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
Psychosocial care of patient and family
Management of complications of treatment and disease
Care of the dying
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
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
In a hospital
At a hospice centre
In a skilled nursing facility
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.