LEC 8: Palliative Care Flashcards
Palliative Care
Seeks to improve a person’s quality of live once a chronic, life-limiting condition is diagnosed. It then continues until death and into family bereavement and care of the body. Palliative care is provided in all primary care settings, including homes, ambulatory clinics, and other community settings, and in all tertiary care settings, including hospitals, hospice, and long-term care facilities.
Palliative Approach
Uses palliative care principles (dignity, hope, comfort, quality of life, relief of suffering) with people facing chronic, life-limiting conditions at all stages, not just at the end of life. It reinforces personal autonomy, the right for persons to be actively involved in their own care and a greater sense of control for individuals and families. The palliative approach of “conversations with people about their needs and wishes”.
Specialized Palliative Care
Involves a specialist palliative care team or health professional to augment palliative care, usually in one of two ways: Assessing and treating complex symptoms Providing information and advice to staff about complex issues (ethical challenges, family issues, psychological or existential distress)
WHO Definition of Palliative Care
- Provides relief from pain and other distressing symptoms
- Affirms life and regards dying as normal process
- Intends neither to hasten or postpone death
- Integrates the psychological and spiritual aspects of patient care
- Offers support system to help patients live as actively as possible until death
- Uses a team approach to address the needs of patients and their families, including bereavement counselling, in indicated
- Will enhance quality of life and may also positively influence the course of illness
- Is applicable in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and mange distressing clinical complications
Considerations and Context
- Reflect on our own experiences, culture
- People die the way they lived in many situations
- Current trends in society
- Death-phobia
- Families under a lot of stress
- Demand for euthanasia and new legislation
- Dying not well-understood or accepted
- Variable responses across cultures
- Nurses need to speak well to establish relationships of trues, and to prepare families who will say “we don’t know what to do”
What can guide our care?
- CHPCA
- In 2013 the Canadian Hospice Palliative Care Association (CHPCA) established an expert advisory committee to review and revise the Model to Guide Hospice Palliative Care to reflect current practice and experience. The document has been streamlined to focus on the principles and Norms and provide only the most used information.
- CNA position statement: A palliative approach in any setting/situation
CNA, CHPA, and CHPC-NG Believe That:
- Nurses are essential providers of health care throughout people’s lives until death occurs.
- Their practice within the palliative approach and primary health care framework is based on CNA’s Code of Ethics for Registered Nurses.
- Person-centred care is the foundation of the palliative approach.
- It honours people’s values and health-care wishes by promoting autonomy, dignity and control as well as shared decision-making (as appropriate) with health-care decisions.
- Nurses, as key stakeholders, advocate for high-quality palliative and end-of-life care that is accessible to all Canadians and is provided in a setting of choice that best suits their care needs.
- Nurses (across practice settings and domains of practice), interdisciplinary colleagues, health-care employers and governments all share a responsibility to support accessible, high-quality palliative and end-of-life care
A Palliative Approach
- Joint position statement of the CAN, CHPCA, and CHPC Nurses group
- Support for the palliative approach
- All nurses have a fundamental role
- Crosses the lifespan and settings of care
- By definition, a palliative approach uses palliative care principles when people face chronic, life-limiting conditions at all stages, not just the end of life.
- Involves impeccable symptom management, pain control, quality of life, and other discussions with patients and families on the goals of care in order to meet their needs in a holistic and integrated way
- Crosses all healthcare sectors
- Focused on prevention and health promotion
The Way Forward (2015)
- Dying is part of life
- The way we die is changing
- Palliative approaches provide us an opportunity
- An integrated palliative approach to care focuses on meeting a person’s and family’s full range of needs- physical, psychosocial, and spiritual
Goals of Palliative Approaches
- More control for patients
- Better health outcomes
- Seamless transitions
- Better use of resources
Advance Health Care Directives
- Only one piece of the puzzle, more useful to have improved communication between patients, families, and HCP, and an ACD is only onse aspect…it is more about a conversation and what the person would want
- Determine a poxy/substitue decison-maker
- Legal issues
Providing Life Support Measures
- Life-prolonging treatment, moral distress, conscientious objection (must not be based on fear, prejudice, or convenience)
- Supreme Court of Canada rules that SDM must have a say, we work with families to ensure their unique values, customs, spiritual beliefs, and social and economic circumstances are taking into accoutn.
- NUrses facilitate a dialoge, rather than loaded terms such as “futile” the nurse can speak about “appropriateness of care” and “goals of care”
Family Meetings
- Clinical practice guideliens developed though expert panel and focus groups in 3 major techching hosptials in AUS
- Prepare for and offer family meeting to all lucid patients (detailed instuctions include confirm family care role, family genorgram, identiy needs)
- Conduct the meeting
- Document and follow-up
Guiding Principles for Conducting Family Meetings
- Goals of care
- Sharing information
- Based on need
- Be resouce effective/triage of priority issues
- A preventative approach, avoid cirisis and conflict
- Offered routinely on admission and prn
Communicating when there is Conflict
- A conversation about goals of care- find out what is most important to the patient and the family
- Assess the patient and family’s knowledge, explain options and answer truthfully
- Assess their values and beliefs about dying
- Document the patient’s or decision-maker’s care choice
- Allow concerns or feelings- recognize that conflicts are quite commong
- You may need to involve an Ethics Consultant
- Asking the right questions:
- Would you like me to explain what will happen if we do or don’t do these things?
- What do you know about palliative and hospice care?
- Are you having trouble letting go? If so, what is getting in the way?
