Hospice-Palliative Care Chapter 17

1. Hospice-Palliative CareChapter 17

2. Class Objectives: • Define both palliative & end-of-life care. • Discuss the legal & socio-cultural perspectives of palliative care & end-of-life care. • Describe the principles & philosophy that guide palliative care. • Reflect on your own experience with and attitudes about death and dying. • Discuss important communication skills when working with terminally ill clients and their families. • Provide culturally and spiritually sensitive care to terminally ill clients and their families. • Use the nursing process to provide and address the physiologic responses to terminal illness

3. Please read End-of-life Care Chapter 17 in your text!! Especially Nutrition & Hydration at end-of -life Canadian Hospice Palliative Care Association http://www.chpca.net/ Reading Effective Communication in Palliative Care http://palliative.info/teaching_material/EffectiveCommunication.pdf Visit:

4. Please Read Chapter 17: End of Life Care Pay attention to Nutrition and Hydration at the End of Life p. 436-438.

5. Case Study 1 Mrs. Hills is a 45 year old woman of Arabic descent. She has advanced ovarian cancer. Recent test results indicate that her cancer is progressing and end-of-life issues need to be discussed. Mrs. Hills immigrated to Canada 10 years ago with her husband and 3 children. Her understanding of English is limited. Her husband accompanies her to all appointments to translate for her. He often answers questions and makes decisions without communicating with her. Today Mrs. Hills appears withdrawn. She is very quiet and does not make eye contact. You are concerned about how she is coping.

6. Consider……… • How would you approach this situation? • What issues are important to consider when caring for Mrs. Hills? • What resources could be considered? • What can you do as a nurse in this situation?

8. Description: I have tried to show on my face the psychological tension cause by the question, 'Has the cancer recurred?'

9. What is hospice-palliative care?

10. Of interest in Canada • Published by The Canadian Hospice Palliative Care Association (CHPCA), in 2002. • The Model is based on nationally accepted principles and norms of practiced that were established through a national consensus-building process between 1993 and 2001. • http://www.chpca.net/resource_doc_library/model_to_guide_hpc/A+Model+to+Guide+Hospice+Palliative+Care+2002-URLUpdate-August2005.pdf

12. Key Features of Hospice Palliative Care • “Whole person” care • Combines science, presence, openness, compassion, mindful attention to detail, and teamwork • The patient & family are the unit of care • Goal is quality of life & relief of suffering • Includes care of the dying and bereavement follow-up

14. Who is the hospice palliative care patient? • The patient facing a life-threatening illness (regardless of the type of illness or the stage, ranging from new diagnosis to terminal prognosis) in need of specialized care to promote physical, psychosocial, and spiritual comfort.

15. Needs of the Palliative Client • To be pain free • To conserve energy • To obtain relief from physical symptoms • To be secure • To feel that they are being told the truth • To trust those who care for them • To be given an opportunity to voice fears • To be with a caring person when dying • To be loved & to share love

16. Needs of the Palliative Client • To be listened to with understanding • To talk • To preserve identity • To feel like a normal person, a part of life right up to the end • To maintain independence • To maintain respect in the face of increasing weakness • To perceive meaning in death • To share & come to terms with the unavoidable future

17. What is end-of-life care? • The care that patients and their families receive when patients are near death or dying. • This can include palliative care, hospice care, and/or supportive care, although not all patients who receive supportive or palliative care are actually receiving end-of-life care (Kinzbrunner ,2005). the founder of the modern hospice movement

18. Premises of End-of-Life Care • The dying are not people for whom “nothing can be done” • Everythingwill be done to • Promote comfort • Promote dignity • Involve & support significant others

19. Goals of Hospice Palliative Care • To achieve the best quality of life for patients & families while maximizing comfort & maintaining dignity. • The patient and family’s wishes are respected • The patient and family feel a sense of control over the situation • The patient is comfortable

20. Hospice Palliative Care Nursing • Provision of effective pain and symptom management • Addressing the psychosocial and physical needs of the patient and family • Incorporating cultural values and attitudes into the plan of care • Supporting those who are experiencing loss and grief

21. Hospice Palliative Care Nursing (cont’d) • Promoting ethical and legal decision-making • Advocating for personal wishes and preferences • Using therapeutic communication skills • Facilitating collaborative practice

22. The Importance of Personal Awareness • Personal experiences with loss and grief • Attitudes and fears of death and vulnerability • What would I want and need if I were seriously ill or dying • Who’s needs am I meeting?

23. Were you aware In Nova Scotia

24. Where is hospice palliative care provided? • Hospice palliative care can be initiated through a number of referral systems and is provided in both community and institutional settings

25. Communication • Active listening • The four C’s • Collaboration • Credibility • Compassion • Coordination

26. Collaboration • Gathering and processing information • Critiquing and evaluating data for veracity • Filtering and communicating knowledge in an accurate, concise, and timely manner • Updating other team members with new data • Engaging in dialogue to solve problems and participate in decision making

27. Collaboration Example: • I noticed her particular style was really effective. She had an itinerary of things she would hit on and she did it exactly the same way for each patient. She was very specific. She gave information quickly and without a lot of the gabby extra stuff. The other nurses responded by asking precise questions. The key stuff was hit right up front. You got the information in a timely manner.

28. Credibility • Avoiding jargon or vague terminology • Adjusting communication style for roles, personalities, and circumstances • Being assertive and confronting conflict directly and respectfully

29. Credibility Example:

30. Compassion • Consideration of and caring for others • Advocacy • Conveying respect in verbal and non-verbal communication • Fostering positive emotions in others

31. Compassion Example:

32. Coordination • Effective leadership • Encouraging input from others • Mentoring • Acknowledging contributions of others • Facilitating participation of others

33. Coordination Example:

34. End-of-Life Decision Making

35. Which treatments to accept or decline and when Arranging for allocation of worldly possessions Possible organ donation Designating care for children Proxy decision-making Taking care of “unfinished business” Common Issues

37. Pain Nausea and vomiting Fatigue Constipation Candidiasis Dyspnea Anorexia/cachexia Depression Fever Urinary incontinence Skin breakdown Confusion/delirium/ restlessness Common Symptoms

38. Increasing physical and emotional withdrawal Reduced food and fluid intake Confusion/agitation Change in breathing patterns Noisy respirations “terminal bubbling” Incontinence of urine & stool Changes in skin temperature and colour Signs & Symptoms of Approaching Death

39. Death is inevitable. Pain , distress & other symptoms do not have to be!

41. Nursing Interventions • Providing comfort • Ensuring safety • Addressing physical and emotional needs • Explaining what is happening to the patient and family • Supporting & sustaining patient/family relationships • Helping the patient/family to retain as much control over the situation as possible • Knowing and following patients' wishes for end-of-life care

44. Nutrition & Hydration • Artificial nutrition & hydration includes tube feedings & IV therapy • General consensus from the literature that providing artificial hydration such as IV therapy does not improve the comfort level of dying clients, provided that the symptoms such as dry mouth & transitory thirst are addressed with good mouth care & oral fluids or ice chips (McCaulay, 2001; Tarrant, 2001)