HOSPICE PALLIATIVE CARE | Palliative Care | Hospice

HOSPICE PALLIATIVE CARE HOSPICE CONCEPT Introduction Definition of Hospice y Hospice is a concept of care that provides support for

the terminally- ill patient and the family allowing the patient to live as fully as possible until death. It is centrally administered program of palliative and supportive services which provides physical, psychological, social and spiritual care for dying persons and their families. Services are provided by a medically supervised inter- disciplinary team of professionals and volunteers.

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The patient and family are both included in the care plan and emotional, spiritual and practical support is given based on the patient s wishes and family s needs. Trained volunteers can offer respite care for family members as well as meaningful support to the patient. Hospice is a concept of care designed to provide comfort and support to patients and their families when a life- limiting illness no longer responds to cure- oriented care. Hospice care contrasts with curative care because it is not designed to cure illness or lengthen life but emphasizes the management of all symptoms of a disease, with a special emphasis on controlling a patient s pain and discomfort. Hospice deals with the emotional, social, and spiritual impact of the disease on the patient and the patient s family and friends. Hospice care is defined as an interdisciplinary approach to provide medical and nursing care, pain management, and emotional and spiritual support directed at fulfilling patient s needs and wishes at EOL (end of life)(National Hospice and Palliative Care Organization, 2008). Hospice care is one option for people with life limiting cancer when curative therapy or control of the disease is no longer realistic. Hospice programs provide holistic care at EOL. With an emphasis on meeting the patient s goals of comfort and quality of life. The hospice model of care uses an interdisciplinary approach to provide nursing, medical, social, spiritual, nutrition, volunteer, and bereavement services. (Carlson, Morrison, Holford, and Bradley, 2007).

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y y Hospice is a special kind of care designed to provide sensitivity and support for people in the final phase of a terminal illness. y y Hospice care seeks to enable patients to carry on an alert, pain- free life and to manage other symptoms so that their last days may be spent with dignity and quality at home or in a home- like setting. Hospice is a concept of caring derived from medieval times symbolizing a place where travellers, pilgrims and the sick, wounded or dying could find rest and comfort. The contemporary hospice offers a comprehensive program of care to patients and families facing a life threatening illness. Hospice is primarily a concept of care, not a place of care. It emphasizes palliative rather than curative treatment, quality rather than quantity of life. The dying are comforted. Professional medical care is given, and sophisticated symptom relief provided.

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following accurate diagnosis. the Jewish and the Angelicans.The Principles of a Hospice Program of Care Who is the terminally. 11. Medical Care is a necessary element of palliative care. Background of the Hospice Movement y It originally started as home for the dying in the community by well innovative carers. Dame Cicely Saunders 1. When cure is not possible. physical and the cultural. Personal. Attention to physical comfort is central to palliative care. these homes were ordered closed. philosophic. No one individual or profession can meet all the needs of terminally. y 9. Pain and other symptoms of incurable disease can be controlled. care is still needed. carers and the dying. y y 13. with the reign of Henry VIII. There is a continual need to improve the techniques of palliative care and to disseminate such information. moral or religious belief systems are important to patients and families who are facing death. Optional utilization of services and resources is an important goal in the administration and coordination of patient care. 8. In the 19th century. From the 4th to the 16th century. Not all patients have a family member available to take on the responsibility of giving care. By covering these needs.ill patient is one in whom. Family participation in care giving is an important part of palliative care. 22. Dame Cicely Saunders started St. spiritual. The need for quality assurance in health care requires the establishment of standards for practice and program operation. embracing all kinds of needs and care: emotional. . these homes were called Hospis where the sick were looked after in religious hospices.makes dying time. 6. The physical environment and setting can influence a patient s response to care.time of spiritual renewal and reunion with loved ones. y 15. 20. Not all persons need or desire palliative care. Continuity of care (services and personnel) reduces the patient s and the family s sense of alienation and fragmentation.ill patient? y The terminally. In 1538. 7. the sisters of Dublin reopened and the name hospice was adopted as homes for the dying patients ran by the Catholics. stress and concerns may arise in many aspects of their lives. When a patient and family are faced with terminal disease. 21. 19. the advent of death is certain and not too far distant and for whom treatment has changed from the curative to the palliative and supportive. Christopher s Hospice in London in 1967 and since then the hospice movement has extended from the hospice to hospital wards and the homes. Family needs continue after the death of one of their members. The amount and type of care provided should be related to client and family needs. Documentation of services is necessary and desirable in the delivery of quality care. y 18. 12. 16. Families experiences significant stress during the terminal illness of one of their members. Dying is a normal process. Patient and family needs may arise at any time. open communication flows between families. 10. 14. 5. 3. This removes the fear of death. 2. 4.ill patients and families all the time. 17. Persons giving care to others need to be supported and replenished in order to continue to give care.

