WellBeing

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Well-Being

• Palliative Care
• The art of living well and dying well are
  one.  Epicurus  

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What are the things you want when you know that
you are going to die in a few months?
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An explanation of Palliative Care

• Palliative care, also called comfort care, is
  primarily directed at providing relief to a
  terminally-ill person through symptom management
  and painmanagement.
• The goal is not to cure, but to provide comfort
  and maintain the highest possible quality of life
  for as long as life remains.
• Palliative care is based on four important
  structures physical care, psychological care,
  social care and spiritual needs.
• Multidisciplinary teams should be well suited for
  palliative care.

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Palliative Care

• Who?
• Terminally ill people
• Cancer
• AIDS
• ALS
• MS

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Palliative Care

• Where?
• Hospice
• Home care settings
• Hospitals
• Day care centres
• Home

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World wide history of hospice palliative care

• Historically, the word hospice meant a place of
  care. Palliative is based on the Latin
  palliatus, meaning to cloak, mask, or shield and
  refers to the management of palliative symptoms.
• Hospice palliative care is a worldwide movement
  with a tradition going back to ancient times. For
  example, in the eastern parts of the Roman
  Empire, there were houses that offered a place of
  refuge for the needy. These sanctuaries became
  known as hospitium, from which the modern terms
  hospital, hospice, hostel and hotel are derived.
• Soon hospices were to be found along pilgrim
  routes, at mountain passes and river crossings
  where travelers met great hazards. Gradually
  local people also came to rely on these houses.
  This tradition of hospice care continued into
  medieval times under religious orders such as the
  Benedictines, who were charged with care for the
  needy.

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World wide history of hospice palliative care

• Later, the running of hospices began to be
  secularized and there gradually emerged medical
  care provided by professional physicians within
  the institution of the hospital. This was because
  modern science had moved away from the spiritual
  dimension of human existence. Death was not seen
  as a state of being, but rather as a failure to
  effect a cure. Thus, care of the dying, and
  especially of the terminally ill, was not a focus
  of medical care, even though the means to
  alleviate distressing symptoms had greatly
  improved.
• In the early part of the 20th century modern
  hospice style care for the terminally ill was
  provided mainly by Christian houses (one example
  is the Irish Sisters of Charity at St. Josephs
  Hospice in England, where, in 1905, a third of
  beds were for patients with a prognosis of three
  months or less to live).
• Not until the 1950s did hospice palliative care
  receive new impetus. Then, Cecily Saunders (later
  Dame Cecily Saunders), a physician with a deep
  concern for the inability of her fellow
  physicians to care adequately for the dying,
  established St. Christophers Hospice in London.

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Palliative Care in Belgium

• The federation of Palliative care in Flanders
  existed in 1990.
• After 1990, lots of local initiatives were
  growing. Hospitals and elderly homes created
  also palliative support teams and there also
  existed some special day centers.
• As palliative care should be for everyone who
  need it in every region, there became a sort of
  pressure, so the Government decided to build a
  geographical system that has to work for in the
  whole country.
• In 1995 networks for palliative care existed, and
  later on these networks became centers for
  co-ordination of palliative care in a specific
  region.

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Palliative Care in Belgium
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Palliative Care in Belgium

• A very specific subject of the Belgian palliative
  care model, is that the model is based on
  emancipation. More specific, they want that the
  patient should stay at home in his last stage of
  live.
• The tasks of the networks are especially to
  support the co-operation between all the
  different settings of palliative care, another
  important task of the network is to support the
  care helpers, also giving brochures to the
  population in general, etc

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Palliative Care in Finland

• Developed from 1970.
• The first palliative care homes were founded in
  1988 at Tampere and Helsinki.
• The finnish law gives the patient the right to
  have good care and treatment.
• The meaning of home palliative care in Finland is
  growing each year because of the change in the
  age structure and the fact that there is less
  treatment places in hospitals and such.
• Well-being and client oriented care are central
  themes that come up in finnish health care
  schools and education.
• In Finland the development of palliative care is
  still in its early stages.

