Hospice-Palliative Care Chapter 17

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Hospice-Palliative CareChapter 17
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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

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• 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/Effective
  Communication.pdf
• Visit

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 Hills appears withdrawn.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

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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?

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Description I have tried to show on my face the
psychological tension cause by the question,
'Has the cancer recurred?'
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What is hospice-palliative care?
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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/AModeltoGuideHospicePalliativeCar
  e2002-URLUpdate-August2005.pdf

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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

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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.

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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

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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

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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
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Premises of End-of-Life Care

• The dying are not people for whom nothing can be
  done
• Everything will be done to
• Promote comfort
• Promote dignity
• Involve support significant others

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Goals of Hospice Palliative Care

• To achieve the best quality of life for patients
  families while maximizing comfort maintaining
  dignity.
• The patient and familys wishes are respected
• The patient and family feel a sense of control
  over the situation
• The patient is comfortable

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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

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Hospice Palliative Care Nursing (contd)

• Promoting ethical and legal decision-making
• Advocating for personal wishes and preferences
• Using therapeutic communication skills
• Facilitating collaborative practice

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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
• Whos needs am I meeting?

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Were you aware In Nova Scotia
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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

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Communication

• Active listening
• The four Cs
• Collaboration
• Credibility
• Compassion
• Coordination

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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

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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.

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Credibility

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

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Credibility Example
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Compassion

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

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Compassion Example
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Coordination

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

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Coordination Example
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End-of-Life Decision Making
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Common Issues

• Designating care for children
• Proxy decision-making
• Taking care of unfinished business

• Which treatments to accept or decline and when
• Arranging for allocation of worldly possessions
• Possible organ donation

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Common Symptoms

• Pain
• Nausea and vomiting
• Fatigue
• Constipation
• Candidiasis
• Dyspnea

• Anorexia/cachexia
• Depression
• Fever
• Urinary incontinence
• Skin breakdown
• Confusion/delirium/ restlessness

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Signs Symptoms of Approaching Death

• 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

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

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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

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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)