Palliative Care

The healing tradition in Western medicine goes back to its Greek origins. What actually constitutes healing is poorly understood even in this first era of cure and advanced medical science. Sickness has usually been defined as the physical result of bodily disease. This is out of date in these times of chronic illness and when the problems of disability and aging are so common. This book uses a different definition: Persons are sick who cannot achieve their goals and purposes because of impairments of function from the molecular to the spiritual that they believe are in the province of medicine. Some impairment may be due to disease, but certainly not all. As the sick person has become the focus of medicine there have been repeated failed attempts to achieve both technologic and humanistic goals. This is wrong; there are not two goals there is only one ultimate goal, the well-being of the patient. All therapeutic interventions toward that end are exercises in healing. There are some impairments of function requiring high technology and others in which the personal actions of healers are most appropriate; proper balance is necessary. This book describes in depth what sickness is, what persons are, and how to understand function and its impairments. Healing skills and actions are explained and the nature of healing for sick and also suffering patients is detailed. The book concludes with a discussion of the moral basis of the patient-healer relationship and finally an understanding of goals.

Participatory research is a relatively new method of researching practice especially within palliative care. It differs from other methodologies in that there is an expectation of action within the research process. The values that underpin participatory research are collaboration, empowerment, and reflection. In the current climate of collaboration and working with people in healthcare, participatory research methods are gaining increasing interest when there is a desire to bring about change. Organisational change is becoming an important focus as we look at ways of not only reducing costs but at the same time improving quality of care. While palliative care puts the patient and family at the centre, this book discusses a new research methodology that puts practitioners at the heart of the research process as collaborators who work together with researchers to resolve problems in practice. Divided into three sections, it provides theoretical groundings of action research, a greater focus on exemplars from studies within palliative care, and discusses prominent issues when using such a methodology. All three sections are illustrated by an action research study undertaken by the author within a palliative care setting.