PALLIATIVE CARE UNIT 1

PALLIATIVE CARE
ALPHA
INTRODUCTION
• Palliative care is the active holistic care of patients with advanced
progressive illness.
• Management of pain and other symptoms and provision of
psychological, social and spiritual support is paramount.
• The goal of palliative care is achievement of the best quality of life
for patients and their families.
• Many aspects of palliative care are also applicable earlier in the
course of the illness in conjunction with other treatment.
DEFINATION
• The word palliative means to “lessen the
severity without curing; to alleviate.”
• This type of care is considered to be a form of
pain management, also referred to as supportive
care, given throughout all stages of cancer or
other life-threatening diseases.
 DEFINITON
• WHO defines palliative care as “An approach that
improves the quality of life of clients and their families
facing the problems associated with life- threatening
illness, through the prevention and relief of suffering by
means of early identification and impeccable
assessment and treatment of pain and other problems
that are physical, psychosocial and spiritual, (WHO,
2002).”
CONTS..
• Palliative Care provides support and care for
individuals with life threatening illnesses across all
care settings through an interdisciplinary team
approach.
• Palliative care also deals with needs of the family as
well (Black and Hawks, 2009:386).
GOAL OF PALLIATIVE CARE

• The primary goal of palliative care is to provide the patient with as much
comfort as possible and a satisfying productive life for as long as it is
possible.
• Some of the more common symptoms that the nurse can help relieve
and control in palliative care include:
• pain by giving strong pain killer;
• Difficulty breathing- depending on the cause you position the patient, give
broncho dilators to ease the breathing;
• loss of appetite –give multivitamin, serve patient small frequent meal and
serve the attractive meal, give the patient the food he/she prefers and
weight loss; fatigue; weakness; problems with sleep some pain killers like
morphine may act as sedatives; anxiety and depression give psychological
support; and confusion
CONDITIONS THAT CALL FOR PALLIATIVE CARE
CONDITIONS THAT CALL FOR PALLIATIVE CARE

• The following types of patients are the patients you can usually provide
with palliative care;
• Patients with AIDS, because their immunity is low and may suffer from any
disease and these patients are usually in pain
• Patients with liver cirrhosis equally these patient may have lost weight and
may present with other symptoms like weight loss.
• Cancer patients these patients in so much pain and they need pain relief
• Chronic renal failure patients,
• Patients in the late stages of heart failure where most of their body systems
are affected and they need some relief of some kind,
PRINCIPLES OF PALLIATIVE CARE

• Provide relief from pain and other distressing symptoms because most of
the patients are in pain
• Integrate psychological and spiritual aspects of client care because most of
these patients are terminally ill and the need psychological and spiritual
support,
• Offer a support system to help clients live as actively as possible until
death- The social support you can offer through palliative care includes
making sure that a person is receiving attention from their family,
community, and from their religious or spiritual leader/family.,
• Enhance the quality of life; enhance quality of life which may also positively
influence the course of illness;
Conts..
• Offer a support system to help families cope during the client’s illness
and their own bereavement.
• Affirm life and regard dying as a normal process
• Neither hastens nor postponed death
TYPES OF SERVICES PROVIDED UNDER
PALLIATIVE CARE
1. In-patient’s bed
• An in-patient palliative care unit may be part of a hospital or an
independent free-standing unit.
• A hospital unit may be either a special ward within the hospital or a
separate unit built in the hospital grounds while a free-standing unit
is physically separate from the hospital.
• Patients may be admitted for:
symptom management (physical or psychosocial).
Conts..
Terminal care especially in the last days
Short duration rehabilitation/convalescence
To provide a period of respite for family careers
 Terminally ill patients who need urgent medical or surgical
intervention are admitted also to the hospital for management of
those life-threatening symptoms such as obstruction, haemorrhage or
infection
2. Hospice care/ Day care
• This type of care is provided in places known as Day Care, Day
Hospice, Day Palliative Care Unit.
• Provide care, rehabilitation, support and respite during the day for
people under care at home, who are still well enough to be
transported to and from the Day Care Unit, often by volunteer
transport.
• Hospice care is usually provided in the patient’s home by a
multidisciplinary team of health-care professionals and trained
volunteers, including family members.
• When home care is not possible, hospice care may be provided in
nursing homes, hospitals, and in homelike hospice centers.
Conts..
• Hospice patients receive medication for pain and anxiety, and other
medications to control various symptoms of their disease.
• Professionals and trained volunteers are essential components of
hospice care, family members provide much of the daily care that a
patient receives at home.
• This practice helps relieve the distress of a dying patient by providing
a familiar environment in which the patient is surrounded by loved
ones, and helps both the patient and family prepare for death in a
way that many find rewarding.
• Hospice services also provide counselling and support to family
members during the terminal illness and grieving process.
3. Nursing Homes
• This refers to residence that is equipped and staffed to provide care
for people with serious medical conditions.
• Nursing homes are designed to provide food, shelter, and medical
care for their residents, as well as social, religious, creative, and
intellectual activities.
• Most nursing home residents are elderly.
4. Community-based care (Home-based care);
• Care is provided to the patients in their homes.
• Family members and community volunteers work hand in hand in
looking after the patient, while the hospital staffs comes in when
there are acute-on-chronic symptoms that are life-threatening.
• One can use various models for community based palliative care
services as follows;
• services providing specialist advice and support for the family doctors
and community nurses managing the patients
• services providing ‘hands-on’ nursing and allied health services to
patients at home, in co-operation with the patient’s own doctor
• comprehensive services providing medical, nursing and allied health
care to patients and their families at home
Hospital Palliative Care Teams
Hospital Palliative Care Teams

