General Principle 3.ppt

7/25/2019 General Principle 3.ppt

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Hospice Palliative Care:A Model for

Quality End-of-Life CareJordan H. Llego, RN, RPT, MSN, PhD(INP)


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Hospice Palliative are and

Service Sites


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Private Ho!e" #nco!passing the philosophical

principle o$ a%tono!&, hospice

s%pports patients and $a!ilies'herever the& choose to live and die


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LongTer! are Settings" s the pop%lation ages, health care

pro$essionals are challenged to

provide care and services in di*erent'a&s. Hospices are increasingl&serving elderl& peo ple, !an& older

than + &ears o$ age, 'ho live aloneor 'ith a $rail $a!il& caregiver.


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ssistedLiving Settings" -ith the aging o$ the pop%lation, there

are a variet& o$ elder care living

settings in 'hich people !a& e d&ing." Recent e/pansion o$ ad%lt living$acilities (L0s) has presented thechallenge to care $or people 'hile

allo'ing the! to age in placeand todie in place.


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Hospice Residences

" Residential hospice care re$ers to the

care provided in a $acilit& that issta*ed and o'ned & hospiceprogra!s


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Palliative are 1nits"These %nits o*er a range o$ services

'ithin those $acilities, incl%ding

palliative care cons%ltation, palliativecase !anage!ent, care givers%pport and co%nseling services


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Hospital Settings and Hospice" In addition to inpatient palliative care

cons%ltation and case !anage!ent

services,inpatient hospital care is anoption $or hospice patients and$a!ilies,%s%all& to !eet their ac%te

care needs


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Hospice are Provided Thro%gh an

Interdisciplinar& Tea!


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The Hospice #/perience Model2

Patient30a!il& 4al%eDirected #ndo$Li$eare Model" N%rses caring $or patients and their

$a!ilies at the end o$ li$e need to 5rstco!prehend the asic di*erenceset'een c%rative approaches andpalliative endo$li$e approaches that

honor the %ni6%e e/periences o$patients and $a!ilies.


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TheHospice #/perience Model" an endo$li$e !odel ased on patient3$a!il& val%es,

is $o%nded on the $ollo'ing principles that appl& tooth the patient and $a!il& caregivers2

7 Illness,caregiving,d&ing,and ereave!ent are

%ni6%e personal e/periences

7 People e/perience the last phase o$ theirrelationships and lives thro%gh !an& relateddi!ensions

7 The last phase o$ li$e and relationships providescontin%ed opport%nit& $or positive gro'th anddevelop!ent in the $ace o$ s%*ering


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Principle 82Illness,caregiving,d&ing,andereave!ent are %ni6%e personale/periences" Respecting patientsindivid%alit& is the

$o%ndation o$ h%!ane care.It re6%ires

con$ronting the $%llness o$ the h%!anconte/t in 'hich illness and agingocc%r. Individ%al patients !%st e the$oc%s o$ attention, and their partic%lar

val%es, concerns, and goals !%st erecogni9ed and addressed


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Principle :2People e/perience the last phaseo$ their relationships and lives thro%gh !an&related di!ensions"The caregiving and d&ing e/perience

is one that a*ects all di!ensions o$ aperson. To co!prehend the nat%re o$s%*ering a!ong the d&ing, it isessential to ;no' and %nderstandthe person


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#ric assell


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" -elleing Di!ension

"Transcendent Di!ension


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" N%rses !%st approach endo$li$ecare and caregiving 'ith the

%nderstanding that a change in oneo$ these di!ensions a*ects the otherdi!ensions.