y For hospice patients and their loved ones help is just a phone call away. The patient s total care is best managed by an interdisciplinary team whose members communicate regularly with each other. with assistance from the hospice team. The hospice movement stresses human values that go beyond the physical needs of the patient. and spiritual needs of the patients and their loved ones. y Patients and their families are included in the decision. Research and Education should be ongoing.is distinguished from multidisciplinary practice in that the former is based on communication and cooperation among the various disciplines. Pain and other symptoms of terminal illness must be managed. y The interdisciplinary hospice team is made up of professionals who can address the medical. 2. Home Hospice. seven. Death must be accepted.hospice care provided while a patient continues to live at home or the place they called home at the time of enrolment. Patients routinely receive periodic in-home services of a nurse. 4.days a week basis. 5. not just the patient. the unit of care. 7. hospice residence. volunteer. Hospice treats the person. Bereavement care must be provided to family members. Although 90% of hospice patient time is spent in a personal residence. social worker. 3. hospice uses sophisticated methods of pain and symptom control that enable the patient to live as fully and comfortably as possible. The family or significant others are generally able to handle the needs and care of the patient. psychological. Home care of the dying is necessary. . y Hospice neither hastens nor postpones death: it affirms life and regards dying as a normal process. Hospice emphasizes quality. some patients live in nursing homes or hospice centers. who founded the world-renowned St. y Under the direction of a physician.making process. emotional. 6. 5. 3. Hospice considers the entire family. and other members of the hospice interdisciplinary team. Principles Underlying Hospice according to Saunders. or nursing home) for symptoms or crises that cannot be managed in the patient s home. and bereavement counselling is provided after the death of their loved one. not the disease. rather than length of life.4. Christopher s Hospice in London: 1. Interdisciplinary collaboration. How Hospice Differs from Other Types of Healthcare 1. each member of the team contributing to a single integrated care plan that addresses the needs of the patient and family. Inpatient Hospice. Hospice offers palliative rather than curative treatment.hours a day.hospice care provided 24 hours per day in a facility (hospital. home health aide. Is Caring for the patient at home the only place hospice care can be delivered? y No. Hospice offers help and support to the patient and family on a 24. The patient and family should be viewed as a single unit of care. 2. including a hospice nurse.

