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Principles of Palliative care
Dr Ibrahim Bashaireh
Palliative derives from the Latin Pallium which means to cloak.
Palliation means to cloak over, to not address the underlying causes, but to eliminate the effects.
History of Palliative Care
4 th Century Christians
1842 Jeanne Garnier Lyon France
1879 Irish Sisters of Charity Dublin
1905 St Joseph’s London
1967 St Christopher’s London
Independent Sector
Marie Curie
Independent Hospices
Macmillan Cancer Relief
Public Sector
NHS Hospices
Palliative Care Beds
% Funding for Hospices
Palliative care (WHO, 2003)
“Palliative care is an approach that improves
the quality of life of patients and their families
facing the problem associated with life-
threatening illness, through the prevention
and relief of suffering by means of early
identification and impeccable assessment and
treatment of pain and other problems,
physical, psychological and spiritual.”
Definition of Palliative Care (contd)
The goal of palliative care is achievement of the best
possible quality of life for patients and their families
Affirms life and regards dying as a normal process
Provides relief from pain and other distressing
symptoms
Integrates the psychological and spiritual aspects of
patient care
Offers a support system to help patients live as
actively as possible until death
To help the family cope during the patients illness and
in their own bereavement
First of all
Main aims
Avoid the avoidable sufferingAvoid the avoidable suffering
Building Capacity : empowerment to adjust, relief and support the unavoidable suffering
Wellbeing
Promote comfort
Improve the Quality of Life
Comprehensive Care
OMS 2002
Values
Principles
•We are focused on the patient and his/her family
•We are Accessible
•We are Collaborative
•We provide high quality:
•We are Safe and Effective
•We are based on Evidence
•We have resources
Ferris and Gómez- Batiste
10 instruments for palliative care1. Needs assessment.2. Systematic therapeutic Plan.3. Symptom control.4. Emotional support.5. Information and communication.6. Clinical ethics as the method for decisions7. Change in the micro organization: the team work8. Change in the organization of resources.9. Evaluation and monitoring results quality and
results.10. Education, training, and research
And….. Advance Care Planning and Case management and continuity of care
Emotional
PsychosocialPhysical
Spiritual
Bereavement Symptom
Control
General Palliative Care Patients with less complexed needs Nursing Homes, PC approach,
Specialist Patients with complexed needs. Multi-professional
team with specialist PC training. Medical, Nursing, Social Work, Spiritual, Physio, OT, Pharmacy
Supportive Provided from pre-diagnosis onwards. Umbrella
term for general & specialist services. Responsibility of all Health & Social care professionals
The Palliative Care Approach NCPC (1997)
The Palliative Care Approach NCPC (1997) Vital and integral part of all clinical practice.
Informed by a knowledge of and practice of palliative care principals and supported by specialist palliative care
Quality of life A whole person approach
Care for both the dying person and those that matter to the person
Patient autonomy and choice
Principles underlying palliative care
provision (NCPC 1997)
Principles underlying palliative care
provision (NCPC 1997)
It is the right of every person with a life threatening
illness to receive appropriate palliative care wherever
they are.
It is the responsibility of every health care professional
to practice the palliative care approach, and to call in
specialist palliative care colleagues if the need arises,
as an integral part of good clinical practice whatever
the illness or stage.
What kind of issues would effect when or why people access palliative care services?
Consider:
Resources available
Regional differences
Education/information
History
When ?
Diagnosis Death
Active – Treatments
Palliative Care
Time
56% wanted to die at home 25% of Cancer patients did 20% of people with other diseases did 11% wanted to die in hospital 47% of Cancer patients did 56% of people with other diseases did
24% wanted to die in a hospice. 17% of Cancer patients did 4% of people with other diseases did
National Council for Palliative Care 2003
Frequency of common symptoms in advanced illness(Atkinson & Virdee, 2001)
Symptom Patients with cancer
Patients with progressive non-malignant disease
Pain
Breathlessness
Vomiting or nausea
Sleeplessness
Confusion
Depression
Anorexia
Constipation
Pressure sores
Loss of bladder control
Loss of bowel control
Unpleasant smell
84
47
51
51
33
38
71
47
28
37
25
19
67
49
27
36
38
36
38
32
14
33
22
32
Palliative Care Nursing
Palliative care nursing
Doing for
Preserving
integrity
empowering
Finding meaning
VALUING
connecting
Palliative care nursingPalliative care nursingConnecting
Making a connection
– establishing a rapport
– building up trust
Maintaining a connection
– being available, spending time, sharing secrets, sharing self,
maintaining trust.
Breaking the connection
– usually as a result of the patient’s death
Empowering..... facilitating –
– recognises patient autonomy
encouraging
defusing
– dealing with negative feelings
mending
– - facilitating healing
giving information
Palliative care nursingPalliative care nursing
Doing for......
Taking charge
– symptom control
– making
arrangements
Team playing
– acting as the
patient’s advocate
Finding meaning
Focusing on living -
helping the patient to
live as fully as possible
Acknowledging death
– giving or reiterating
bad news
– talking about death
and the time left
Preserving Integrity
Confronting own mortality
Burnout Supporting
Colleagues
Hope
Comfort
Attachment
Worth
Hope D
iminishing
Hope S
us tai ning
Physical distress Physical Ease
Abandonment
& Isolation
Caring relationships
Feeling devalued Feeling valued
Hope nurturing interventions in palliative care
ComfortAssessment, psychosocial issues.
AttachmentBe there, caring environment, promote
communication
WorthExplore previous experience, future
wishes,enhance independence
The tyrannies of palliative care (Aranda, 2001)
Niceness
Glowing testimonial
Depressing/Sad
Passive
Ethics
Treatment OptionsFeeding/Fluids
Sedation
CPR
Carers
Euthanasia