Career Highlight: Palliative Care

Palliative care is a multidisciplinary approach to specialized medical care for people with life-limiting illnesses. It focuses on providing people with relief from the symptoms, pain, physical and mental stresses of the terminal diagnosis. The goal of such therapy is to improve quality of life for both the person and their family.

Palliative care is provided by a team of physicians, nurses, physiotherapists, occupational therapists and other health professionals who work together with the primary care doctors and referred specialists. It is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care of along with curative treatment.

Although it is an important part of end-of-life care, it is not limited to that stage. Palliative care can be provided across multiple settings including in hospitals, in the patient’s home, as part of the community palliative care programs, and in nursing facilities. Spiritual support is often provided in more interdisciplinary teams.

When a medicine or treatment relieves symptoms, but has no curative properties, it is said to be palliative. The word noncurative is sometimes paired with palliative for clarification purposes.

Scope

Palliative care is for patients with any serious illness and who have a physical or mental distress as a result of the treatment they are undergoing. Palliative care increases comfort by reducing pain, alleviating symptoms, and lessening stress for the patient and family. It is mutually beneficial for both patient and caregiver.

Emergency care nurses and doctors have a critical role to begin discussions with patients and their families regarding palliative care as they see them go through difficult times in life.

Paediatric palliative care is a rapidly growing subset of this field, and services directed specifically for children with serious illness are in dire need of this.

Responsibilities

Assessment of symptoms

A method fr the assessment of symptoms in patients admitted to palliative care is the Edmonton Symptoms Assessment Scare, in which there are eight visual analog scales of 0 to 10, indicating the levels of pain, activity, nausea, depression, anxiety, drowsiness, appetite and sensation of well-being. On the scale, 0 means absent, and 10 means the worst imaginable possible. Medications are often managed at home by family or nursing support.

Further actions

Effective methods to ensuring successful palliative care is to provide a safe way for the individual to address their physical and psychological distress, that is to say their total suffering.

Dealing with total suffering involves addressing a wide range of concerns, starting with treating physical symptoms such as pain, nausea, and breathlessness. The palliative care teams have become very skillful in prescribing drugs for physical symptoms, and have been instrumental in showing how drugs such as morphine can be used safely while maintaining a patient’s full functions.

Importance of counselling

Usually, a palliative care patient’s concerns are pain, fears of the future, uncertainties, and worries of their family and feeling like a burden. There are counselling, visual methods, cognitive therapy, and relaxation therapy to deal with it.

Pallliative care sees an increasingly wide range of conditions in patients at varying stage of their illness it follows that palliative care teams offer a range of care. This may range form managing the physical symptoms in patients receiving treatment for cancer, to treating depression in patients with advanced disease, to the care of patients in their last days and hours.

Training

In most countries hospice and palliative care is provided by an interdisciplinary team consisting of physicians, pharmacists, registered nurses, nursing assistant, social workers, and others. The focus on the team is to optimize the patient’s comfort.

Nurses in palliative care are given extensive training in counselling, medication dispensing, and support. The aim is about relieving distressing symptoms for the patient. Nurses are also part of the management of the imminently dying patient, more so than the physicians or doctors themselves.

Work Opportunities

The work opportunities that we get is aplenty. Palliative care is often used interchageably as a term with hospice care, albeit some slight differences. They share some similar goals of providing symptom relief and pain management. Palliative care services can be offered to any patient without restriction to disease or prognosis, and can be appropriate for anyone with a serious, complex illness, whether they are expected to recover fully or not.

Hospice is a type of care involving palliation without curative intent. usually it is used for people with no further options for curing their disease or in people who have decided to not pursue treatment that is hard on them.

Typically hospice and palliative care nurses work in non-hospital settings.



Other Articles




 Geriatrics is the specialty of care of the elderly. The main goal is to assist aging patients to improve their health by preventing or treating illnesses or disabilities. 

 Currently the mean age of the global populace is increasing[1]. Demand for geriatric care has rapidly risen within the past 10, 20 years. This trend is also seen in Malaysia. Unfortunately, it is a profession that not many young nurses or doctors would want to pursue[2]. 



 Definition: 

 The word geriatrics is derived from Greek. “Geron” means “old man.” “Iatros” is defined as “healer.” 

 Gerontology, a word commonly used together with geriatrics, is the study of the aging process itself. 

 Duties: 

 Geriatric nurses assist their patients in their daily life. They help them to live healthily, and improve their independence by treating or staving off disabilities that cause dependency of care. 

 It is not uncommon for geriatric nurses to ensure the comfort of their patients is taken care of as well. They also assist in recognizing and managing syndromes that are common to older adults. 

 Educating the family members of the elderly patient is also a key responsibility in the geriatric nurse. The nurses have to ensure the care provided by the family are only good practices. 

 Ultimately their job scope depends on the institution they work in. 



 Education: 

 The study of geriatrics and gerontology itself is a relatively new branch of medicine. Medical capabilities have progressed to the point where people are now living longer than ever before.  

 The global average life expectancy was at 45[3] years old in 1950-55, and it has now jumped to 76. Recently, the Baby Boomer generation has started to encroach the age of 60-70. As a result there are only a few established centers of learning for the advancement of this field of medicine. 

 Post-basic or advanced diploma courses in geriatrics can also be listed under the name of elderly care[4]. Unfortunately, not many learning institutions or hospitals offer this in Malaysia, as of time of writing. 



 Workload and Working Conditions: 

 It depends on the institution they work in. Geriatric nurses can work in mental health facilities, hospitals, private hospitals, private practices, clinics, and also nursing homes. 

 Some wards may employ geriatric nurses to assist in treatment and recovery of their older patients. For example, renal, cardiology, and neurology all often do this in larger hospitals. 



 Opportunities in Geriatric Nursing 

 As it is a rapidly growing field of high importance, the opportunities for academic study and research are very high. There is a big need for healthcare workers to be trained in the field of gerontology, so local healthcare can keep up with global standards. 

 Some geriatric nurses even can opt to open up their own practices as well. 

  Read more on advancing your nursing career into nursing education HERE . 



 Salary and income 

 The median salary of geriatric nurses is higher than that of a registered nurse[5]. However this depends on many factors, such as duties/responsibilities, experience, and work location. 

 This is expected to increase as demand for geriatric nurses continues to grow ever-rapidly. 

  Read more on how nurses can increase their income HERE.  

 Source:  
    1.  http://today.mims.com/topic/what-are-the-options-for-aged-care-in-singapore-?country=Malaysia&channel=GN-Health-Wellness   
    2.  http://today.mims.com/topic/specialist-spotlight–geriatricians   
    3.  https://upload.wikimedia.org/wikipedia/commons/2/29/Life_Expectancy_at_Birth_by_Region_1950-2050.png   
    4.  http://www.imc.edu.my/elderly-care-setting-standards-elderly-care/   
    5.  http://www1.salary.com/Staff-Nurse-RN-Geriatric-Salary.html  

 Search for high-paying geriatric nursing jobs here at  MIMS Career . Sign up and apply today with our safe, secure, and free site. MIMS Career is an extensive job portal for healthcare practitioners such as nurses, doctors, and dentists throughout Malaysia, Singapore, Indonesia and the Philippines. 

 Browse through our vast directory of job vacancies by top healthcare employers. See any jobs you like? Apply with one click, or save it for later if you need some time to think about it.  

 Can’t find what you’re looking for? Set up an email alert, and we’ll notify you when a job vacancy that meets your desired criteria becomes available.

Career Highlight: Geriatric Nursing

Geriatrics is the specialty of care of the elderly. The main goal is to assist aging patients to improve their health by preventing or treating illnesses or disabilities. Currently the mean age of the global populace is increasing[1]....

Read More

 For those nurses serving with  Kementrian Kesihatan Malaysia  (KKM), the start of your work life will present you with one of the toughest choices you’ll make: 

 
 EPF (Employees’ Provident Fund, also known as KWSP), or choose the pension fund? 
 

 Both are viable options in securing your financial health after you retire. Although retirement might seem like ages away, a good amount of planning and successful investments can mean the difference between being able to live comfortably in your golden years, or struggle with daily or medical expenses. 

 So which to choose? We’ll break down the points below. 

 Pension fund 

  What is it?  
It’s a monthly stipend of a set amount, provided by the Public Services Department upon your retirement. In addition to that, you also receive a  gratuity  payment, and medical/health benefits. 

  Calculation  
Here we will be assuming that you start work at 20 years old, with a starting salary of RM2,000, and continue working until you retire at 55 with a salary of RM5,600 (3% annual pay increase). 

 Your monthly pension will be your last drawn salary, divided by two. For example, if your base salary is RM5,000 when you retire, your monthly stipend will be RM2,800/mo. 

 In addition to that, you will receive gratuity payment, which is calculated as such: 

 
 gratuity = 7.5% x 35yrs x 12 months x RM5,600 (final drawn salary) 
= RM 176,400. 
 

 RM176,400 will be given as a lump sum, while RM2,800 will be given per month. Again, this is all assuming you retire at 55, with a final salary of RM5,600. 

  Benefits  

 
	 No subtraction from base pay. 
 

 Unlike EPF, as we will see later, there is no subtraction from your base salary. 

 
	 Guaranteed monthly retirement funding 
 

 Again, unlike EPF, where your money can be withdrawn for other uses, pension takers are guaranteed to have a monthly source of income. 

  Disadvantages  

 
	 You have to start and end your service in the public/government sector. It might hamper your ability to seek work overseas, better base salaries, or even some chances to study. 
 

 EPF or Employees Provident Fund (KWSP - Kumpulan Simpanan Wang Pekerja) 

  What is it?  
EPF is the accumulation of savings generated from deductions of your base salary. Currently, you can choose either 11%, or 8%, as  recently announced . 