1990). Hospice Palliative Care is now widely accepted in Canada. y y Is Palliative Care the same as Hospice Care? YES. 3. HOSPICE y y y Focus is on pain and symptoms management Patient has a terminal diagnosis with life expectancy of less than six (6) months Not seeking curative treatment Palliative Care y is an approach to care for the seriously ill that has long been a part of cancer care. comfort.Multidisciplinary care. hospice care and palliative care are no longer recognized as separate entities. 2nd Edition) It is recorded that due to the fluidity of the English language.and family. (The IAHPC Manual of Palliative Care.focused treatment ends. Palliative care is sometimes called hospice care. A comprehensive. The active. or to care in the final days of life. y y Palliative care is sometimes confused with hospice care since one of the main goals of hospice care is comfort and most hospice patients are dying. total care of patients whose disease is not responsive to treatment (WHO. HOSPICE CARE y Palliative care is closely associated with hospice care. It is better to adopt and use the term palliative care. The goal is to improve the patient s and family s quality of life. where comprehensive symptom management and psychosocial and spiritual support can enhance the patient s and family s quality of life. this type of care is not just for the dying. y y y y DIFFERENCES BETWEEN PALLIATIVE AND HOSPICE CARE PALLIATIVE CARE y y y Focus is on pain and symptom management Patient does not have to be terminal May still be seeking aggressive treatment What Unites Hospice and Palliative Care CHPCA Core Values 1. y  In both hospice and palliative care.refers to participation of clinicians with varied backgrounds and skill sets but without coordination and integration. palliative care is being offered to patients with non-cancer chronic illnesses.it is variously used to refer to a philosophy of care. and many aspects of this type of comprehensive. Increasingly. Not care that begins when cure. y y y Hospice means different things in different countries. Care is positioned as that which occurs at the time of life. the focus is on quality of life of the patient.  In Canada.threatening diagnosis is identified and becomes progressively the focus of concern as curative treatments prove ineffective. It emphasizes management of psychological. y PALLIATIVE CARE VS. Patient centered Family oriented Holistic Active .focused approach to care are applicable earlier in the process of lifethreatening disease. social. 4. to care offered by unpaid volunteers. The Canadian Hospice Palliative Care Association (CHPCA) defines hospice palliative care in terms of its aim to relieve suffering and improve the quality of living and dying.centered care when disease is not responsive to treatment.  The goal for both types of care is to address any adjustment to illness or end of life issues. to the buildings where it is practiced. 2. the principles are the same. and spiritual problems in addition to control of pain and other physical symptoms. the clarity concerning these differences was also taking shape. person.

h. Distancing or blocking tactics. Explanation  Explanation about care and treatment options is vital to the delivery of effective care and empowers patients and carers to be involved as equal partners in the decision. Open communication involving not only patients and family members but also all relevant health professionals will facilitate informed decisionmaking. 6. will assist the professional to understand the impact of symptoms from the patient s perspective. Evaluation  Self. In implementing any intervention or treatment related to the management of symptoms. This includes agreeing to non.making process. Attention to Detail  throughout the process of symptom management.  The patient s priorities must be considered and realistic goals set in conjunction with the patient and then documented in the management plan. Symptom Control Effective Communication Rehabilitation Continuity of Care Terminal Care Support in Bereavement Education Research 1. Problems that professionals have with Communication: 1. Listening to the patient s own story. . 5. 3. the missing of details by health professionals can have dire consequences. c.treatment as an option. e. 2001). 7. It is estimated that 90% of patients who access palliative care services have a diagnosis of cancer ( Bruera & Portenoy. governments worldwide are now committed to ensuring that palliative care is available to all who need it.  Health professionals should work in partnership with the patient. 2003). EFFECTIVE COMMUNICATION 2. the preferred choice of the patient should be at the forefront of the minds of practitioners. b. B. including past and present life experiences. Management  Management builds on the assessment process. including patients diagnosed with incurable non-malignant diseases (Armstrong.   Key Principles of Symptom Management 1. WHO. Scottish Executive. f. COMMUNICATION   Key aspect of the role of the nurse. 2003).2001.5. Evaluation 2. g. Universally accessible Complementing disease modifying therapy Delivered by an educated and regulated interprofessional team THE PROCESS OF SYMPTOM MANAGEMENT Five main Principles (EEMMA) 1. 3. 4. 2001. A. 3.being (de Conno and Martini 2001). Explanation 3. Buckman (1993) proposed that effective symptom control is impossible without effective communication. 4. SYMPTOM CONTROL  Symptom management is a fundamental aspect of palliative care (WHO. 2. Ignoring cues False Reassurance Avoidance tactics  Symptoms are multidimensional in nature and therefore symptom management is best achieved by adopting a multi-professional approach.  The first stage is to identify the cause and determine what is reversible and treatable. Monitoring 5.reporting instruments are most accurate 2. Management 4. d. Monitoring  Will not only determine the efficacy of interventions but also facilitate regular reassessment of the severity of the symptom and impact on the patient. It is the primary therapeutic goal of service delivery and is aimed at subjective well. Attention to Detail ESSENTIAL COMPONENTS OF PALLIATIVE CARE: a.

