Principles of PALLIATIVE CARE

SLIDES PREPARED BY Ms. SABITHA SADANANDAN

PRESENTER Ms. Limna Mahaboob
COLLEGE / CENTRE COHS
PROGRAM NURSING
SEMESTER Spring 2023-2024
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 COURSE OUTCOME
• A1. Discuss the concepts, principles and theories related to palliative care.
• A2. Explain selected symptoms with corresponding nursing management in
palliative care.

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 Learning Objectives
At the end of the class students will be able to
• List down principles of palliative care.
• Identify the goals
• Discuss the Components
• Discuss the models of palliative care
• Explain the domains of palliative care
• Enumerate the goals and components of palliative care.
• Discuss the role of a nurse in palliative care

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 PRINCIPLES OF PALLIATIVE CARE
 Respect the likes and dislikes, goals choices of the dying person
 Integrate the psychological and spiritual aspects of patient care
 Offer a support system to help patients live as actively as possible until death
 Patient centered rather than disease focused
 Concerned with healing rather than curing
 Affirms life & regards dying as normal process i.e as a part of the life cycle
 Builds ways to provide excellent care at the end of the life

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 • Offers support system to help the family to cope during the patients illness
and in their own bereavement, including the needs of children
• Uses a team approach to address the needs of patients and their families
including bereavement, counseling, if indicated
• Enhance the quality of life, may also positively influence the course of a
patients illness
• What is the goal of Palliative Care?
• The goal is to improve the quality of life for individuals who are suffering
from severe diseases.
• Offering a diverse array of assistance and care to the patient.
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 GOALS OF PALLIATIVE CARE
• Relieve pain and other symptoms.
• Address your emotional and spiritual concerns, and those of your
caregivers.
• Coordinate your care.
• Improve your quality of life during your illness.

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 KEY COMPONENTS OF PALLIATIVE
•CARE
Recognizing symptoms such as pain, nausea, fatigue, breathing or swallowing
difficulties, constipation, and hopelessness.
• Identifying the patient’s goals and development of a palliative care plan,
especially for the patient.
• Understanding that many patients and their families struggle to make
decisions.
• Assisting with advanced care directives to help people formulate and
communicate their preferences regarding care during future incapacity.

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 MODELS OF PALLIATIVE CARE
• Hospice Care — a well-established program to provide patients
with a prognosis of six months or less. As delineated within the
Medicare Hospice Benefit, these services can be provided in the
home, nursing home, residential facility, or on an inpatient unit.
• Palliative Care Programs — institutional based programs in the
hospital or nursing home to serve patients with life-threatening
or life-limiting illnesses. Occur in hospital settings (academic,
community, rehabilitation) and skilled nursing facilities. Provide
services to patients anywhere along the disease continuum
between initial diagnosis and death.

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 Continue…….
• Outpatient Palliative Care Programs — occur in ambulatory care settings
to provide continuity of care for patients with serious or life-threatening
illnesses.
• Community Palliative Care Programs — occur in communities as
consultative teams who collaborate with hospices or home health
agencies to support seriously ill patients who have not yet accessed
hospice

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 DOMAINS OF QUALITY PALLIATIVE
CARE
• Domain 1: Structure and Processes of Care
• Domain 2: Physical Aspects of Care
• Domain 3: Psychological and Psychiatric Aspects of Care
• Domain 4: Social Aspects of Care
• Domain 5: Spiritual, Religious and Existential Aspects of Care
• Domain 6: Cultural Aspects of Care
• Domain 7: Care of the Imminently Dying Patient
• Domain 8: Ethical and Legal Aspects of Care

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 Domains of Quality Palliative Care
• Structure and Processes of Care -interdisciplinary team assessment based on
patient/family goals of care; prognosis; disposition (level of care — inpatient
unit, home); safety
• Physical Aspects of Care — pain, dyspnea, nausea/vomiting, fatigue,
constipation, performance status, medical diagnoses, medications
(add/wean/titrate)
• Psychological Aspects of Care — anxiety, depression, delirium, cognitive
impairment; stress, anticipatory grief, coping strategies; pharm/non-
pharmacological treatment; patient/family grief/bereavement;
• Social Aspects of Care — family/friend communication/interaction/support;
caregiver crisis
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 COMPONENTS OF PALLIATIVE CARE

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 PHYSICAL ASPECTS OF PALLIATIVE CARE

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 Symptoms Experienced by Patients at the End of
Life
• Fatigue
• Anorexia
• Pain
• Nausea
• Dyspnea
• Constipation
• Sedation and Confusion

