Hospice Care for End of Life Client in the Culture of Mountain and Beach of Papuan

Development and advancement of the health of the world by leaps and bounds lately have made the world of medicine and nursing a lot of dealing with the problem of quaint. As globalization increasingly demanding turnaround improved quality individually, then the improved quality is the thing that absolutely needs to be done in order not to be left behind with the rotation of the times. Similarly, in the field of nursing services, improving the services must be by the values of professionalism. Professional nursing services should be grounded by the intellectual values, moral commitment towards self, and responsibility towards society, autonomy, and control. Therefore, health workers expected to contribute optimally in accordance with knowledge, technology and aesthetics of patient care [1].


Introduction
Development and advancement of the health of the world by leaps and bounds lately have made the world of medicine and nursing a lot of dealing with the problem of quaint. As globalization increasingly demanding turnaround improved quality individually, then the improved quality is the thing that absolutely needs to be done in order not to be left behind with the rotation of the times.
Similarly, in the field of nursing services, improving the services must be by the values of professionalism. Professional nursing services should be grounded by the intellectual values, moral commitment towards self, and responsibility towards society, autonomy, and control. Therefore, health workers expected to contribute optimally in accordance with knowledge, technology and aesthetics of patient care [1].
The increasing number of patients with a disease that is not yet curable at both adults and children such as cancer, lung disease, degenerative, chronic airway diseases, cystic fibrosis, stroke, Parkin son's, heart failure, disease and genetics infectious diseases such as HIV/AIDS who need palliative care, in addition to promotion, preventive, curative, and rehabilitative. Currently the Ministry of health in Indonesia have not yet touched on the needs of patients with a disease that is difficult to be cured, especially on next stadium where is priority of service not only in healing but also in order to achieve quality care life is best for the patient and his family. At an advanced stage patient with chronic diseases are not only experience a variety of physical problems such as pain, shortness of breath, weight loss, interruption of activities but also psychosocial and spiritual disorder that affects quality of life patients and their families. Then the needs of patients in advanced stages of a disease not only physical symptoms/treatment compliance, but also the importance of the support to the need of psychological, social and spiritual conducted by an interdisciplinary approach is known as palliative care.
The needs of patients in advanced stages of a disease not only physical symptoms/treatment compliance, but also the importance of the support to the need of psychological, social and spiritual conducted by an interdisciplinary approach is known as palliative care.
Palliative care is a form of medical care and comfort patients who control the intensity of the disease or slow its growth, whether or not there is hope to recover.
Approach the palliative care that can effectively improve the quality of life of patients [2]. The community considers the palliative care only for patients in the terminal condition that will soon be dead. But new concepts of palliative care emphasize the importance of early treatment palliative more integration so that problems of physical, psychosocial, and spiritual can be overcome by good.
Palliative care is holistic and integration which health services by involving various professions on the basis of fundamentals that every patient deserves the best care until his death. Palliative care is an approach to developing the quality of life of the patient and the family of the problems associated with life-threatening illnesses, on a variety of disorders is chronic or terminal illness. Palliative care focuses on aspects of the multifactor such us psychological, social, spiritual, physical, and interpersonal and cures components.
According to Tejawinata (2006), one important aspect in palliative care is love saying, caring, sincere, and gratitude. So, the importance of these aspects are to exceed the importance of handling an absolute pain to do in palliative care. He also stated, on a cancer client is not possible palliative nurse again; incurable illness is basically an attempt to prepare the beginning of a new life (afterlife). It makes no difference with the content of treatment done a prospective mother, who from the very beginning of her routine check to ensure his health and a growing swell of prospective baby, in order to pass through the birth process with healthy and happy, next in his new life as a human being can grow into a human healthy and quality.
Another way to see palliative care is the concept of "a good death" free from avoidable pain and suffering for the patient and the patient's family. At first glance, this definition seems to have little to do with acute care delivered in settings such as emergency, even reported at least 35% of the patients want to die at home. As a result, many terminally ill are patients which present to the Emergency Department. They can do that when death is near, for the treatment of acute illness superimposed on the existing illnesses on them, or to control the symptoms, especially pain.
Issues that are crucial in the field of bioethics and bio law are concerned the "life and death". For the life of a need to eat and drink, sometimes in a State of pain, a patient cannot eat themselves, so should be given nutrition and hydration by a nose (Naso Gastric Tube). According to calculations in General a could survive for 40 (forty) days without eating. A fatty client instead can survive more because fat cells slowly land will be ruined and provides durability.
Without drinking (liquid) someone would die quicker in time 3 -10 days depending on your health and energy.
With the progress of science and technology in the field of nursing and medic, the life of a patient can be extended by giving fluids through NGT and giving help breathing through ventilators. ICU doctors now often on expose's dilemma whether the granting of the aid have to go through this life is given or not and who have given or stopped. The doctors and nurses had already been detained for helping a patient soul, but now have to decide whether they could "answer to the patient died". Otherwise it is no longer possible to help him. If it remains conducting, the sufferer will it be extended and sometimes the patient is no longer her suffering. Indeed, the issue are casuistic, so a definite guideline and is not possible given the raw. Responsibility towards the doctor conscience and beliefs and religions are adhered to. Also depending to the laws of the applicable is stated [3].
In the culture of Western treatment is each patient in the liability by insurance. Each patient's care needs including bio, psycho, and the spiritual primary on the patient's terminal illness characterized by care and medical personnel in a hospital or hospice. In the culture of Indonesia as the country's East, when a patient in a terminal condition in the verdict and discussed with her family, they tend to bring patients back home and out of the hospital by force to their care at home. On the other hand, they still desperately need care by holistic palliative health workers from hospitals or clinics. The concept of palliative care family and community are from clinics and referral system of hospitals to clinics that do not exist well in Indonesia [4][5][6][7][8].