 This accumulation of money is further grown by annual dividends. On average the dividend is around 6%, depending on the GDP (gross domestic product) of the country. 

 What makes EPF great as long term savings is due to the magic of  compound interest. . Your employer also contributes to your fund (12% of your pay). These two things make an EPF account grow substantially when properly managed. 

  2 accounts  

 Your EPF savings are divided into two accounts. 70% goes into account 1, and the rest to account 2. Account 1 is your retirement funds. Account 2 is withdrawable, under a few conditions: 

 
	 more than 50 years old 
	 Housing downpayment for your 1st house 
	 housing loan payment 
	 education 
	 medical costs 
	 Hajj pilgrimage 
 

 Upon reaching the age of 55, you will be able to withdraw from account 1. You will have to choose to withdraw one lump sum, or as a monthly stipend like a pension. 

  Calculation  

 Let’s take the same example as just now. Start work at 20, salary RM2,000, retire at 55, salary RM5,000. 

 
 Deduction from pay = 11% = RM220 
Employer contribution = 12% = RM240 
 We will assume no withdrawals are made over entire working period  
EPF annual dividend = 6% 
 

 The interest adds up year over year, and with the help of EPF’s  online calculator , 

 Total EPF savings at 55 years old = RM461,900 

 It is a marginally higher amount than RM176,400 gratuity you will receive from a pension. 

  Benefits  

 
	 Flexibility. At the age of 55, you can withdraw that money and invest in another scheme, venture, or fund that offers greater returns. 
	 Faster growth. As shown, even with a contribution of 11% of your pay, over the course of 35 years it balloons into a large amount of money. 
	 Freedom of employment. You no longer have to work within the constraints of the government or public service. You are free to pursue study or work opportunities as you wish. 
 

  Disadvantages  

 
	 Sometimes things don’t go as planned. You might hit a financial roadblock that forces you to withdraw from your EPF fund. An example of this is a medical emergency. 
	 It subtracts 11% of your base salary. 11% might not seem like much, but for people who live paycheck to paycheck, it can be a bitter pill to swallow. 
	 Annual dividend from EPF can decrease, depending on economic climate. 
 

 Making a comparison 

 Monthly funds 

 Assuming that you live until the mean life expectancy age in Malaysia, which is 76 years old. 

 
 Years to live off retirement fund (pension) = 76-55 = 21 years 
 

 To make a fair comparison, let’s subtract the gratuity amount of a pension scheme from the lump sum of EPF savings. 

 
 EPF at 55 years old - gratuity of pension at 55 years old = RM461,900 - RM176,400 = RM285,500 

 Stipend per month that EPF provides = RM285,500 / 21 years / 12 months = RM1,132.94/month 
 

 Even if we did not subtract the gratuity value, it would be: 

 
 RM461,900 / 21 years / 12 months = RM1,832.94/ month 
 

  It is far less than RM2,600/month from a pension scheme . 

 What if we invest all of EPF savings? 

 Say at the age of 55, you embark on another investment with better returns. We will assume 8%. You pile up all your savings into it. 

 Investment return x EPF savings = 8% x RM 461,900 = RM36,952/year or RM3,079.33/month. 

  It is more than what you’ll obtain from a pension.  However you’ll need to ensure that the second investment has better returns than EPF dividends. That in itself can sometimes be a challenge. 

 Conclusion 

 They both have their advantages and drawbacks. It seems like it is up to you to play it well, to ensure you can lead a comfortable life upon retirement. 

 However the main question of choosing either EPF or pension as retirement savings often boils down to your choice of employer. 

 Will you stay with the government sector for another 30+ years? You don’t want to end up with no retirement fund… No EPF or no pension. That’d be the worst. 

 If yes, go for the pension scheme. It is safe, guaranteed, and offers great peace of mind in your golden years. 

 However, with EPF, you are free to take up opportunities that come your way. Countries like Saudi Arabia, Singapore, and Australia are actively seeking out Malaysian nurses with extremely attractive pay. Opportunities for post-graduate education are more limited in the government sector; if in private, you get to choose when you want to do it. You can also fund it with your EPF savings, something you can’t do on a pension. 

 Choose the freedom of choice. Search for high-paying nursing jobs, and overseas jobs on MIMS Career. Browse, save, and apply for nursing jobs, all in one-click. Take the opportunity for higher pay and better work locations. Our pages are all mobile-responsive, allowing you to take that leap for a better job whenever, wherever you are. All our job postings are heavily screened to prevent scams and mistrustful behavior. 
   

 
 Our Most Popular Articles 

  Think About These 5 Things Before You Decide On A Specialization  

  5 Things Nurses Need To Know To Be Paid More  

  10 Ways Malaysian Nurses Can Increase Their Income

EPF (KWSP), or Pension? Which to choose?

For those nurses serving with Kementrian Kesihatan Malaysia (KKM), the start of your work life will present you with one of the toughest choices you’ll make: EPF (Employees’ Provident Fund, also known as KWSP), or choose...

Read More