Lecture 9 - Palliative Care and Families Flashcards
What is the who definition of palliative care
Improves the quality of life of patients and their families facing the problem 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, physical, psychosocial and spiritual.
Palliative Care
- Provides relief from what
- Affirms what and what as normal
- Intends neither to what or what
- Integrates what and what in care
- Offers a what system to help the family
- Use a what approach to address the needs of who
- will enhance quality of what and also positively influence what
- Is applicable early in the course
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early 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 manage distressing clinical complications.
Three forms of P Care
GLG
Current trends in society
Nurses need to what
Living rooms come from where
Getting over it (advocating use of the term and using education
Living with it (Supportive care and using it at end of life)
Getting around it (stepping away from the term)
Death phobic, death as the enemy Families under stress Demand for medical aid in dying (maid) 80% of deaths are not good, despite our best efforts Dying not well understood or accepted
Nurses need to speak well, to establish relationships of trust and prepare families who will say they don’t know what to do
living rooms comes from the fact people would die in from the front parlor, no longer the dying room but should be the living room
Bill C-14 Medical Assistance in Dying (MAiD)
How has the criminal code been changed
Eligibility:
- Be how old
- Have a grievious and irremediable med condition, this means SASP
- Make a request for what
- Give informed what
The Criminal Code would be changed so that physicians, nurse practitioners - and those who help them - can provide assistance to die to eligible patients without the risk of being charged with assisted suicide or homicide.
be at least 18 years old and mentally competent (this means capable of making health care decisions for yourself);
have a grievous and irremediable medical condition; This means:
- have a serious illness, disease or disability
- be in an advanced state of decline that cannot be reversed
- be suffering unbearably from your illness, disease, disability or state of decline; and,
- be at a point where your natural death has become reasonably foreseeable, which takes into account all of your medical circumstances (Note: You do not need to have a fatal or terminal condition to be eligible for medical assistance in dying.)
make a request for medical assistance in dying which is not the result of outside pressure or influence; and,
give informed consent to receive medical assistance in dying (this means you have consented to medical assistance in dying after being given all of the information needed to make your decision.
MAiD: Concerns raised
- Will what be cut
- Does the public understand what Maid is
- Who will provide the service
Path for maid ends but p care continues if u have the resources
Will the funding be cut to environments who choose to “opt out” of providing this service? (not good for P care)
Does the public understand what a “medical assisted death” is?(20% of public understood)
Who will provide the service?
-Medical community divided… many physicians assume that hospice and palliative care physicians will take on the responsibility
P Care video What is important in p care Who is the doctor in the video What are our major accomplishments What means nothing Connect how
Definition of good death
Dr Sharon baker
Major accomplishments are our relationships with others
Possessions mean nothing
Connect with patients and don’t be distant, emotional and spiritual support
Exquisite Empathy
- Highly what
- Sensitively what
- Well what
- Heartfelt what
- Invigorated rather than what
Highly Present
Sensitively attuned
Well-boundaried
Heartfelt empathic engagement
Invigorated rather than depleted by intimate connections
What do patients receiving palliative care for cancer and their families want to be told
- Info shared with who
- Depends on the stage of the illness, info about what and depending if they had what
- what need for what message at all stages
How to give info
- Playing it how
- Making it what
- Showing you what
- Giving what
- Pacing what
- Staying the what
Information
Shared with families
Depends on the stage of the illness, information about prognosis not too soon, and depending if they had asked for it (understanding what happens along the way)
Hope need for hopeful messages at all stages (miracles)
Playing it straight (honesty) Making it clear Showing you care Giving time Pacing information Staying the course (will not be abandoned)
Its all about the process
How to support hope (Kirk, Kirk, Kristjanson, 2004)
Pt/Family orientations to hope:
- Needing to believe in what
- Living what realities
Messages from health care professionals:
- Leaving what
- Retaining what
- Pacing the move towards what
- Respecting what
Pt/Family orientations to hope:
Needing to believe in a miracle
Living parallel realities (acknowledge terminal nature of the disease but still hope for a cure)
Messages from health care professionals: Leaving the door open Retaining professional honesty Pacing the move towards palliative care Respecting alternative paths
talk about what you should not expect.
You should not expect:
- Pain that cant be what
- Breathing what
- Going what
- pain that can’t be controlled.
- breathing troubles that can’t be controlled.
- “going crazy” or “losing your mind”
“If any of those problems come up, I will make sure that you’re comfortable and calm, even if it means that with the medications that we use you’ll be sleeping most of the time, or possibly all of the time”
“Do you understand that?”
“Is that approach OK with you?”
Things to say as they approach death
“You’ll find that your energy will be less, as you’ve likely noticed in the last while”
“You’ll want to spend more of the day resting, and there will be a point where you’ll be resting (sleeping) most or all of the day.
Gradually your body systems will shut down, and at the end your heart will stop while you are sleeping.
No dramatic crisis of pain, breathing, agitation, or confusion will occur -
we won’t let that happen.
Grief and Loss
P care extends into the grieving period
- Process of what and what
- Loss as a what and grief as as the what
Challenges assumptions and meaning
- Grief is not an what
- Normal part of the what
- Meaning will affect
- Normal response to what
- No set what
What types of loss do we or others experience?
Are there different types of grief?
ADAP
Process of adjustment, healing
Loss as a wound, grief as the healing
Challenges assumptions and meaning: Grief is not an illness Normal part of the life cycle Meanings will affect bereavement outcomes Normal response to breaking of bonds No set time
P care extends into the grieving period
What types of loss do we or others experience?
Death, Relationships, job loss
Are there different types of grief?:
Anticipatory (see it from a distance)
Disenfranchised (a not recognized kind of grief/ Divorce, shows removal,
Ambiguous (people becoming a shadow of themselves, changing who they are by day, the long goodbye)
Prolonged/ Complicated (Overwhelmed and cant move forward)
What about stages of grief and loss? DABDA -is it linear -How does it occur -Reflect on what -ABout what
What is the 6th stage
What about stages of grief and loss?
(e.g., Denial, Anger, Bargaining, Depression, Acceptance)
Not linear or certain
Occur naturally, unconscious
Reflect on where we are
About change and dealing with change
Is there a 6th stage?
Finding meaning in loss
What happens when nurses grieve?
Assumption that HCP are what to grief
Absorption of what
What Fatigue?
How can HCP be supported?
- What and what feelings of loss and grief
- Specialized what and what
- What and what grief support
- RC
Assumption that HCP are immune to grief
Is it unprofessional or inappropriate to show your grief?
Absorption of being in the presence of suffering… we sometimes take on the suffering ourselves
Compassion fatigue (high empathy, repeated exposure)
How can HCP be supported? Normalize and acknowledge feelings of loss and grief Specialized education and training Formal and informal grief support Rituals and ceremonies