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PHYSICAL CARE: GUIDELINE 2.1*
THE NATIONAL CONSENSUS PROJECT FOR QUALITY
PALLIATIVE CARE
• The interdisciplinary team assesses and manages symptoms
using the best available evidence:
• Evidence based assessment tools & treatment guidelines are used
• Interventions e.g. pharmacological, behavioral, and complementary
interventions
• Ongoing assessments are documented
• Barriers to use of opioids are assessed and addressed

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 Physical Care: Guideline 2.2*
The National Consensus Project for Quality Palliative Care
• The assessment and management of symptoms and side effects are
contextualized to the disease status.
• Treatment plans are developed in context of disease, prognosis, and
functional limitations
• Patient/family understanding of illness and treatment options assessed
with consideration to culture, cognitive function, and developmental
stage

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 PSYCHOLOGICAL ASPECTS OF
PALLIATIVE CARE

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 PSYCHOLOGICAL CARE
Care of the psychological health and wellbeing of patients is essential in the
complex and multifactorial care of critically ill patients.
Aspects of psychological health:
• anxiety,
• delirium,
• sedation needs,
• pain and sleep

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 PSYCHOLOGICAL CARE
• 35-70% of people with cancer suffer from anxiety and depression
• Nurses spend the most time with patients and families
• Communication is vital in this situation.

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 COMMUNICATION SKILLS

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 IMPROVING PSYCHOLOGICAL
OUTCOMES

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 PSYCHOLOGICAL ISSUES
• Concerns
• Fears
• Distress
• Anxiety
• Sadness and depression
• Grief
• Anger
• Spiritual distress

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 ROLE OF A NURSE IN PALLIATIVE CARE

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 PALLIATIVE NURSES ROLE

FACILITATOR

MANAGEMENT CASE MANAGER

EXPERT

ASSESSMENT ADVOCATE

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 PALLIATIVE CARE PLAN
Palliative care plan includes:
• Care goals
• Symptom management
• Advance care planning
• Financial support
• Spiritual care
• Functional status support and rehabilitation

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 MULTIDIMENSIONALITY OF
SUFFERING
PHYSICAL

PHYCHOSOCIAL
SUFFERING EMOTIONAL

SPIRITUAL
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 COMMON SYMPTOMS
• Fatigue • Anorexia;
• Pain • Impaired mental status
• Nausea • Dry mouth
• Vomiting • Constipation
• Insomnia • Diarrhoea
• Dyspnoea • Fever
• Pyrexia

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 DYSPNEA
• Address the anxiety with assurance and relaxation
techniques
• Maintain saturation above 90% with supplemental
oxygen
• Suctioning is generally not indicated
• Administer 5-10mg morphine q4h if the patient is not on
opioids

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 ANXIETY
• Types include situational anxiety, drug related anxiety and
psychological anxiety.
Multidisciplinary assessment
Treat the reversible causes
Non pharmacological therapy
Spiritual support
Short term psychotherapy
Short term psychotherapy
Tranquilizers for severe anxiety

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 NOURISHING AND HYDRATING
• Suggest small meals and liquid supplements
• Treat the symptom that may cause decreased appetite
• Administer appetite stimulants

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 FUNTIONAL STATUS SUPPORT
• Assess ability to perform ADL
• Find and rule out underlying reversible causes of functional
impairment
• Refer to rehabilitation evaluation as appropriate
• Optimize and maintain functional status with physical,
occupational and complementary therapies

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 PALLIATIVE SEDATION
• Intermittent sedation for relief of the intractable
symptoms.

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 SPIRITAUL CARE
• Assess the desire for spiritual counselling and support
• Obtain information regarding significant religious rituals, beliefs and practices
• Encourage their practice to the extent possible outcomes.
• Foster the insights
• Spiritual coping strategies enhance self empowerment

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 SUPPORTING FAMILY
• Assess family structure, functioning, strengths and
weaknesses, knowledge deficits
• Encourage communication among family members
• Respect their privacy and accept the coping styles
• Conduct meetings to review the goals and decisions
• Teach care giving skills to the primary caregiver
• Assist throughout grieving process and in bereavement

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 ETHICAL DECISION MAKING
• Nurses can seek the help of the ethical standards of decision
making. Shared decisions should be made after,
• Considering what is known of the patients wishes and
preferences given the current condition
• Balancing the burdens and benefits of each option in terms of
quality of life
• Achieving a consensus among decision makers

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 References
• https://www.slideshare.net/networknursing/role-of-a-nurse-in-palliative-
care

• http://www.Slideshare.net/ParasuramanParasuraman/palliative-care-634570
76?subid1=20220927-0334-0368-a455-512c70f87e7e

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Thank You
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