Home Health & Palliative Care

Question 1

What is Home Health Care?

Answer 1

• includes chronic and rehabilitative healthcare
• Helps patients maintain independence
• Delivered in homes, schools, workplaces, long-term care facilities, clinics, and community settings.
• 70 % is funded by the government

Question 2

Why do people remain in the home?

Answer 2

• they are more comfortable
• remaining in their environment allows for changes to be made within that existing environment
  ○ Ex. If they are eating certain meals at the hospital, they will likely change their diet once they get home

Question 3

What is Home Health Nursing?

Answer 3

Home health nurses mobilize resources to support health by:
- coordinating care
- planning services, programs, and policies with individuals, caregivers, families, other members of the interprofessional team, organizations, communities, and governments

Question 4

What is a Home Health Nurse?

Answer 4

• focus on prevention, health, restoration, maintenance, or palliation
• initiates, manages, and evaluates the resources needed for the client to reach optimal well-being and function (ie. decides that certain tests need to be done, medication should be changed, other supports that are needed)

Question 5

What are the 3 Home Health Nursing Competencies:

Answer 5

1) Elements of home health nursing
- surrounding activities, function, goals and outcomes crucial for home health nurse

2) Foundations of home health nursing
- Primary care philosophy relating to home health nursing

3) Quality and Professional Responsibility
- Strategies for home health nurses to promote the quality of care and demonstrate responsibility

Question 6

What are the 8 Elements of Home Health Nursing:

Answer 6

1) Assessment, Monitoring, and Clinical Decision Making

2) Care Planning and Care Coordination

3) Health Maintenance, Restoration, and Palliation

4) Teaching and Education

5) Communication

6) Relationships
- Working non-judgmentally to establish relationships with the family

7) Access and Equity
- culturally appropriate care when working with diverse client groups

8) Building Capacity
- Recognizing their capacity to manage the illness, work with their strengths, adapt and be flexible to changing needs of the client

Question 7

What are the 2 Foundations of Home Health Nursing:

Answer 7

1) Health promotion

• How systemic factors; social determinants have impacted their life to lead them to the current situation they are in
• Helping people to change successfully within their environment
  
  • including awareness of the context of their situation

2) Illness prevention and Health Protection

• Take action to protect clients from unsafe circumstances

Question 8

What is Quality Care and Professional Responsibility:

Answer 8

1) Quality Care
- Participate in risk management and quality improvement.
- Evaluate programs in relation to the determinants of health and health outcomes.

2) Professional Responsibility
- Demonstrates professionalism and accountability.
- Performs continuous reflective practice.
- Integrates multiple ways of knowing into practice

Question 9

Who is Eligible for Homecare?

Answer 9

Individuals of any age:
- with long-term care needs due to a disability or frailty,
- who require care in their home, at school, or in the community

Question 10

What is involved in the transition to homecare?

Answer 10

• Patients transitioning into home care are assessed in the hospital for the appropriate type, amount, and timing of home care and community support services.
• The amount of support a patient need can be short (days-weeks) or long (> several weeks)

Question 11

What is Chronic Care:

Answer 11

Chronic Care: care provided to patients with chronic conditions who require comprehensive, coordinated healthcare services from healthcare professionals

• A chronic condition is a persistent diagnosis that requires ongoing medical management for several years. Ex. Dementia Cardiovascular disease, Diabetes, COPD, HIV/ AIDS

Question 12

Palliative Care is __________.

Answer 12

Developmental

Question 13

Palliative Care Vs. End-of-Life Care

Answer 13

Palliative Care
- both a philosophy and approach to care
- aims to improve the quality of life for those suffering life-limiting illness
- partial relief of suffering through treatment of symptoms

End-of-Life Care
- improving QOL for people who are expected to die in the upcoming future
- the nurse ensures that the patients’ comfort and support is consistent with their goals of care

Question 14

Qualities of Palliative Care Nurses

Answer 14

• Care and respect for human dignity.
• Utilize holistic care prioritizing the psychical, psychological, spiritual, and social needs of the client.
• Support the client and their families.
• Must always be respectful.
• Value the ethical principles of autonomy, justice, confidentiality, and truth.
• Work well with the interprofessional team.

Question 15

Roles of a Palliative Care Nurse

Answer 15

• Improve quality of life
• Relieve suffering
• Help the family to prepare for the dying process, and cope with the grief they will experience
• Address the physical, psychological, spiritual, and social needs of the patient

Question 16

What is the Palliative Performance Scale?

Answer 16

• Developed by the Victoria Hospice Society, in British Columbia
• 11-point scale including 5 observable parameters in the functional assessment:
  1) Degree of ambulation
  2) Ability to do activities.
  3) Ability to do self-care.
  4) Intake
  5) Level of consciousness

Question 17

What is Hospice Palliative Care?

Answer 17

• Offered in the patient’s home, hospitals, long-term care facilities, or hospices.
• uses a holistic approach to address:
  1) Pain management
  2) Symptom management
  3) Social, psychological, emotional, and spiritual support
  4) Caregiver support

Question 18

What is MAID?

Answer 18

• initiated in 2016
• Performed by NPs and physicians
• drugs used in the procedure are commonly prescribed to the general public (in smaller doses) for nausea, pain control, and anesthesia purposes

Question 19

What are the 2 Types of MAID:

Answer 19

1) Physician or NP directly administers a substance causing death

2) Physician or NP prescribes a drug that the patient administers themselves to induce death

Question 20

Who is Eligible for MAID:

Answer 20

• Be eligible for health services funded by the federal government.
• Be at least 18 years old.
• Be mentally competent (capable to make health care decisions).
• Have a grievous or irremediable medical condition
• Make a voluntary request for MAID with the absence of pressure and influence.
• Provide informed consent to MAID to your practitioner after one has received all the information one needs to make the decision including:
  1) Your medical diagnosis
  2) Available forms of treatment
  3) Available options to relieve suffering, including palliative care.

Question 21

__% of Individuals Receiving Long-Term Care have an unpaid caregiver.

Answer 21

96%

Question 22

More than ____ in these caregivers are distressed.

Answer 22

1/3

Question 23

How do you Support Family Caregivers Through the Dying Process?

Answer 23

• Communication
• Emotional support
• Therapeutic, trusting relationship

Question 24

Symptoms dying persons may experience at the end of life

Answer 24

• Activity level decreases significantly
• Interest in surroundings fades
• Desire for food and drink is reduces
• Bowel and bladder changes
• VS decrease
• Increases in pain due to progression of disease, worsening of chronic conditions such as arthritis or stiff/inflamed joints, or increase in pressure wounds to skin
• Skin of the knees, feet, and hands may become purplish, pale, grey, and blotchy or mottled
• Periods of rapid breathing, and no breathing for brief periods of time, coughing or noisy breaths, or increasingly shallow respirations, especially in final hours or days of life
• Consciousness fades
• Sensory changes - ie. illusions, hallucinations, or delusions