Most authors agree that effective communication in palliative care incorporates effective listening skills and appropriate nonverbal communication. as well as through support groups. Looking after yourself as you look after the needs of the bereaved. y In order to communicate effectively with patients and their families. Bereavement  The time of mourning after a loss. Care of the family. nurses must be supported in the workplace. 3. 6. Able to make decisions about care Initiate discussions about end. clergy member. the handling of difficult questions or conflict. 3. 2. Faulkner & Maguire (1994) note that. supportiveness. 2. . Assessing risk and identifying current and future social support network. y   BEREAVEMENT CARE according to Anstey and Lewis (2001): 2. Legal and medical interventions. Information giving and receiving Care of the deceased. Referring on to other members of the multiprofessional team for more specialist support. 5. The hospice care team works with surviving loved ones to help them through the grieving process. Communicating effectively involves providing patients and their families with information: A trained volunteer. and/ or letter contact. (2001). such as reflection. or professional counselor provides support to survivors through visits. The hospice team can refer family members and care. 2. nurses need to pay attention to assessment skills.giving friends to other medical or professional care if needed. Hospice Care  Usually begins when the patient has six (6) months or less to live and ends with the family one (1) year after death. This can be achieved through clinical supervision (Heaven. 1. phone calls. Future care and support. BEREAVEMENT CARE   Continuation of care for the family after the death. Supporting ritual and mourning customs. Good quality information and communication at all points in the bereavement journey. 5.quality pain and symptom control in the runup to the patient s death. 3. clarification and empathy. C. 1. Bereavement services are often provided for about a year after the patient s death. 3. SUPPORT IN BEREAVEMENT  Supporting those who face loss or have experienced loss presents one of the challenging dimensions of palliative care. 4. counselling skills. 1. in order to communicate effectively with patients. selfawareness. above all. and providing support and supervision. High. GOOD PRACTICE IN SUPPORTING THE BEREAVED: 1. dealing with anger and denial. 4.life care when the patient can actively participate Facilitating discussions with patients and their families in a supportive and compassionate manner. and.of.

it is after all an issue which will at some point affect each us. 9.judgmental way. always ensuring that you are safe in the situation. 2. personal experiences. when they will be confronted with the gaps left by their loved ones. In order that the bereaved can make sense of what they are experiencing: a. If the situation has made you feel angry. you may have seen some television programmes highlighting the need for improvements in supporting those faced with a life limiting illness. age.  Allow people to grieve in a way that suits them. 8. Offer assurances based on the person s actions in the run. 3. their personality.  Silence is often a productive time during which the bereaved may experience new insights about themselves and the situation they now find themselves in. 5. This has shown publicly how palliative care is rapidly advancing.  It is important to keep calm and to try and understand the cause.  If there is escalation then you should remove yourself and seek help Consider diversity/ cultural differences. 3. . RESEARCH NURSES ROLE 1. Providing direct care Advocate Counselor Collaborative Role .  Different cultures.  REHABILITATION  CONTINUITY OF CARE  TERMINAL CARE EDUCATION  As healthcare is constantly developing and changing.   7. To ensure that you are working with their feelings and not yours.  You may need to seek an interpreter to aid with communication but you must ensure that (except emergency) the interpreter is not a family member but properly qualified. helpless or sad it is worth checking out with the individual how they feel. Palliative care is no exception. 4. and vulnerabilities. Tolerate and stay with silences. indeed. b. cultural background. and challenges.  It also help you to understand the patient s and family s reactions to their situation. belief system.  As a nurse it is imperative that you find out what these are to ensure the appropriate care.  Vary from day to day and depend on what the person is facing. external interpreter who is acceptable to the patient.SOME SUGGESTIONS TO HELP SUPPORT THE BEREAVED 1. needs.YOU DID EVERYTHING YOU COULD  6. Advancement means an even greater need to enlighten and inform. values.up to the death. Don t take anger personally.  Use good listening skills. Listen and accept the person in a non. especially in the months ahead.  Part of this involves giving the person permission to express the unhappiness they are feeling at that moment in time. but also the public. so education plays an important role in keeping all professionals updated and informed of new practices in order that patients can benefit from these innovations. rites and rituals around the dying process and death. c. You need to maintain an awareness of your own reactions to death. life experience and loss history. religions and ethnic groups may have different views. 4. Allow for Coping Strategies. 2. Demonstrate empathy with the person s position and challenges. Encourage the person to be patient with themselves. not just healthcare professionals.  This and other emotions are likely to be part of the grief process.  There is no right or wrong to grieve. Stay in touch with your own feelings about death and dying. stay focused on addressing their experience.

