients
with serious illness, while supporting their families and loved ones.
This article will discuss the various facets of the role of the Personal
Care Manager (PCM) who helps a palliative care client stay comfortable
and safe as they do pass on.

During the final weeks of life, new symptoms may appear, and existing symptoms
might suddenly become worse. A Personal Care Manger (PCM), or a qualified
Registered Nurse can and often does serve as the clients primary
confidant. The PCM monitors symptoms closely and responds quickly to calls
for guidance and support, 24/7. The PCM has the professional knowledge
and skills needed to help the client and his or her supports negotiate
the many complex issues that can arise during this period in the dying process.

There are many strategies for preventing a crisis in end-of-life palliative
care. The Personal Care Manger works closely with the physicians anticipating
symptoms that may arise as the illness progresses. The physician explains
what signs and symptoms may occur as end of life draws near.

The PCM can review the benefits and side effects of the various therapies
and medications that may be tried to combat any uncomfortable symptoms.
The idea is to ensure the client and his or her loved ones have a clear
understanding of what the physician has discussed and what options they
have. It is also important to try and eliminate any misperceptions that
they may have. Although a palliative care client might say they want to
die at home, this decision must be reviewed regularly.

Issues based on the clinical course and the support that family and friends
are able to provide must be considered. It is not unusual for a patient
to become increasingly uncomfortable as the illness progresses, even when
provision of care and services at home is optimal. If, in the end, a client
decides to die in a health care facility that specializes in end of life
care, being cared for at home by a PCM will still have made it possible
to reduce the number of admissions to hospital during the period of advanced
disease. When dying at home is not feasible, the goal then becomes helping
the client remain comfortably there for the longest time possible.

The PCM also becomes involved in working with the family to deal with the
emotions and stress of observing a loved one in their final stages of
life. Families of a terminal patient might not know what to do or how
to feel or even if what they are feeling is normal. Grief is universal,
yet very individual. Grief can affect a person physically, emotionally
and spiritually. The impact of grief may affect a family members
interpersonal relationships with other family members and with the medical
staff involved. PCMs tend to list lots, offer emotional support
to all, and provide ongoing options that help to maintain a calm, caring
and peaceful atmosphere.

Family dynamics are complicated and often affect the way one grieves. PCMs
are highly professional and do not judge the client or family Their priority
is always to ensure the client is as comfortable as possible, regardless
of the type of person he or she may have been prior to arriving in these

Good physical care is mandatory for a palliative care client in the final
stages of life. Superb physical care and oral hygiene is in order to maintain
the clients dignity. A nurturing sponge bath may soothe aches and
pains unlike any pain medicines are capable of doing. Massages with lotion
are an amazing treatment that allows a person to relax their mind and
body. The physical care time also allows for bonding time with the client
and PCM/caregivers which is imperative if trust is to be established.

PCMs help manage the medications that have been ordered by the physician.
Patient controlled devices like the PCA (Patient Controlled Analgesic)
device is very popular as it allows for the client to be involved in controlling
their pain. The PCM acts as an advocate for the client if the pain is
not being adequately managed and the client is experiencing breakthrough
pain. The PCA pump can be adjusted by the physician so the pain will again
become managed. In the last moments of a persons life, they may
not be able to leave until everyone has come to say goodbye
or until everyone has left the bedside. The PCM is trained to manage end
of life care as they treat the dying process as a continuation of the
circle of life. Many clients die within minutes of family members leaving
the bedside for the first time in weeks. When family members leave, the
PCM sits and holds the clients hand, so no one has to pass on alone.
Every client/person deserves the utmost respect and the gentlest of care
at the end of his or her life.

Personal Care Managers consider being with a client as he or she
passes on to be a gift and great honour. There is never a time in someones
life where being a nurse can make more of a difference and that a nurse
feels as though they can make such a significant difference.