Paliative care

Ns.Endang Murwaningsih, S.Kep, WOC(ET)N,OCN

Bengkulu, 14 Maret 2020

Outline 01 Pendahuluan

02 TREND ISSUE IN PALIATIVE CARE

03 SYMPTOM MANAGEMENT IN
PALIATIVE CARE

04 Kesimpulan
1 PENDAHULUAN
What is palliative care and why is it important ?
 Florence
the first Palliative Care Nurse

Florence herself stated :

“I use the word nursing for want of a better”

She went on to say :

“The very elements of nursing are all but unknown”

( Nightingale, 1860)
 DASAR HUKUM

Kepmenkes No.604/Menkes/SK/IX/1989
tentang pengendalian penyakit kanker
nasional

Kepmenkes No.812/Menkes/SK/VII/2007
Tentang Kebijakan Perawatan Paliatif
(Jakarta, Surabaya, Yogyakarta, Bali and
Makasar)

Draft Permenkes th 2019 tentang Paliatif

 Pelayanan Paliatif
(draft Permenkes, 2019 ttg Paliatif)

 RUMAH SAKIT
 KLINIK PRATAMA
 KLINIK UTAMA
 RUMAH PALIATIF !!!!!!
dibawah Puskesmas
 RUMAH PASIEN
What is Palliative Care?

Medical care that

focuses on alleviating
the intensity of sy
mptoms of disease.

Palliative care focuses on

reducing the
prominence and
severity of symptoms.
What is Palliative Care?
The World Health Organization describes palliat
ive care as "an approach that improves the qual
ity of life of patients and their families facing th
e problems associated with life-threatening illn
ess, through the prevention and relief of sufferi
ng by means of early identification and impecca
ble assessment and treatment of pain and othe
r problems, physical, psychosocial and spiritua
l."
2 TREND ISSUE IN PALIATIVE CARE
Evolving Model of Palliative care
 Paradigm:
Continuum of cancer care
Supportive care & Rehabilitation care

Curative treatment
Terminal
side effects
Palliation
{
QoT
Palliative
Phase QoD
Tumor
Palliative Symptom
LoL Palliative
QoL
Cancer Death
diagnosis Bereavement care
Progressive cancer
 Cancer and Palliative Care
It is generally estimated that roughly 7.2 to 7.5 mi
llion people worldwide die from cancer each year.

 More than 70% of all cancer deaths occur in dev

eloping countries, where resources available for p
revention, diagnosis and treatment of cancer are l
imited or nonexistent.

More than 40% of all cancers can be prevented.

Others can be detected early, treated and cured.
Even with late-stage cancer, the suffering of patie
nts can be relieved with good palliative care.
 Palliative Care
Goals :
The goal is to improve the q
uality of life for individuals
who are suffering from seve
re diseases.
Maintain function
Relief of physical, emotiona
l, psychological and spiritual
suffering
Who receives Palliative Care?

Individuals struggling
with various diseases

Individuals with chron

ic diseases such as can
cer, cardiac disease, ki
dney failure, Alzheime
r's, HIV/AIDS and Amy
otrophic Lateral Sclero
sis (ALS)
 What Does Palliative Care Prov
ide for the Patient’s Family?
Helps families und
erstand the choices
available for care
Improves everyday
life of patient; reduc
ing the concern of l
oved ones
Allows for valuable
support system Image courtesy of mdanderson.org
Who Provides Palliative Care?
Usually provided by a team of individuals
Interdisciplinary group of professionals
Team includes experts in multiple fields:
Doctors
Nurses
social workers
massage therapists
Pharmacists
Nutritionists
 Settings for Palliative Care

Outpatient practi
ce
Hospital Inpatient
Outpatient practice
Unit based
Hospital Inpatient
Consultation Team
Unit based
Home care Consultation Team
Nursing Home Home care
Hospice Nursing Home
Hospice
 Palliative Care Patient Support S
ervices
Three categories of support:

1. Pain management is vital for comfort and to re

duce patients’ distress. Health care professional
s and families can collaborate to identify the so
urces of pain and relieve them with drugs and
other forms of therapy.
Palliative Care Patient Support Ser
vices
2. Symptom management involves treating symp
toms other than pain such as nausea, weakness,
bowel and bladder problems, mental confusion, f
atigue, and difficulty breathing
Palliative Care Patient Support Ser
vices
3. Emotional and spiritual support is important fo
r both the patient and family in dealing with the
emotional demands of critical illness.
3 SYMPTOM MANAGEMENT IN PALIATIVE CARE
 Symptom Management
Care given to improve the quality of life of patients who
have a serious or life-threatening disease.

The goal of symptom management

is to prevent or treat as early as possible the symptoms of

a disease, side effects caused by treatment of a disease,
and psychological, social,and spiritual problems related to
a disease or its treatment.

Also called comfort care, palliative care, and supportive

care. ( NCI Dictionary)
Oncology care dimensions

4 Dimensions
assesment
assesment
Symptom management is the key
for optimalisation of palliative care

• Symptoms have 4 Dimensions

• Somatic
• Psychologic
• Social
• Spiritual
• Symptoms need 4D-Analysis
• Disease
• Distress
• Discomfort
• Dysfunction
 KESIMPULAN
Perawatan paliatif sangat di butuh kan oleh pasien yang
menderita penyakit serius dan menahun

Perawatan paliative tidak hanya berfokus pada pasien t

etapi juga melibat keluarga khusus nya pada saat menga
mbil keputusan dalam semua aspek yang terkait per
awatan penderita.

Penting nya pemahaman dalam penangan managemen

simptom untuk mengatasi semua gejala dan respon p
enderita, baik respon pasca terapi maupun respon dari p
enyakit nya
 Bibliography
• Rosser.,Walsh.(2014).Fundamental of Palliative Care for St
udent Nurses.
First edition.wiley:UK
• http://www.who.int/cancer/palliative/definition/en/
• http://www.who.int/cancer/media/FINAL-Palliative%20Car
e%20Module.pdf
• http://www.cancer.gov/cancertopics/factsheet/support/pal
liative-care
• http://www.getpalliativecare.org/whatis
• http://www.nlm.nih.gov/medlineplus/palliativecare.html
• http://www.nhpco.org/i4a/pages/index.cfm?pageid=5953
• http://www.liebertonline.com/doi/abs/10.1089/jpm.
2005.8.1127
• Ministry of Health Republic of Indonesia. Regulation No 812/
Menkes/SK/VII/2007 on Palliative Care. [cited 2010 20 Nove
mber]; Available from: http://spiritia.or.id/Dok/skmenkes81270
7.pdf.
Endang Murwaningsih

ONCOLOGY NURSE | WOC(ET)N |

CEO BATAVIA NURSING CENTRE

@Endang Murwaningsih @Emurwaningsih

emurwaningsih@gmail.com