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pplication o$ the Hospice #/perience Model" Hospice n%rsing involves

incorporating the 5rst t'o principleso$ the Hospice #/perience Model.Illness, caregiving, d&ing, andereave!ent are %ni6%e individ%aland interdi!ensional e/periences o$the patient and caregiver,'ith li$e and

relationship develop!ental land!ar;sand tas;s $or co!pletion and clos%re


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D&ing is a part o$ living"The period o$ ti!e re$erred to as

d&ing can e considered a stage in

the li$e o$ the individ%al person andthe $a!il&


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" Develop!ental ps&cholog& involvesthe st%d& o$ li$e stages and the

related tas;s to e acco!plished andopport%nities $or gro'th associated'ith each stage


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" >&oc; concept%ali9ed d&ing as astage o$ the h%!an li$e c&cle that

inherentl& holds opport%nities toroaden the personal e/perience,deter!ine 'hat !atters !ost,in?%ence the o%tco!e $or i!proved

6%alit& o$ li$e clos%re, and, in sodoing, reveal ne' so%rces o$ hope


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Integrating the N%rsing Process 'iththe Hospice Interdi!ensional are

Process


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Step 82Per$or!ing Interdi!ensionalssess!ent" ssess!ent egins 'ith disc%ssion soliciting

in$or!ation ao%t the patients and $a!il&ssit%ation,incl%ding the val%es,'ishes, and

drea!s that the& identi$& as i!portant.

"The $oc%s o$ a palliative care assess!ent isto as; the 6%estion, -hat is happening thatis helping or hindering this patient and $a!il&$ro! reaching their endo$li$e goals@


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Step :2Identi$&ing Speci5cIss%es,Prole!s,and Apport%nities and Theira%ses"The ne/t step involves identi$&ing

speci5c iss%es,'hich is co!paraleto developing the n%rsing diagnosis. speci5c iss%e, prole!,oropport%nit& is de5ned $ro! a

palliative perspective, and the ca%seis identi5ed


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Step =2Planning Interdisciplinar& Tea! are" Interdisciplinar& care planning is a

process that occ%rs $ro! the ti!e thepatient is re$erred thro%gh the $a!il&sereave !ent period. It occ%rs oth in$or!al IDT care planning !eetingsand, et'een !eetings, as patient and

$a!il& needs change and !e!ers o$the IDT collaorate on care.


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Be& co!ponents" collaoration

" patient3$a!il& directed goal setting

" IDT planning o$ interventions.


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Step C2Providing Interventions to MeetPatient and 0a!il& oals

"The hospice care plan involvesinterventions in $o%r areas2palliativetherape%tic interventions,ed%cational interventions,collaoration interventions,and

assess!ent interventions


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Palliative Therape%tic Interventions" Palliative therape%tic interventions

incl%de those that have een

identi5ed to e cond%cive to !eetingthe patients and $a!il&s goals.


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#d%cational Interventions" s'ith all n%rsing practice,patient and

$a!il& ed%cation is a cornerstone o$hospice n%rsing. >eca%se !ost patients$ollo'ed & hospice do sta& in their ho!es%ntil death, the pri!ar& role o$ the hospicetea! is to e!po'er the patient and $a!il&

caregivers so that the& can develop thes;ills to co!$ortal& provide care and 5nd!ean ing and p%rpose in the e/perience.


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ollaoration Interventions" r%cial to ens%ring %ni5ed deliver& o$

care to patients and $a!ilies is the

practice o$ collao ration.


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ssess!ent Interventions"The 5nal t&pe o$ hospice n%rsing

intervention is ongoing assess!ent

necessar& to deter!ine 'hethercontin%ation o$ the care plan ise*ective or opti!al


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Step 2#val%ating Interventions andontin%ation or Revision o$ the are Plan

" -ith the patient and $a!il& as thecore o$ the hospice tea!, eval%ationegins 'ith their perspective o$ thee*ectiveness o$ the care planinterventions in !eeting their endo$

li$e and relationship clos%re goals.


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Interdi!ensional are Delivered & anInterdisciplinar& Tea!


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Ph&sical di!ension" ph&sician,n%rse,phar!acist,

therapists,n%tritionist,and vol%nteers


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0%nctional di!ension" n%rse,n%rsing assistant,

therapists,and vol%nteers


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Interpersonal di!ension" co%nselors,social 'or;er,

ps&chologist,and vol%nteers


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-elleing di!ension" co%nselors,social 'or;er,

ps&chologist,chaplain,and vol%nteers


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Transcendent di!ension" chaplain,co%nselors,social

'or;er,ps&chologist,and vol%nteers


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General Principle 3.ppt