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Nursing 304 > Intro to Palliative Part I > Flashcards

Intro to Palliative Part I Flashcards

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1
Q

What is “hospice” and “palliative care”?

A

In Canada, the terms “hospice” and “palliative care” are often used interchangeably to denote a philosophy of care. In fact the term “hospice palliative care” has been adopted by the Canadian HCP Association and utilized to indicate the integration of care throughout a variety of settings. In addition, the word “hospice” may refer to a place of care.

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2
Q

What is “hospice” specifically?

A

Primarily a “concept” of care - not always a specific place of care, but often combined.
I.e. a specific philosophy and/or approach to care rather than merely a type of building or service, or both.

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3
Q

What kind of patients are fit for hospice care?

A

The word “hospice” is used to identify a place outside the acute care environment where quality HPC is provided for a specific group of patients who do not require hospitalization in an acute care setting, but cannot be managed safely or comfortably at home.

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4
Q

What is palliative care according to the Word Health Organization (WHO)?

A

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention of relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

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5
Q

What are the principles of Primary Health Care that guide palliative care?

A

Palliative care is guided by the principles of Primary Health Care: accessible, participatory, interprofessional, health promoting, uses appropriate technology/skills.

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6
Q

What is palliative care, according to Canadian Hospice and Palliative Care Association?

A
  • Affirms life/regards dying as normal process
  • Neither hastens nor postpones death
  • Provides relief from pain/other symptoms
  • Integrates psychological/spiritual aspects of care
  • Offers ongoing support systems to dying patients and family members.
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7
Q

What are some arguments for the case that palliative care is a human right?

A

An aging population, a growing incidence and prevalence of cancer, and a growing HIV/AIDS epidemic has brought increased attention to palliative care as a public health issue and a human right.

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8
Q

What is the main difference between curative focus vs. palliative focus of care?

A

Curative focus: disease-specific treatments

Palliative focus: comfort/supportive treatments, bereavement support (for family)

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9
Q

What are the focuses of curative/disease treatment (indepth list)

A

Diagnosis of disease and related symptoms
Curing disease
Treatment of disease
Alleviation of symptoms

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10
Q

What are the focuses of palliative treatment?

A

Patient/family identify unique end-of-life goals
Assess how symptoms, issues are helping/hindering reaching goals
Interventions to assist reaching end-of-life goals
Quality of life closure

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11
Q

What are the 10 Guiding Principles of Hospice Palliative Care?

A
  1. Person/family centered = basic “unit of care”.
  2. Ethical
  3. High Quality
  4. Team-based/Circle of care
  5. Safe and Effective
  6. Accessible
  7. Adequately Resourced/sufficient to support HPC activities
  8. Collaborative
  9. Advocacy-based
  10. Evidence-informed/knowledge based
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12
Q

What are the goals of palliative care?

A

Assure patient receives excellent pain control/other symptom/comfort measures.
Give patient (and/or family) information needed to participate in care decisions.
Offer ongoing emotional/spiritual support.
Obtain expert help in planning care outside hospital i.e. discharge planning.

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13
Q

What is evidence-based palliative care?

A

Evidence-based practice is the conscious, explicit and judicious use of current evidence in making decisions about the care of individual patients.

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14
Q

Why is it difficult to gather quantitative data on palliative care?

A

It is more difficult to measure quality of life and altered outcomes in patients and families whose illness or frailty make it difficult to collect data.

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15
Q

Why is it important to know the difference between palliative care and curative care?

A

Outcome and quality of life measures need to be sensitive to the wider aspects of palliative care, not merely mortality, function, or absence of symptoms.

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16
Q

How should people who work in palliative care use research?

A

Those working in palliative care must use existing research through appropriate systematic reviews to maximize the value of data yielded in caring for patients and families.

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17
Q

Why do we need to use evidence-based clinical practice guidelines in hospice palliative care? (12 points)

A

• Reduce variation in professional practice.
• Ensure equitable allocation of resources.
• Measure the quality of our care.
• Identify opportunities for improvement.
• Improve management of the health care system.
• Provide a foundation for the future.
To provide the best care possible and…
To help:
• Inform health care providers, patients and families.
• Educate health care providers and the public.
• Include all members of the health care team.
• Improve clinical decision-making.

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18
Q

What is quality of life (according to all models)?

A

There are many models of quality of life, the important aspect is that they encompass all dimensions and focus on what is important for the patient and the “family”.

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19
Q

What are four areas that relate to quality of life?

A

Physical
Psychological
Social
Spiritual

20
Q

What are some things are related to “physical” quality of life?

A 
Functional ability
Strength/fatigue
Sleep and rest
Nausea
Appetite
Constipation
Pain
21
Q

What are some things related to “psychological” quality of life?

A 
Anxiety
Depression
Enjoyment/leisure
Pain distress
Happiness
Fear
Cognition/attention
22
Q

What are some things related to “Social” quality of life?

A 
Financial burden
Caregiver burden
Roles and relationships
Affection/sexual function
Appearance
23
Q

What are some things related to “spiritual” quality of life?

A 
Hope
Suffering
Meaning of pain
Religiosity
Transcendence
24
Q

What is bereavement?