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Palliative Care in Denmark

• In the year of 2000 there was a new law that say
  that every person have the right to come to a
  hospice. For that purpose the private hospices a
  given an ammount per year per hospital that
  correspond to about 1.5 million euros.
• That law commit the regions and the local
  authority to offer nursing, treatment and
  care for dying persons in their home, in hospice,
  hospitals or nursing homes.
• If you choose to die in your own home you
  relative can get payed by the local authority.
• The region can deside to make a hospice and then
  got some of the money from the local authority
  when their patients go there but it has to be
  free for the patient.
• If private persons will establish a hospice there
  a no speciel demands. The goverment expects that
  the authorized personel know how to behave and
  how to work in their professions etc.

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Palliative Care in Spain

• We have worked only 15 years with palliative
  care, and the evolution has been incredible and
  its consolidating day by day.
• We had 206 palliative care programs in year 2000,
  which are divided in
• 104 shifts for home care
• 29 units for palliative care at hospital
• 52 units in socio-sanitary centers
• 21 units for stand hospital
• In Spain there work 400 doctors, 663 nurses, 400
  nurse assistants, 91 psychologist, 134 social
  workers and 50 chaplain in a palliative care.
• In Spain we look after approximately 27643
  different patients in programs for palliative
  care.

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Palliative Care in Spain

• Spanish society of palliative care
• It is an asociation multidisciplinary, their
  objectives are promove a good cualitive for
  terminally ill patient , teaching future
  profesional health care investigation, and help
  the administration for the development of
  paliative care in our country.
• Definition of terminaly ill patient
• Treatment

Hospital
Socio-Sanitary Center
Home attention
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A professional point of view

• Nursing
• In palliative care tasks of the nurses is
  different than normally than they used to work.
  The main thing is to listen and just to be there
  for the patient.
• They want the patients to have a nice surrounding
  and make their last days as good as the patients
  wants.
• It depends where the nurse is working. If it is
  hospital surrounding the tasks of the nurses may
  be much more different than for example home care
  environment.
• The task is not only to care about the physical
  part but also to spend time to psychological, to
  religion and to social approach

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A professional point of view

• Physiotherapy in palliative care
• Most important thing is to listen the patients
  needs
• Usually the client needs release of pain
• Physiotherapy can include
• Massage (for example lymfamassage, touching, )
• Mobilisation of the joints
• Active exercises
• Breathing exercises
• Effecting the clients in a holistic way through
  the physical therapy

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A professional point of view

• Podiatry
• Also podiatrist have to be able to listen the
  palliative patients. Their thoughts and feelings
  about treatment, for example the treatment should
  only consist of nice massage and nail treatment
  if the patient want so.
• Allthought podiatry professional have to
  understand the situation and also give
  information about treatment and things which
  could relief the patients pains.
• Podiatrist can give sort of continuing palliative
  care so that patients feet are also treated every
  while and then.
• Podiatrist should also listen patients thoughts
  about their everyday lives and be ready to
  correspond with them.

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Conclusion

• Well-being in palliative care
• Human point of view
• All professions are involved
• Empathy
• Holistic point of view
• Client centered action
• EU
• Budget

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Principles of a good death 1/2

• To know when death is coming, and to understand
  what can be excepted
• To be able to retain the control of what happens
• To be afforted dignity and privacy
• To have control over pain relief and other
  symptom control
• To have a control over where death occurs (at
  home or elsewhere)
• To have access to information and expertise of
  whatever kind is necessary
• To have access to hospice care in any location,
  not only in hospital

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Principles of a good death 2/2

• To have access to information and expertise of
  whatever kind is necessary
• To have access to any spiritual or emotional
  support required
• To have access to hospice care in any location,
  not only in hospital
• To have control over who is present and who
  shares the end
• To be able to issue advance directives which
  ensure wishes are respected
• To have time to say goodbye, and control over
  other aspects of timing
• To be able to leave when it is time to go, and
  not to have life prolonged pointlessly