Hospice Power Point Lecture

8/3/2019 Hospice Power Point Lecture

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Prepared by:

AUBREY C. ROQUE RN, MAN


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It is designed to give supportive care topeople in the final phase of a terminal illnessand focus on comfort and quality of liferather than cure.

GOAL: To enable patients to be comfortableand free of pain, so that they live each dayas fully as possible.

PHILOSOPHY: To provide support for thepatient's emotional, social, and spiritualneeds as well as medical symptoms as part oftreating the whole person.


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Palliative care is an approach that improvesthe quality of life of patients and theirfamilies 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


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Palliative care for children is the active total care ofthe child's body, mind and spirit, and also involvesgiving support to the family.

It begins when illness is diagnosed, and continuesregardless of whether or not a child receivestreatment directed at the disease.

Health providers must evaluate and alleviate a child'sphysical, psychological, and social distress.

Effective palliative care requires a broadmultidisciplinary approach that includes the familyand makes use of available community resources; itcan be successfully implemented even if resourcesare limited.


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It can be provided in tertiary care facilities,

in community health centers and even in

children's homes.

PALLIATIVE CARE- is designed to givesupport and comfort rather than cure of the

illness or problem.


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Current licensure in the state of practiceMinimum of one year of clinical practice

in nursing.

Oncology

Psychiatry

Home care experience are prepared

Knowledge of pathophysiology and disease

progressionUnderstanding of pain and symptom

management


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Excellent assessment communication skills

Ability to work within and contribute to an

interdisciplinary team

Ability to assist the patient and family incoping with emotional stress

Understanding of an aptitude for

organization and communication with

patient, family and team members


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Capacity to manage physical , 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, managing,

instructing, caring and communicating skills

and knowledge.

Ability to balance the nurses self-care needswith the complexities and intensities of

repeated encounter with death.


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Affirms life and regards dying as a normalprocess

Neither hasten nor postpones death

Provides relief from pain and other

distressing symptoms Integrates the psychological, ethical, legal

and spiritual aspects of care

Offers a support system to help patients live

as actively as possible until deathOffers a support system to help patients

families to cope during the patients illnessand in their own bereavement.


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1.) Effective Communication

COMMUNICATION- is the essential process bywhich individual share something of them,whether it is thoughts, feelings, opinions, ideas,

values, or goals.

1. Principles of human communication Its multidimensional The content of the message sent (true or false, sensible

or non-sense or undecipherable) Emotional content / feelings that modify the message

(grief, anger, joy, confidence, peace, boredom, etc..) Relationship aspect- refers to how the message is

received given the perceived social positions of thecommunicants.


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Perception is selective Only a part of the information sent is perceived.

The idea that what is perceived is not precisely what

actually is.

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

Its 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, communication is occurring.


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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.

Culture involves customs, beliefs, values, andrelationship patterns, prescribed behaviors (dress,

food preferences and time consciousness).


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2. Importance of good communication at theend 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.


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3. Barriers to good communication

patients and families

death is considered a taboo subject

Common reactions are withdrawal from the patient or

situation, denial of the reality of a terminal diagnosis,

or avoidance of behavior, such as telling jokes or

changing the subject.


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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, "Can you help me

understand?" as well as open-ended questions such as,"What is it that you need to do now?" are veryimportant, as is being comfortable with silence.


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Depth of the physicianpatient relationship: Health CareProviders (HCPs) may develop strong bonds with patient

and family, whether they have known them for years or

just a short time. 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.

Personal experiences of illness and death: May affect

their ability to care for a person who is at the end of life.

Physical, emotional and psychological stress anddepletion: May affect ability to communicate caring,empathy and compassion.


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Fears of confronting own mortality and fears of death:

Caring for someone who is dying leads to physiciansconfronting their own mortality and fears of death.

Lack of training and poor role models: A lack of training androle models results in poor communication skills and either alack of awareness of patients feelings and reactions orinability or fear of discussing these emotions.

Fears of emotional outbursts: HCPs are often not taught howto show empathy and caring and may fear emotionaloutbursts.

Fears of appearing weak or unprofessional for displayingemotions: Many HCPs have been taught that displayingemotion is a sign of weakness or unprofessional. These HCPsmay have difficulty in discussing end-of-life issues for fear offeeling or displaying emotion.


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Guilt and self-blame due to iatrogenic complicationsresulting in poor quality of life, increased severity ofillness and/or death: When illness is due to or has beenexacerbated by iatrogenic complications, HCPs may be

consumed with self-blame and guilt which may affect their

ability to consider the patients situation.

Communication Problems: Inconsistent approach to theissues, differences in language can lead to confusion (the

perception of mixed messages) and misunderstandingswith patients and families.


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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 providingfollow-up-end-of life conversations?


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Practical aspects of communicating at theend of life

Understand oneself and speak honestly (self-awareness)

But remember that the key to talking to dyingpersons is to focus on their needs, rather than ones

own.

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


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Allow the patient to guide the communication process;

patients personal autonomy and control should be

preserved.

Use open ended questions (e.g. what is it that

you need to know?)


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Make no assumptions about what the patientknows; a patient who has not told of their

diagnosis might be aware that they are

dying.

ask and listen, listen and ask, the mostimportant general rule in the end-oflife

setting is to listen more and to talk less


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yes or no questions are helpful initially to broach a

difficult subject, (e.g. have you experienced the

death of a loved one before.. 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


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use understandable terms

ask patient what they want

use silence liberally

support varying emotional response accept denial , 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


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4. Breaking bad news

-- All the communication skills discuss applyto the very difficult task ofbreaking 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 ones own mortality


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NOTE:it is often the doctors responsibilityto break the bad news but it is helpful to

be present when the bad news is initially

shared, that is to understand the realsituation/condition of the patient.


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5. Assessing suicide potential

Requisite skills for end-of-life care is the abilityto identify depression and assess for suicidal

potential

Depression A psychiatric disorder characterized by an

inability to concentrate, insomnia, loss ofappetite, anhedonia, feelings of extremesadness, guilt, helplessness and hopelessness,and thoughts of death. The condition is alsocalled clinical depression.


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NOTE: Anhedonia: Loss of the capacity toexperience pleasure. The inability to gain

pleasure from normally pleasurable

experiences. Anhedonia is a core clinical

feature ofdepression, schizophrenia, and

some other mental illnesses.

Subtypes of Depression: Major depression severe, lasts for at least 2 weeks

(decrease energy, feeling of worthless, guilty)

Dysthymic depression less severe (lasts for 2 years

or more).
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General appearance of a depressed person

Sadness

Resignation

Apathy Hopelessness

Or may become cheerful when decision come

to end suffering


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For assessment of suicide potential a directapproach is recommended. Eg. Have things gotten so bad that you are thinking

of killing yourself.

Risk factors for SUICIDE: S Sex (more female attempts suicide but

more malescommits).

U Unsuccessful previous attempt. I Identification with a family member who

committed suicide.

C Chronic I Illness Ex. CancerD depression/dependent personality A age (18-25 and 40 above) and alcoholism L Lethality of previous attempts/looses.


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Hospice Power Point Lecture