Hospice & Palliative Care

Kristal Liza C. Besario,RN, MAN

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 Objectives:
At the end of the module, the students will be
able to:
1. Able to know what is hospice/palliative care
2. Describe types & sources of losses
3. Identify & discuss stages of grieving
4. Discuss factors affecting grief
5. Identify measures that facilitate the grieving
process
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 Hospice Care
• Was founded by the physician Cecily Saunders
in London, England in 1967 and was later
extended.
• It focuses on support & care of the dying
person & family, with the goal of facilitating a
peaceful & dignified death
• Based on holistic concepts, emphasizes care to
improve quality of life rather than cure

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 Hospice Care
• Supports the client and family through the
dying process and during bereavement
• Services focus on symptom control & pain
management
• Commonly, clients are eligible for hospice care
or hospice insurance benefit when certified by
a physician to be likely to die within 6 mos.

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 Palliative Care
• An approach that improves the quality of life
of clients & their families facing problems
associated with life-threatening illness,
through prevention & relief of suffering by
means of early identification & impeccable
assessment & treatment of pain & other
problems.

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 Palliative Care
• Focuses on symptom care of clients for whom
disease no longer responds to cure-focused
treatment.

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LOSS & GRIEF

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 LOSS
• An actual or potential situation in which
something that is valued is changed, no longer
available or gone.
• DEATH is a fundamental loss, both for the
dying person & for those who survive.

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 Types & Sources of LOSS
• Actual Loss – can be recognized by others
• Perceived Loss – is experienced by one person
but cannot be verified by others.

• Anticipatory – is experienced before the loss

actually occurs.

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• Loss can be viewed as situational or
developmental.

SOURCES:
1. Loss of an aspect of oneself
2. Loss of an object external to oneself
3. Separation from an accustomed environment
4. Loss of a loved or valued person
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 ASPECT TO ONESELF
• The loss of an aspect of self changes a
person’s body image, even though the loss
may not be obvious.

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 External Objects
• Loss of inanimate objects
• Loss of animate object

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 Familiar Environment
• Separation from an environment & people
who provide security

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 Loved ones
• The death of a loved one is a permanent &
complete loss

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 Grief, Bereavement, & Mourning
• GRIEF is the total response to the emotional
experience related to loss.

• BEREAVEMENT is the subjective response

experienced by the surviving loved ones after
the death of a person with whom they shared
significant relationship.

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 Grief, Bereavement, & Mourning
• MOURNING is the behavioral process through
which grief is eventually resolved or altered

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 Types of Grief Response
GRIEF RESPONSE
1. Abbreviated Grief – is brief but genuinely felt
2. Anticipatory Grief – experienced in advance of
the event.
3. Disenfranchised Grief – when a person is unable
to acknowledge the loss to the person.
4. Dysfunctional Grief – unhealthy & Pathologic
5. Unresolved Grief – extended in length & severity
6. Inhibited Grief – normal symptoms of grief are
suppressed
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 Stages of Grieving
(Kubler Ross)
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

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 FACTORS INFLUECING the
Loss & Grief Response
• AGE – Age, Early & Middle Adulthood & Late
Adulthood
• Significance of the Loss
• Culture
• Spiritual Beliefs
• Gender
• Socioeconomic Status
• Support System
• Cause of Death & Loss
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 NURSING MANAGEMENT
• Nursing History
• Personal Coping Resources
• Physical Assessment

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 IMPLEMENTING
• The skills most relevant to situations of loss &
grief are:
1. Attentive Listening
2. Silence
3. Open & Close Questioning
4. Paraphrasing
5. Clarifying & Reflecting Feelings
6. Summarizing
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 IMPLEMENTING
• Less helpful to the clients are responses that
give advice & evaluation
• Interpret & Analyze
• Giving of unwarranted reassurance

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 EVALUATING
• Evaluating the effectiveness of nursing care of
the grieving client is difficult because of the
long-term nature of the life transition.

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DEATH & DYING

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 DEATH & DYING
• Concept of death is developed over time
• As the person grows, experiences various
losses
• Thinks about concrete & abstract concepts

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 Response to Death & Dying
• Also depends on all the factors regarding loss
and the development of the concept of death

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 Definitions & Signs of DEATH
• Heart-Lung death
• Cerebral Death

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 Legalities Related to Death
• The nurse’s role in legal issues to death is
prescribe by the laws of the region & policies
of the health care institute

1. Advance Health Care Directives

 The Living Will
 Health Care Proxy

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 Legalities Related to Death
2. Autopsy – examination of the body after death
3. Certification of Death
4. Do-N0t-Resuscitae Orders
5. Euthanasia – act of painlessly putting to death
persons suffering from incurable/distressing
disease.
6. Inquest – a legal inquiry into the cause or
manner of a death

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 Legalities Related to Death
7. Organ Donation

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 ASSESSING
• The nurse needs to recognize the states of
awareness manifested by the client & family
members
1. Closed Awareness – unaware of impending death
2. Mutual Pretense – know the prognosis is
terminal but do not talk about it & make an
effort not to raise the subject
3. Open Awareness – know about the impending
death & comfortable discussing it
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 PLANNING
• Major goals for dying clients are:
1. Maintaining physiologic and psychologic
comfort
2. Achieving a dignified & peaceful death

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 IMPLEMENTING
• To provide relief from loneliness, fear, &
depression
• To maintain clients sense of security, self-
confidence, dignity and self worth
• To help client accept losses
• To provide physical comfort

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 IMPLEMENTING
1. Helping Clients Die with Dignity
Nurses need to ensure that the client is treated
with dignity, that is, with honor and respect.
Involves maintaining of their humanity,
consistent with their values, belief and
culture.
Introducing options available to the client & SO

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 IMPLEMENTING
2. Hospice & Palliative Care
Can include end-of-life care

3. Meeting the Physiologic needs of the dying client

Interventions include providing personal hygiene
measure, controlling pain, relieving respiratory
difficulties, assisting with movement, nutrition,
hydration, elimination & providing measures
related to sensory changes.
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 IMPLEMENTING
3. Meeting the Physiologic needs of the dying
client
Pain Control is essential to enable client to
maintain quality in their life & their daily
activities

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 IMPLEMENTING
4. Providing Spiritual Support
Great importance in dealing with death

5. Supporting the Family

Using of therapeutic communication to facilitate
their expression of feelings

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 IMPLEMENTING
6. Post Mortem Care
RIGOR MORTIS – is the stiffening of the body
that occurs about 2-4 hours after death.
ALGOR MORTIS – the gradual decrease of the
body’s temperature after death
Livor Mortis – discoloration of the parts of the
body

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 EVALUATING
• The nurse collects data in accordance with the
desired outcomes established in the planning
phase.

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The Respiratory System

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 Functions of the Respiratory System

• Oxygen Transport
• Respiration
• Ventilation
• Lung Volumes and Capacities
• Diffusion & Perfusion

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