 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.

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

(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.”

 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

Family
Patient
You matter

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

•
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

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

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

(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

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

VALUING connecting empowering
Preserving integrity
Doing for
Finding meaning

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

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

 Confronting own mortality
 Burnout
 Supporting
Colleagues

Comfort
Physical distress
Attachment
Physical Ease
Abandonment
& Isolation
Caring relationships
Worth
Feeling devalued Feeling valued

 Comfort
Assessment, psychosocial issues.
 Attachment
Be there, caring environment, promote communication
 Worth
Explore previous experience, future wishes,enhance independence

(Aranda, 2001)
 Niceness
 Glowing testimonial
 Depressing/Sad
 Passive


Feeding/Fluids
Sedation
CPR
Carers
Euthanasia