**5. The impact of economic depression on health**

Economic depression is a period of time of economic slowdown presenting low output, not having enough funds and unemployment. It is considered by its length, abnormal upsurges in unemployment, falls in the obtainability of adequate health services, shrinking output and investment, etc.

#### **5.1 General causes of economic depression**

The major causes of economic depression in any given economy (lessons from great depressions, 1981, 1991, 2008 economic recession) may include:


Health is an essential part of man's existence even in the midst of economic depression. Before the current economic crisis, most present-day societies especially in the developing countries were still suffering disease epidemics while other nations incessantly experienced the endemic diseases affecting millions of lives. The global economic crisis persists to worsen the structure and purpose of the health sector. The economic depression has affected several segments of the economy including the health sector, contributing to low output, poor service delivery and poor health outcome. This has led so many people to resort to home care where so much will not be required from them.

The health sector is still struggling to provide rudimentary health care services with the collaborative efforts of government and individuals but determinations to realise this seem unfeasible due to the current state of the economy especially in the developing countries. The current economic position has affected health care funding and the level of support of the public and private health care services particularly among the rural poor is reduced due to increased proportion of poverty [28]. The economic predicament has contributed essentially to poor health outcome; it offers the occasion for careful government health modifications to improve the health system operation [28]. Health is directly or indirectly connected to other sectors such as food security and nutrition, family income generation, housing, education, employment status and other social security services.

Following initial treatment for terminal diseases or elderly patients, they are usually given dates for followed-up appointment in hospital outpatient departments at steady intervals for routine checking in order to assess the patient and timely discovery of recurring of the ailment [29]. This method of follow-up places anxiety on the patient and their family members and most of them defaulted due to religious and cultural beliefs. Secondly, they may complain of inability to travel to the hospital, especially patients living in the rural communities. Most of these patients present late in the hospital either because of poor knowledge, cultural/ spiritual beliefs and non-availability of resources for prevention, diagnosis and treatment [28]. Patients and families are not well prepared after diagnosis about the diseases or palliation; this has led to most of the patients not responding to checkup appointments because they are not well informed and no form of follow-up programmes are put in place to track these patients [29].

Based on the above premise, several countries have been able to put in place measures for providing home care services to a lot of their citizenry so as to alleviate the suffering of the poor masses. Most of the developing countries are still struggling as a result of poor economic position of these nations. Home care cannot be instituted without adequate resources.

#### **6. The home care situation in a depressed economy**

From a nursing viewpoint, it is imperative to have information about the type of care needed, the explanations of care needed and quality of life among the elderly people and those diagnosed with terminal illnesses living in their own homes, in order to sustain their independence and make best use of their quality of life.

**259**

*Holistic/Palliative Management of Patient's Health Care and Home Situation in a Depressed…*

At several stages during our lives, we are each dependent on the care of others [30]. For many, that need comes with old age, chronic illness or ill health. In some occasions, the care is provided by a family member or a friend; in other cases, it comes from a paid care worker such as a registered nurse, a registered practical nurse or a personal support worker. Sometimes, the care is given by a combination

This chapter describes the involvements of these three care beneficiaries, their family caregivers and their paid care workers in our survey of the direction of the substantial practices of care associations in home care. Current reorganisation of health and social care services means the home is gradually the site of long-term care and is a place where implications of both home and care must be discussed [31]. The focus on the familiar care points up the diverse forces at work of care through which caregivers, care recipients and home space are established. Most nurses have their own individual principles and morals, and there are certain professional standards on which all nurses are anticipated to establish their care. Nurses have a duty to make the care of patients their major concern and to practise care giving without harm and efficiently. They must be ethical and truthful [1]. Patients trust their nurses because they believe that, in addition to being experienced, their nurses will not take advantage of them and will demonstrate character traits such as honesty, straightforwardness, reliability and empathy. Good professional decision and behaviour in clinical practice should be patient-centred. It involves nurses understanding that each patient at the end stage of his or her disorder is exceptional, and working in partnership with their patients to discourse the needs and realistic prospects of each patient. The moral pronouncement as proposed by Plato and Aristotle highlighted the part of purpose both in observing what is fair and in permitting us to act reasonably rather than give in to conflicting desires and