• Successful palliative care requires attention to all aspects of a

patient’s suffering, which requires input or assistance from a range of
medical, nursing and allied health personnel—a multidisciplinary
approach.
• Established palliative care services work as a multidisciplinary or
inter professional team
• Inter professional is the term now used for teams that meet on a
regular basis to discuss patient care and develop a unified plan of
management for each patient, and provide support for other
members of the team
The ideal multidisciplinary team

• Medical Staff the medical staff together with the nursing stuff need to assess the
patient and come up with treatment plan
• Nursing staff – together with the medical staff need to assess the patient and
come up with treatment plan
• Social worker The social worker to look at the social aspect like home
environment where the patient comes from and the financial stance as some
finances may be needed at some point.
• Physiotherapist- some patient s may be admitted for rehabilitation where they
will need rehabilitation services
• Occupational therapist
• Dietician- The patient may need diet modification depending on the problem
• Psychologist (or liaison psychiatrist) –they attend to psychological aspect of the
patient as other s may be depressed
• Chaplain (or pastoral care worker)
• Volunteers-Volunteer also work hand in hand with family members in
looking after patients
• Family members- Family members and community volunteers work
hand in hand in looking after the patient
conts
• The patient may be considered a ‘member’ of the team as all treatment must be with
their consent and in accordance with their wishes
The palliative care team also provides consultative advice on patients referred to them in
any department of the hospital.
Some of the consultative services the palliative care provide include the following:
 The team to advise on every aspect of palliation because the team has some expertise
The team provide support for family member and also provide support and education
for the staff because they are part of the care
The team facilitates the provision of high quality palliative care in all wards without the
need to be transferred to another where the patient is familiar with the staff and
surroundings.
The team educates the ward staff about matters pertaining to palliative care.
Palliative care and suffering
SUFFERING
• Suffering; Suffering may be defined as the distress associated with events
that threaten the wholeness of the person.
• Patients with these conditions whose symptoms need relief they are often
distressed because there is something threatening their health.
• For easy understand better, it is helpful to have a simple classification of
the causes of suffering;
• Pain, mostly patients especially those with cancer the major symptom is
pain
• Vomiting, some patients on radiation therapy often experiences vomiting,
difficulty breathing, sleep problems, weight loss; fatigue, weakness
• suffering. Respect the cultural differences and treatment planned in a
culturally sensitive manner
• Psychological- patient has anxiety and depression, give the patient
and family psychological support; Patient is usually worried of death,
you need to understand what the patient is going through.
• Social – patient and the family go through different social problems
which may include finances and rejection. It is you duty to connect
the patient and the family to appropriate people who can come in to
assist..
• Cultural ethnic, racial, religious and other cultural factors may have a
profound effect on a patient’s
COMMUNICATION WITH PATIENTS
• Some people may need a more complex form of care from the
beginning, especially those who have communication problems
(difference in language, or are hard-of-hearing);
• who have family problems; or who have repeatedly requested
physician-assisted suicide.
• Whatever the situation, the palliative care team will work with the
appropriate mental health professionals, medical professionals,
social services, to make sure that their needs are met.
• This would include people: with a past history of psychiatric problems
or substance abuse problems etc.
Conts..
• After a loved one has died, the palliative care continues, making sure
that the body is treated in a culturally sensitive and respectful way,
that the family has time with the body, that funeral arrangements are
made and finalized, and that all healthcare professionals and
insurance companies are notified.
• For the family, the palliative care team will help provide support with
their grief by identifying available help or community
grief/bereavement groups, and will make sure that family members
are receiving the help needed in order to cope with the death.
BARRIERS TO PALLIATIVE CARE
Conts..
• When we say barriers to palliative care, we are looking at what can make a
patient not to access palliative care.
• Some of the things which can make the patient not to access palliative are
as follows:
Late disease presentation
Inadequate diagnostic facilities and assessment skills. This can be a
hindrance because you should know the diagnosis before you put the
patient on any treatment.
Poor availability of chemotherapy and radiotherapy
Absence of opioids –opioids are strong pain killer associated with addiction
and because of this the ordering is restricted such that they may not be
available when required hence patients cannot be relieved of pain thereby
becoming a hindrance to palliative care
Conts..
Regulatory and pricing obstacles drug administration of strong pain killer is
being regulated restricting even the palliative care which means they
cannot do certain things they want to do and this is a barrier to palliative
care
Ignorance and false beliefs, a lot of people may be ignorant of these
palliative care services and there are certain beliefs like addiction because
of this people may not access palliative care service which can be a barrier.
Limited access to care there few places where palliative care is being
offered and even people who are trained in palliative care are few.
Lack of trained personal to make accurate assessment of palliative care
needs
Conts…
Culture variation preferences
Traditions dictate appropriate models of care
Terminally ill people might be removed from villages to avoid risk to the
community or
Some are returned from hospitals to the community. In all these times
patients are not able to access care
Stigma – stigma may mean shame, disgrace or dishonor usually patient
with terminal illness have that shame because of the terminal illness.
So these patients may not even seek treatment because they are
disgraced.
TO BE CONTINUED…..