**7. The integration of palliative/holistic care in clinical and home-based care in terminally ill patients and the elderly**

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

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

• High-interest rate—discouraging investors.

much will not be required from them.

security services.

• Fall in aggregate demand; fall in wages, income etc.

• Mass unemployment and general loss of confidence in the government [27]

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

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

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

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

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.

programmes are put in place to track these patients [29].

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

instituted without adequate resources.

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adequate care, especially to elderly and terminally ill patients. The main focus of nursing care as observed is curative approach without taking into consideration effective communication between them and patients/families the truth about diagnosis/prognosis of the disease, lack of patient and family readiness as a result of inadequate training/discharge planning and lack of follow-up [33].

Specifically, since there are no functional palliative care programmes in most health care facilities, the phases being addressed are:

