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When People Are Dying:
Palliative Care
By
Pamela Parrish, RN, CHPN
Clinical Consultant
School of Nursing, University of Pennsylvania
Diane Stillman, RN, MSN
Clinical Consultant
School of Nursing, University of Pennsylvania
Neville Strumpf, PhD, RN, C, FAAN
Edith Clemmer Steinbright Professor in Gerontology
School of Nursing, University of Pennsylvania
In collaboration with Genesis ElderCare and the University of Pennsylvania School of
Nursing with funding from the Robert Wood Johnson Foundation
Delaware Valley Geriatric Education Center
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Objectives
Direct care staff will be able to:
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Distinguish between palliative care and
hospice
Describe the domains of palliative care
Describe the process of advance care planning
Discuss approaches to relieving emotional and
physical symptoms
Discuss roles of various staff and services,
including team functions, in social and
emotional support
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Definitions of Palliative Care
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Study and management of persons with
progressive, far advanced disease for
which the prognosis is limited and the
focus of care is on quality of life
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World Health Organization: Active, total
care of persons whose disease is no
longer responsive to curative treatment
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Delaware Valley Geriatric Education Center
Palliative Care
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Distinctions from Hospice:
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Focuses on end-stages of chronic illness
Targets people earlier in disease process
Is not linked to reimbursement or
prognosis
Has greater flexibility to accommodate
individual and family wishes
Is complementary to hospice care
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Domains of Palliative Care
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Advance care planning
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Physical and emotional comfort
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Social, bereavement, and spiritual
support
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Advance Care Planning
Understand Values of the Person
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What makes life worth living
Quality vs. prolongation of life
Concerns over illness, suffering, control,
alertness, family, death
Religious or spiritual concerns
Understand Legal Requirements
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Statutes and requirements vary by state
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Process of Advance Care
Planning
Step 1: Introduce the Topic
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Define ACP process and philosophy, determine
comfort level with discussion, determine
competence and desire to name an agent
Step 2: Structure Discussions
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Discuss preferences and wishes and explore any
inconsistencies
Step 3: Document Preferences
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Document thoroughly and review frequently
Update as needed
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Assessment & Management
of Symptoms
Physical symptoms may include pain,
nausea/vomiting, diarrhea, constipation,
itching, shortness of breath, lack of appetite,
and others
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Attend to self reports and behavioral cues
Manage symptoms
Assess frequently and communicate with
appropriate professionals
Develop an ongoing plan of care focused on
maximizing comfort
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Assessment & Management
of Symptoms
Emotional symptoms may include depression,
anxiety, agitation, irritability, and
others
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Assess frequently
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Communicate with primary care provider(s) and, if
appropriate, psychiatrist, therapist, or clergy
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Develop an ongoing plan of care focused on
minimizing patient and family distress
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Social, Bereavement, and
Spiritual Support
Meeting the needs of the dying person
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Offering hope
Providing comfort
Assuring community
Maintaining meaning
Sustaining dignity
Limiting fears of abandonment
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Social & Spiritual Support
Nursing
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Assist with hygiene, dignity, and privacy;
maintain open communication with individual and
family; encourage family involvement in care
Social Services
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Coordinate family support; engage community
services; assure wishes are congruent with
advance directives and resolve any conflicts
Dietary
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Arrange meals for family; provide comfort foods;
liberalize diet; provide extra fluids for person
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Social & Spiritual Support
Activities
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Offer pet therapy, reminiscence, aromatherapy,
music therapy, gardening, and visits from
children as desired
PT/OT
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Assist in maintenance of independence and
comfort; consult on positioning, safety issues,
and pressure ulcer care
Community
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Involve hospice, local clergy, and volunteers
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Delaware Valley Geriatric Education Center
Moment of Death
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Develop approaches to ensure that death
does not occur alone
Maintain on call system-- family, staff,
and volunteers to spend time with those
actively dying
Support family members at time of death
Assume care of and show reverence for
the body
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Bereavement Support for
Survivors
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Sympathy cards
Pamphlets on grief and loss, referral to
community services
Memorial services
Bedside services
Flowers and cards in reception area
Angel tree, memorial garden, or other
remembrance area
Follow-up call or letter to family
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“I knew I could count on you to listen to
my fears, and I often ran them by
you…I always knew I could tell
my wife anything, but I worried
about her anguish over my
suffering. You never stopped fighting
for my comfort, and you never forgot
that my pain was her pain. Thank
you for that.”
A husband writing to his late
wife’s caregiver
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Objectives Review
Can you now:
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Distinguish between palliative care and hospice?
Describe the domains of palliative care?
Describe the process of advance care planning?
Discuss approaches to relieving emotional and
physical symptoms?
Discuss roles of various staff and services.
Including team functions, in social and
emotional support?
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Thank you for your attention!
The End
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