Hellström and Hallberg examined people aged 75 years and older dependent on care from professionals and/or a next of kin, their functional health, diseases and complaints in relation to quality of life as perceived by themselves [32]. The study revealed that the number of elderly persons in need of support ranged from 18.5 to 79.1% in the different age groups, and that aid came mostly from informal caregivers [32]. The authors also discovered that assistance from formal caregivers was given in combination with that from a next of kin in 38.8% of the cases. Furthermore, next of kin function more than formal carers; they assisted in all Contributory Activities of Daily Living (CADL) and Personal Activities of Daily Living (PADL) chores, with the exclusion of house cleaning and rendering a bath/ shower. Although the respondents had supported themselves, they were also of

From the above study, it is seen that care giving at home is mostly carried out by informal caregivers, than the professionals. Patients, therefore, would see care at home more acceptable during this critical period of their lives. Most patients resolved to care at home because their financial status cannot cope with hospital bills, transportation, waiting time in the health care facilities among other reasons

**7. The integration of palliative/holistic care in clinical and home-based** 

Nurses are the most valuable member of the palliative care team who are in the best position to look into the physical, purposeful, social and spiritual needs of the patients, but in most situations, they (nurses) are not well-prepared to give the

assistance to another person in 6.5% of circumstances [1].

**care in terminally ill patients and the elderly**

*DOI: http://dx.doi.org/10.5772/intechopen.92736*

of both [30].

feelings [32].

that promote home care.

#### *Holistic/Palliative Management of Patient's Health Care and Home Situation in a Depressed… DOI: http://dx.doi.org/10.5772/intechopen.92736*

At several stages during our lives, we are each dependent on the care of others [30]. For many, that need comes with old age, chronic illness or ill health. In some occasions, the care is provided by a family member or a friend; in other cases, it comes from a paid care worker such as a registered nurse, a registered practical nurse or a personal support worker. Sometimes, the care is given by a combination of both [30].

This chapter describes the involvements of these three care beneficiaries, their family caregivers and their paid care workers in our survey of the direction of the substantial practices of care associations in home care. Current reorganisation of health and social care services means the home is gradually the site of long-term care and is a place where implications of both home and care must be discussed [31]. The focus on the familiar care points up the diverse forces at work of care through which caregivers, care recipients and home space are established.

Most nurses have their own individual principles and morals, and there are certain professional standards on which all nurses are anticipated to establish their care. Nurses have a duty to make the care of patients their major concern and to practise care giving without harm and efficiently. They must be ethical and truthful [1]. Patients trust their nurses because they believe that, in addition to being experienced, their nurses will not take advantage of them and will demonstrate character traits such as honesty, straightforwardness, reliability and empathy. Good professional decision and behaviour in clinical practice should be patient-centred. It involves nurses understanding that each patient at the end stage of his or her disorder is exceptional, and working in partnership with their patients to discourse the needs and realistic prospects of each patient. The moral pronouncement as proposed by Plato and Aristotle highlighted the part of purpose both in observing what is fair and in permitting us to act reasonably rather than give in to conflicting desires and feelings [32].

Hellström and Hallberg examined people aged 75 years and older dependent on care from professionals and/or a next of kin, their functional health, diseases and complaints in relation to quality of life as perceived by themselves [32]. The study revealed that the number of elderly persons in need of support ranged from 18.5 to 79.1% in the different age groups, and that aid came mostly from informal caregivers [32]. The authors also discovered that assistance from formal caregivers was given in combination with that from a next of kin in 38.8% of the cases. Furthermore, next of kin function more than formal carers; they assisted in all Contributory Activities of Daily Living (CADL) and Personal Activities of Daily Living (PADL) chores, with the exclusion of house cleaning and rendering a bath/ shower. Although the respondents had supported themselves, they were also of assistance to another person in 6.5% of circumstances [1].

From the above study, it is seen that care giving at home is mostly carried out by informal caregivers, than the professionals. Patients, therefore, would see care at home more acceptable during this critical period of their lives. Most patients resolved to care at home because their financial status cannot cope with hospital bills, transportation, waiting time in the health care facilities among other reasons that promote home care.
