Prepared by: AUBREY C.

ROQUE RN, MAN

 It

is designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life rather than cure.

GOAL: To enable patients to be comfortable and free of pain, so that they live each day as fully as possible. PHILOSOPHY: To provide support for the patient's emotional, social, and spiritual needs as well as medical symptoms as part of treating the whole person.

 Palliative

care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through:

the prevention and relief of suffering by means of :
  

Identification of pain Impeccable assessment and treatment of pain Identification, assessment and treatment of physiological, psychosocial and spiritual problems

mind and spirit. Palliative care for children is the active total care of the child's body. and also involves giving support to the family. Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources. and social distress. It begins when illness is diagnosed. Health providers must evaluate and alleviate a child's physical. it can be successfully implemented even if resources are limited.    . psychological. and continues regardless of whether or not a child receives treatment directed at the disease.

is designed to give support and comfort rather than cure of the illness or problem. in community health centers and even in children's homes. It can be provided in tertiary care facilities. CARE.  PALLIATIVE .

 Current licensure in the state of practice  Minimum of one year of clinical practice in nursing.    Oncology Psychiatry Home care experience are prepared  Knowledge of pathophysiology and disease progression  Understanding of pain and symptom management .

family and team members . Excellent assessment communication skills  Ability to work within and contribute to an interdisciplinary team  Ability to assist the patient and family in coping with emotional stress  Understanding of an aptitude for organization and communication with patient.

instructing. managing.  Ability to balance the nurse‟s self-care needs with the complexities and intensities of repeated encounter with death. . caring and communicating skills and knowledge. psychological. social and spiritual problems of dying patients and their families  Ability to coordinate the extended and expanded component1s of hospice service  Acquisition of counseling. Capacity to manage physical .

life and regards dying as a normal . ethical. legal and spiritual aspects of care  Offers a support system to help patients live as actively as possible until death  Offers a support system to help patient‟s families to cope during the patient‟s illness and in their own bereavement. Affirms process  Neither hasten nor postpones death  Provides relief from pain and other distressing symptoms  Integrates the psychological.

ideas.is the essential process by which individual share something of them. opinions. 1. joy. or goals. feelings. values. boredom. peace. Principles of human communication  Its multidimensional    The content of the message sent (true or false..) Relationship aspect. confidence. anger. etc.1.) Effective Communication COMMUNICATION. . sensible or non-sense or undecipherable) Emotional content / feelings that modify the message (grief. whether it is thoughts.refers to how the message is received given the perceived social positions of the communicants.

communication is occurring. The idea that what is perceived is not precisely what actually is. Perception is selective   Only a part of the information sent is perceived.  It is an interactive and continuous process   The sender is also a receiver of information The receiver is also a sender of information. during the communication process  It‟s inevitable  It is impossible not to communicate. . (it is essential for health providers to be aware that even when words are not used or spoken.

values. prescribed behaviors (dress. and relationship patterns. beliefs. Culture influences communication pattern  It is critical for health provider to recognize their own cultural conditioning in order to explore the impact it has in their communication with those of another cultural background. food preferences and time consciousness).  . Culture involves customs.

2.  . Importance of good communication at the end of life  Honest communication increases the likelihood that the dying experience will be one through which all the participants can grow emotionally and spiritually Families are better prepared for the final death event and have better bereavement experiences.

such as telling jokes or changing the subject. Barriers to good communication  patients and families   death is considered a taboo subject Common reactions are withdrawal from the patient or situation. or avoidance of behavior.3. . denial of the reality of a terminal diagnosis.

 health care provider  using the dying person's name throughout the conversation  making eye contact  holding the person's hand  placing one's hand on a shoulder or arm  smiling  gesturing  leaning forward  caring in what the person is saying (or not saying) and feeling.  Asking specific questions such as. "What is it that you need to do now?" are very important. "Can you help me understand?" as well as open-ended questions such as. as is being comfortable with silence. .

These bonds may make breaking bad news or discussing issues around end-of-life care difficult since they may find it difficult to contemplate losing a patient they care for deeply. Depth of the physician–patient relationship: Health Care Providers (HCPs) may develop strong bonds with patient and family. empathy and compassion. Personal experiences of illness and death: May affect their ability to care for a person who is at the end of life. whether they have known them for years or just a short time. Physical. emotional and psychological stress and depletion: May affect ability to communicate caring.   .