Erb. PROVIDING DIRECT CARE 1. SEVEN (7) CRITICAL NURSING BEHAVIOURS IN PALLIATIVE CARE (Degner et al (1991) Responding during the death sense. -This role require great communication skills. -The nurse in this role may have to lead group counselling sessions. the nurse advocate acting as a supporter can provide much.needed comfort and reassurance to the family members as they try to make sense of their impending loss and a future without their loved one. How people die remains in the memories of those who lives on. Clients would come back to the healthcare system with no improvement of themselves. 5. 6. 2. collaboration. Providing comfort Responding to anger Enhancing personal growth Responding to colleagues Enhancing the quality of life during dying Responding to the family EXAMPLE OF HOW NURSE PROTECT THE INTERESTS OF THEIR PATIENT An uninsured homeless man is being released from the hospital. WITHOUT THIS ROLE: a. 2. APILADO Jan. and teach the desired behaviours. e. 5. behaviours and attitudes. 4. ALBERT C. 4. continuous knowing and continuous giving Fostering hope Providing comfort Providing an emphatic relationship Clinical. Also demonstrate interest and caring in the welfare of others. b. or one to one counseling and be very understanding. 3. 4. b. Protects the patients right to have the treatment he/ she have chosen. a. Recognize the significance of the meaning of the illness and the death for the family. and Blais. and to promote personal growth (Kozier.Any relationship in which one person is helping another person to better understand and solve some problem (CMR Canada (2003)). consultative with teaching. COUNSELOR COUNSELLING . 1997). -As a person is dying. Have a very flexible attitude. 2. . 3. DEFINITIONS OF THE NURSE IN PALLIATIVE CARE 1. 2011 . -The nurse in this role. Protects patients rights. 5. A client may not be willing to help themselves. is there to help a client to develop and see new feelings.The process of helping a client recognize and cope with stressful psychologic or social problems. Supportive Intensive caring. must be sincere when dealing with clients. Works on patient behalf. ADVOCATE NURSE AS PATIENTS ADVOCATE 1.no one to guide them in bettering themselves.THE NURSE AS A COUNSELOR MUST: 1. leadership and research functions Being there and acting on the patient s behalf THANK YOU VERY MUCH! PROF. 7. 4. d. Makes sure the patient is an active participant in deciding what type of treatment he/ she will have. Have a great sense of humor. 3.no one was there in the first place to guide them properly. 2. The nurse calls a social service organization and makes arrangements for his care. 3. but has no one to care for him and nowhere to go. Be very inventive. g. c. Be willing to model. f. to develop improved interpersonal relationships. COLLABORATIVE ROLE -collaborate with other providers to give consistent information. 15.

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