PALLIATIVE CARE
Palliative Care Team
Heart of England NHS Foundation
Trust
AIMS:•
•
•
•
To define what we mean by palliative care
To define what we mean by end of life care
To identify the needs of patients that are dying
To highlight what the needs of the family are when a
patient is dying
• To identify the role of the HCA in caring for patients at
end of life and their families
• To identify factors that lead to a ‘good’ or ‘bad’ death
OBJECTIVES
At the end of the session HCA’s should be able to:• Define what we mean by palliative care
• Define what we mean by dying
• To enable HCA’s to recognise signs that a patient may
be dying
• Identify the most important aspects of care for a
patient at end of life
• Appreciate the needs of the family and their main
concerns at end of life
>4,000 Patient Deaths at
HoEFT per Year!
Aim of palliative Care
The goal of palliative care is the achievement of
the best possible quality of life for the patients
and their families.
(WHO 1990)
DEFINITION OF PALLIATIVE
CARE
………to achieve the best quality of life for
individuals with any advanced, progressive
illness, and their families, by the management of
their physical symptoms and the provision of
psychological, social and spiritual support.
World Health Organisation 2002
End of Life Care Strategy
50% of complaints are related to end of life care in
some way.
Of 50 cases looked at relating to end of life care
the complaints were around poor
communication, lack of basic comfort, privacy
and psychological care, and late or no referral to
palliative care
Relatives are often the 1st to notice a patient is
dying!
DoH 2008
DEFINITION OF DYING
‘If the patient has a progressive incurable disease,
if reversible causes of deterioration have been
excluded (eg infection, hypercalcaemia) and if
they are very weak and drowsy and getting
weaker every day, then they are dying.’
(Kaye 1999)
Recognising a Dying Patient
Drowsy/
unresponsive
Poor urine
output
Cold peripheries
Patient
Laboured
breathing
Pale in colour
Abnormal
Observations
Shallow
breathing
End of Life Carea daunting prospect ! !
REMEMBER
“all the care she received before meant
nothing, because she died the way she
died”
Husband of 43yr old lady who died in hospital
“There is little
time and only
one chance to get
it right”
Common End of Life Symptoms
•
•
•
•
Pain
Agitation / terminal restlessness
Nausea / Vomiting
Moist Chest
How does focus of care change?
•
•
•
•
Investigations become irrelevant.
Aiming to prolong life becomes irrelevant.
Patient comfort takes priority.
Increased support for the family is needed.
(Kaye 1999)
Other considerations
•
•
•
•
•
•
Maintaining patient privacy and dignity
Ensuring patients wishes are respected
Support of family.
Place of death.
Spiritual requirements of patient.
Staff support
Cultural and Social Issues
•
•
•
•
•
•
Social taboos
Social denial of death
Materialism
Role of religion
Experience of loss in the family
Expectations of health and life
HCA ROLE
•
•
•
•
•
•
•
•
Maintaining privacy and dignity
Provision of good essential nursing care
Respecting wishes of patients and families
Listening to patients and families
Spending time with patients and their families
Communicating with patients and families
Communicate with other team members
Recognising your own limitations and areas of concern
What do we mean by Essential
Nursing Care
• Meeting patients hygiene needs
• Providing good oral care
• Monitoring of micturition
• Maintaining regular bowel pattern
• Regular visual observation
• Appropriate pressure relief/skin care
NB:- Think of caring for that person as you would
wish a loved one to be cared for!
Communication
With dying patients and their relatives
Barriers perceived by patients
• Perceive
Doctors/nurses as
too busy
• Don’t want to burden
them with their
worries
• Believe
Doctors/nurses
primarily
concerned about
physical care
• Think their
perspectives may
depend on treatments
so don’t want to
complain
Continued . . .
• Think their worries are
silly or trivial or that
professionals will think
that.
• Fear of admitting being
unable to cope, breaking
down, losing control.
• Not being able to find
the words to explain how
they feel.
• Anxiety about having
their worse fears
confirmed.
Barriers to communication
by Staff
Being frightened of
– - upsetting the patient
– - causing more harm than good
– - being asked difficult/unanswerable
questions
– - saying the wrong thing
Continued. . .
Feeling that
– - there is not enough time
– - cannot handle the emotions of patient or
themselves
– - not knowing enough
– - not being part of their job
– - not being able to do anything about the
situation/helplessness
Skills Required for
Good Communication
• Listening
• Body language
• Clinical skills/knowledge base
• Awareness of family dynamics
• Self awareness
• Managing time, boundaries, endings
• Empathy
• Advocacy
• Touch
• Responding appropriately
Non-verbal
•
•
•
•
•
•
Eye contact
Nodding
Sit down
Close door/pull curtain across
Switch off mobiles
Plan time for talk
Verbal
•
•
•
•
Checking
Respond to emotional distress
Use open questions
Ask directly how they are ‘feeling’,
(psychological state)
• Make supportive comments
Words to try
When you think you want to
say:
• You are going to be just fine.
Try this instead:
• Are there some things that worry
you?
• Don't talk like that! You can
beat this!
• This must be hard to come to
terms with
• I can't see how anyone can
help.
• We will work with you.
• What do the doctors know?
You might live forever.
• Don't be glum. You will get
well.
• Do you think the doctors are
right? How does it seem to you?
• It must be hard. Can I just sit
with you for a while.
Key Points
• Ensure patients privacy and dignity are
maintained at all times.
• High quality essential nursing care is a priority
• Good communication with both patients and
relatives is essential
• Recognising spiritual needs of patients is
important