Fears of emotional outbursts: HCPs are often not taught how to show empathy and caring and may fear emotional outbursts. . Lack of training and poor role models: A lack of training and role models results in poor communication skills and either a lack of awareness of patient‟s feelings and reactions or inability or fear of discussing these emotions.    Fears of appearing weak or unprofessional for displaying emotions: Many HCPs have been taught that displaying emotion is a sign of weakness or unprofessional. These HCPs may have difficulty in discussing end-of-life issues for fear of feeling or displaying emotion. Fears of confronting own mortality and fears of death: Caring for someone who is dying leads to physicians confronting their own mortality and fears of death.

increased severity of illness and/or death: When illness is due to or has been exacerbated by iatrogenic complications. Guilt and self-blame due to iatrogenic complications resulting in poor quality of life.  . Communication Problems: Inconsistent approach to the issues. HCPs may be consumed with self-blame and guilt which may affect their ability to consider the patient‟s situation. differences in language can lead to confusion (the perception of “mixed messages”) and misunderstandings with patients and families.

 health care system    fast pace modern health care system. inadequate time to discuss important matters such as death Unclear who is responsible for initiating and providing follow-up-end-of life conversations? .

Practical aspects of communicating at the end of life  Understand oneself and speak honestly (self-awareness)  But remember that the key to talking to dying persons is to focus on their needs.  Consider the timing of communication ( ask “is this a good time to talk”)  Provide a setting for open communication  arrange the environment and how to adapt their own behavior to facilitate conversation  avoid sense of arrogance  maintain eye contact . rather than one‟s own.

Practical aspects of communicating at the end of life  Allow the patient to guide the communication process. patient„s personal autonomy and control should be preserved.g. what is it that you need to know?) .  Use open ended questions (e.

Practical aspects of communicating at the end of life  Make no assumptions about what the patient knows. the most important general rule in the end-of –life setting is to listen more and to talk less .  ask and listen. a patient who has not told of their diagnosis might be aware that they are dying. listen and ask.

followed by do you feel like talking about it …… attentive listening means no interruption. but listening patiently until there is a pause in the conversation before speaking  . have you experienced the death of a loved one before…. yes or no questions are helpful initially to broach a difficult subject.g. (e..

usually  accept symbolic language  encourage patient to tell their life stories  tell people what to expect  at the very end of life. assume that hearing is still intact . use understandable terms  ask patient what they want  use silence liberally  support varying emotional response  accept denial .

All the communication skills discuss apply to the very difficult task of breaking bad news Factors that add to the distress of the situation:     Fear of being blamed for the bad news Fear of not knowing all the answers Fear of showing emotions Fear of being reminded of one‟s own mortality . Breaking bad news -.4.

that is to understand the real situation/condition of the patient.NOTE: it is often the doctor‟s responsibility to break the bad news but it is helpful to be present when the bad news is initially shared. .

and thoughts of death. guilt. .5. anhedonia. loss of appetite. helplessness and hopelessness. insomnia. feelings of extreme sadness. The condition is also called clinical depression. Assessing suicide potential  Requisite skills for end-of-life care is the ability to identify depression and assess for suicidal potential  Depression  A psychiatric disorder characterized by an inability to concentrate.

feeling of worthless. lasts for at least 2 weeks (decrease energy. and some other mental illnesses. guilty)  Dysthymic depression – less severe (lasts for 2 years or more). schizophrenia. Anhedonia is a core clinical feature of depression.NOTE: Anhedonia: Loss of the capacity to experience pleasure.  . Subtypes of Depression: Major depression – severe. The inability to gain pleasure from normally pleasurable experiences.

General appearance of a depressed person      Sadness Resignation Apathy Hopelessness Or may become cheerful when decision come to end suffering .

Have things gotten so bad that you are thinking of killing yourself.  Eg. Risk factors for SUICIDE:  S – Sex (more female attempts suicide but more males commits).  U – Unsuccessful previous attempt.  C – Chronic  I – Illness Ex. .For assessment of suicide potential a direct approach is recommended. Cancer  D – depression/dependent personality  A – age (18-25 and 40 above) and alcoholism  L – Lethality of previous attempts/looses.  I – Identification with a family member who committed suicide.

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