Palliative care

by
Henok L. (Bsc, Msc in Adult Health
Nursing)

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 Contents

• Palliative care basics

– Principles of palliative care
• Components of palliative care

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 Palliative Care (PC)

• Provides symptom management for the patient

with progressive disease rather than offering a
cure for that disease
 Includes:
– Early identification, assessment and treatment of
symptoms/problems
– Physical, psychosocial and spiritual support
Example: Pain management for cancer

• A multidisciplinary team-based care

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Historical Background

• In 1967 the modern hospice movement founded in the

UK
– The term ‘palliative care’, used synonymously with
‘hospice care’

• PC then evolved into an alternative to traditional care

for patients who believed/assumed to have no further
medical hope

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Historical Background…

• In Ethiopia, the modern hospice and PC movement started

as a response to the health system’s inadequacy to respond
to the HIV/AIDS epidemic than a desire to provide an
alternative care setting
• More organized initiatives were introduced in 2000, such as
care and support services by Organization for Social
Services for AIDS (OSSA)
• The establishment of Hospice Ethiopia in 2003 further
boosted advocacy
• Now a days there are certain Pain management guidelines
and PC hubs in referral hospitals

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 Epidemiology

• In 2017, Globally, ~45% of all deaths required

palliative care
• 40% of PC patients were aged ≥70 years
• Palliative care can benefit ~75% of people
approaching the end of life
• Is a growing need: growing older population and
increased chronic illnesses

(Reference: Knowledge on PC of nurses in Ethiopia)

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Goals of Palliative Care

• Relieve suffering
• Work towards patient goals
• To help prepare patient and family for expected
death

Assist with advance planning

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Goals of Palliative Care…

• Palliative Care provides:

– Relief from pain and other distressing symptoms
– 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 patient's illness and in their own
bereavement
– Uses a team approach to address the needs of
patients and their families
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 Hospice Care (End of life care)

• Hospice care is comprehensive care for patients and

families experiencing the challenges of terminal
illness with a limited life expectancy

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The last steps…..
Goals of Hospice Care

• To promote dignity and quality of life during the

dying process

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 Centers for Medicare and Medicaid Services (CMS)
Hospice Coverage

• Medicare: American health insurance

program for:
– Persons 65 and older
– Persons with disabilities, including patients with cancer
• Medicaid: American health insurance program for
patients with income below a certain level
– Covers hospice care for patients who meet the low
income level required

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 Palliative Vs. Hospice Care

Palliative care Hospice Care

• Can be provided any • Appropriate for 6
time after the diagnosis month or less
of life limiting or life prognosis
threatening illness • Focuses on comfort
• Palliative care patients and support for the
can receive life patient and family
prolonging treatments

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Hospice/Palliative Plan of Care for a Patient and
Family

Physical Information Monitoring Spiritual

Symptom Needs & Emotional
Control Prevention Support Support
•Providing •Safety • Worry
• Pain • Meaning of
informati intervention: • Grief
• Nausea fall life
on about • Bereaveme
• Dyspnea • Guilt
dying •Skin care: nt
• Constipation process pressure • Personal
• Confusion • Anxiety connectio
•Providing ulcer ns
information •Monitoring • Decrease
about for bowel fears
resources obstruction
• Financial •Monitoring
matters for delirium

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Nurse’s Role in Hospice/Palliative Care

Teaching

Advocating Caring

Coordinating

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Palliative Care Focus: Promote Quality of Life

Physical
Care

Spiritual Emotional
Support Care

Patient
Caregiver
s, family,
relatives

Financial
Social Care
Support

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 END

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