A

Bereavement is the time we spend adjusting to loss. There is no standard time limit and there is no right or wrong way to feel during the bereavement period - everyone must learn to cope in their own way. The time spent in a period of bereavement may depend on how attached the person was to the person who died, and how much time was spent anticipating the loss.
-As with grief, it is individual and complex.

25
Q

What is the purpose of bereavement counselling?

A

Bereavement counselling can offer an understanding of the mourning process and explore areas that could potentially prevent you from moving on.

26
Q

What are the 7 C’s of quality hospice palliative care?

A 
Competence
Consistency
Coordination
Climate
Cooperation
Communication
Compassion
27
Q

What are the six dimensions of the supportive care model? (Davies and Oberle, 1990)

A 
Valuing
Connecting 
Empowering 
Doing for
Finding meaning
Preserving integrity
(-Self care)
28
Q

How does hospice/palliative care provide opportunities for growth?

A

The last phase of life provides continued opportunities for positive growth in the face of suffering

29
Q

What are the things involved with life closure?

A

Life closure is a personal experience. It involves:

  • Completion of worldly affairs.
  • Completion of community relationships.
  • Meaning about one’s individual life.
  • Love of self.
  • Love of others.
  • Completion of family/friend relationships.
  • Acceptance of the finality of life/”fading away” with dignity and at peace.
  • New self beyond personal loss.
  • Meaning about life.
  • Surrender to the unknown (“letting go”)
30
Q

What kind of clients are served by palliative or hospice care?

A

Patients and families with a life threatening illness or facing end of life issues
Anticipated prognosis of weeks or months rather than years
Primary intent of treatment is improved quality of life not cure of disease.
Patient/family agree to the referral or to consultative support
DNR/”No Code” Status will be required for admission to a Hospice Unit but NOT for admission to the Program.

31
Q

What are some patient services available to palliative care patients?

A 
visits by a Home Care nurse
community health care workers
support from consultation team for managing symptoms such as pain and nausea
family conferences
grief and bereavement counseling
hospice volunteer visits
access to Hospice Facility/ specialized hospital beds in acute care.
equipment and supplies
32
Q

What is the role of the community palliative team?

A

The community palliative team will provide:
Education and support to care providers, the community, individuals and families
Consultation around pain and symptom management, discharge planning
Coordination and planning of care
Participation in case conferences
Services in residential care, acute care, and in the community

33
Q

What is the role of primary health care providers in hospice palliative care?

A

Manage disease, it’s manifestations and the predicam it creates. Identify issues. Provide the core competencies of hospice palliative care.

34
Q

What is the role of secondary health care experts in hospice palliative care?

A

Expert in hospice palliative care. Support primary providers in every setting where patient/families receive care.

35
Q

What is the role of tertiary health care experts in hospice palliative care?

A

Consult to secondary experts and primary providers on difficult to manage cases.
Educate/train secondary and tertiary experts.
Conduct research.
Develop advocacy strategies.

36
Q

Why consult palliative care/hospice care?

A

Any health care provider can ask for advice and support from the team members re:

  • Pain and symptom management
  • Psychosocial issues
  • Ineffective family or caregiver coping
  • Care planning
  • End of life issues
  • Assessment re:need for hospice, acute tertiary palliative care bed
37
Q

Who is involved in a consultation team? (what kind of places/homes)

A 
Consultation teams support patients wherever "home" is:
Home care
Acute care hospital
Palliative care unit
Residential care
Hospice
38
Q

What are some settings for hospice/palliative care?

A 
Tertiary Hospice Palliative Care Unit(Burnaby) 
Acute care ( SMH, PAH, ARH)
Hospice beds (Burnaby,Tricities, Delta)
Home
Residential care
39
Q

What are some examples of patient/family situations appropriate for referral to acute care (tertiary) units?

A

difficult pain syndromes
complex physical symptom assessment/management
complex psychological/spiritual/social issues
significant family /caregiver distress
extensive support required to improve QOL
complex care planning exceeding resources at present community site

40
Q

What is acute care? (what happens during acute care re:palliative patients)

A

Short stay beds are utilized for patients requiring diagnostic tests and treatment
Consultation from the Hospice Palliative team can occur in acute care

41
Q

What is the role of hospice beds?

A

May be in a community setting or a part of a reconfiguration within a hospital ie. Delta, Mission and Chilliwack General, ARH, Hope

42
Q

What are some examples of hospice beds in the fraser valley?

A

Community Hospice beds are located in at St Michael’s Care Centre in Burnaby(16), Crossroads Hospice in Port Moody(10), Queens Park in New Westminister(7) Chilliwack Cascades (10).

43
Q

What is the admission criteria for palliative/hospice care?

A

End-stage, length of stay (LOS) maximum 3 months with average expected to be 16-22 days
Symptom management plan in place
DNR (Do Not Resuscitate) must be written
Patient may be admitted under family physician
Family physician involves consultation team
FH resident with patient placement as close to own community as possible.

44
Q

What is the role of home care in palliative care?

A

Most patients will spend the majority of their time being cared for in their own home
Home Care referral is the most common entry point for identifying the need for hospice palliative care supports
The BC Palliative Care Benefits program provides medications, and equipment and supplies

45
Q

Which palliative patients are good candidates for residential care?

A

People with many months to live who cannot remain at home can be cared for in long term care facilities
Palliative care teams can be consulted to provide support to patients in a residential facility

Nursing 304 (12 decks)

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