Principles of Palliative care Dr Ibrahim Bashaireh

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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 lifethreatening 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

Family

Patient

You matter

Main aims

Improve the

Quality of Life

Avoid the avoidable suffering

Wellbeing

Promote comfort

Building Capacity : empowerment to adjust, relief and support the unavoidable suffering

Comprehensiv e Care

OMS 2002

Values

Respect their values

Active, alive conception

Patient and relatives

Integrity

Trust Honesty

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 care

5.

6.

7.

8.

9.

1.

2.

3.

4.

10.

Needs assessment.

Systematic therapeutic Plan.

Symptom control.

Emotional support.

Information and communication.

Clinical ethics as the method for decisions

Change in the micro organization: the team work

Change in the organization of resources.

Evaluation and monitoring results quality and results.

Education, training, and research

And…..

Advance Care Planning and Case management and continuity of care

Physical

Spiritual

Symptom

Bereavement

Control

Emotional

Psychosocial

 General Palliative Care

Patients with less complexed needs

Nursing Homes, PC approach,

 Specialist

Patients with complexed needs. Multiprofessional 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)

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)

 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

Active – Treatments

Death

Time

Palliative Care

 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

Pain

Breathlessness

Vomiting or nausea

Sleeplessness

Confusion

Depression

Anorexia

Constipation

Pressure sores

Loss of bladder control

Loss of bowel control

Unpleasant smell

Patients with cancer

51

33

38

71

84

47

51

47

28

37

25

19

Patients with progressive nonmalignant disease

36

38

36

38

67

49

27

32

14

33

22

32

Palliative Care Nursing

Palliative care nursing

VALUING connecting empowering

Preserving integrity

Doing for

Finding meaning

Palliative care nursing

Connecting

 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 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

Physical distress

Attachment

Physical Ease

Abandonment

& Isolation

Caring relationships

Worth

Feeling devalued Feeling valued

Hope nurturing interventions in palliative care

 Comfort

Assessment, psychosocial issues.

Attachment

Be there, caring environment, promote communication

 Worth

Explore previous experience, future wishes,enhance independence

The tyrannies of palliative care

(Aranda, 2001)

 Niceness

 Glowing testimonial

 Depressing/Sad

 Passive

Ethics

Treatment Options

Feeding/Fluids

Sedation

CPR

Carers

Euthanasia

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