Statement of the Study
Based on the background issues written above we're interested in doing a research in palliative referral system-level hospitals to Clinics with the title "Hospice Care on the client End of Life/Palliative in the involvement of the House pain and clinics as consul and satellites in the inland and coastal community affordability ".

Method of Research
This type of research is descriptive qualitative approach to phenomenology the study i.e. research that generates descriptive data in the form of the written word or spoken of people and behavior that can be observed. While according to Husserl (Creswell, 1998) phenomenological researchers trying to find about things that need to be (essential), the structure of invariant (the essence) or the meaning of the fundamental experience and emphasis on intensity of awareness where experience is composed things looked from the outside and the things that are in the consciousness of each based on memory, image and meaning. In this research we are trying to find about palliative care activities have been done or still to be developed by the hospitals and clinics as well as what is perceived and required by the client and his family when the patient has returned to his home [9,10].

American Journal of Biomedical Science & Research 425
The method of data collection used in this study is an in-depth interview with (Deep Interview)  c. The readiness of public health care in palliative care will be the order of the family and the community.
In depth interview is with the community health center in mind that they did not prepare its staff members in handling patients with palliative conditions. Whereas in Eastern culture, communi- With the strong support is expected to help clients more prosperous that can prolong support from their life.

Figure 1
Based on the research was conducted, we found the model of referral system from the bottom of clinical area to the highest type of the hospital (Figure).
In the referral system model above explain that client and the family are the center of health care system of Palliative care. As regulation of the Indonesian government, all clients must be attended in the lower type of the hospital before coming to the type A of the hospital with referral system. In the lower type of the hospital until the higher type of the hospital, they must provide palliative team health care system to give care to the client with terminal diseases.
The culture of eastern people is bringing home to their family when the doctor or nurses inform their family about the terminal diseases of their family. The government or the high type of the hospital must give descendent referral to the lower type hospital or public health center around client's home. So, the palliative team can give care to client all the time client's need.