Palliative care
Meaning:
Care which focuses on
promoting through optimal management of physical, psychological, emotional and
spiritual symptoms, the best possible quality of life for patients facing
serious, life threatening illness.
Palliative care is
"the active total care of patients whose disease is not responsive to
curative treatment “ -WHO
Principples
of Palliative Care:
Palliative Care is an
interdisciplinary team approach including experts from medicine, nursing, social
work, the clergy, and nutrition. This team approach is needed to make the
necessary assessments and to institute appropriate interventions.
The essential components
of palliative care are relief of symptom distress, improved quality of life, opening
of communication on a regular basis,
and psychosocial support for patients and families.
The goal is not to cure
but to provide comfort and maintain the highest possible quality of life long
as possible.
The traditional focus of
palliative care is not on death but on a compassionate, specialized care for
the living. It is based on a comprehensive understanding of patient suffering
and focuses on providing effective pain and symptom management to seriously-ill
patients while improving quality of life.
Skill
sets of palliative care
Communication
Symptom control
Decision making
Psychosocial care of
patient and family
Management of
complications of treatment and disease
Care of the dying
Nursing management:
Physical
aspects of care: pain and other symptoms management,
management of side effects based on best available evidence. Grief and
bereavement programmes.
Social
aspects of care: Identification of social needs of patient
and families respond effectively.
Spiritual
and religious aspects of care
Cultural
aspects of care: assess and meet the cultural specific
aspects of care.
Care of imminently dying
patient
Ethical
and legal aspects of care:
Assess goals, preferences and choice of the
patients, consider state and federal laws in the process of care, be aware and
address the complex ethical issues arising in the care of life threatening
illness, care according to the legal and regulatory aspects of care.
Home care, hospice care
Hospice
care
A concept of care that
provides compassion, concern and support for the dying.
Hospice and palliative
care are frequently used interchangeably.
Hospice exists to provide
support and care for persons in the last phases of incurable diseases so that
they might live as fully and as comfortably as possible
Hospice programs provide
multidisciplinary care at the end of life with emphasis on symptom management,
advance care planning, spiritual care, and family support, including
bereavement. Bereavement counselling is an important aspect of hospice programs
Hospice
care settings
At home
In a hospital
At a hospice centre
In a skilled nursing
facility
Home
care
home care is provided on
a part-time, intermittent, on-call, regularly scheduled, or continuous basis.
available 24 hours a day
and 7 days a week to provide help to patients and families in their homes.
Staff and volunteers are
available to the patient and family.
A medically supervised
interdisciplinary team of professionals and volunteers provides hospice
services.
The hospice nurse is an
integral part and plays a pivotal role in coordination of the hospice team.
Hospice nurses work
collaboratively with hospice physicians, pharmacists, dietitians, physical
therapists, social workers, certified nursing assistants, clergy, and
volunteers to provide care support to the patient and family members.
Criteria
to enter in hospice care
The patient must desire the services.
A physician must certify
that the patient has 6 months or less to live.
Role
of a nurse in palliative and hospice care:
Provide pain relief,
symptom control (air hunger, nausea, constipation, anxiety, agitation), and
prevention of complications.
Encourage patient and
family to exceed their current situation.
Encourage patient and
family to pursue enjoyable activities.
Assist them to focus on
present and past joys.
Shate positive and hope
inspiring stories.
facilitate participation
in religious or spiritual activities.
Encourage families to
minimize social isolation.
Provide private time for
relationships.
Discuss end-of-life
issues early in patient's treatment plan.
Encourage patients to
express their preferences about end of life in the form of a legal document.
Advance directives, such
as a living will and durable power of attorney, allow for the refusal of
further treatment or authorize a family member or friend to make decisions for
the patient
After discussion with the
patient and family, the primary care provider in an inpatient setting can write
orders based on the directives such as
do not resuscitate.
Make referrals for
respite care, counselling, pastoral care, and bereavement services as needed.
Assist patients and families
with decisions for withholding or withdrawing life-sustaining therapies and
transfer in and out of inpatient settings by explaining such therapies and
clarifying how they fit with the goals of care.
Promote ethical practice
by organizing interdisciplinary rounds on patients with end-of-life issues,
setting up a partnership in care with family members, collaborating with other
who have been through similar situations, and consulting with the ethics
committee your institution.
COMMENTS