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Palliative Care

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Shaun Durkin

on 2 March 2015

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Transcript of Palliative Care

€66 per candidate
Judy Morrissey
FETAC 5N2770
Introduction to Palliative Care
Palliative Care
FETAC Accreditation
Component Specification

15 Learning Outcomes grouped into 4 units
Assignments x 2 (40%)
Skills Demonstration (60%)
LO1: Discuss the philosophy and principles of Palliative Care;
LO2: Summarise the structure and organisation of palliative care services to include the role played by the multi-disciplinary team and diverse family structures in the provision of care for a terminally ill person
LO4: Explore differing attitudes to death and dying (to include an understanding of individual patterns of grief, bereavement and loss);
Communication and Individual Responses
LO3: Discuss the role of the support worker in the promotion of key issues such as life quality, self-esteem, respect, privacy and dignity in palliative care work;
LO5: Employ a range of communication strategies and processes which are central to the work in palliative care.
The Last Days of Life
Common Symptoms at End of Life
LO7: Respond appropriately to the needs of the person who is confused in the last days of life
LO9: Use a range of skills required from a palliative support worker in relation to end of life care.
LO6: Apply a person-centred approach to caring for a person in the last days of their life to include the provision of supportive and holistic care promoting safety, dignity, respect and comfort;
LO8: Work effectively and with great sensitivity in relation to the dying person and their significant others in a palliative care setting.
Defining Palliative Care
End of Life Care - is the term used to describe care that is provided during the period when death appears to be imminent, and life expectancy appears to be limited to a short umber of hours or days. The term has been used to describe the last 12 months of life. The clinical programme does not use the term in this way
(HSE 2012: Glossary of Terms. Palliative Care Programme, Clinical Strategy and Programmes Directorate)
End of life care must include palliative care, not all palliative care is end of life care (Mahon & Sorrell 2008)
Philosophy and Principles of Palliative Care
Challenges to End of Life Care
Culture - ? acceptance of dying among staff
Suitable physical environment
Team decision-making regarding plan of care
Need for education and training for staff
Adequate symptom management – especially non-physical symptoms
Palliative Care is an approach that improves the quality of life of people and their families facing the problems 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, psychosocial and spiritual
(World Health Organisation 2002)
Palliative care focuses on preventing and relieving suffering and improving quality of life for people facing serious illness.
It is not dependent on prognosis and can be delivered along with curative treatment (Meier 2007).
WHO 2002 Palliative Care Principles
The relief of pain and other distressing symptoms
The affirmation of life and acceptance of dying as a normal process
The intention to neither hasten or postpone death
The integration of psychological and spiritual care of the person
The support of patients to enable them to live as actively as possible until death
The support of family to help them to cope with the illness and the bereavement
A team approach to meet patient and family needs
Enhance the best quality of life for the person, positively influencing their experience of illness
Applicable early in the course of illness in conjunction with other therapeutic interventions
Uses a team approach to address the needs of the person and their family, including bereavement counselling if indicated
Will enhance quality of life, and may also positively influence the course of illness
Can be applied early in the course of illness, along with other therapies that are intended to prolong life such as chemotherapy / radiation therapy, and includes investigations needed to better understand and manage distressing symptoms (WHO 2002)
The structure and organisation of palliative care services
Hospice could be described as a place and a philosophy of care
It is often used to describe care offered to patients when the disease is at an advanced stage
Who should receive palliative care:
All persons with a life-limiting condition irrespective of age or setting
A Life-limiting condition is a condition, illness or disease which:
Is progressive and fatal, and
The progress of which cannot be reversed by treatment.
HSE (2012)Glossary of terms. National Clinical Programme for Palliative Care, Clinical Strategy & Programmes Division
Who provides palliative care:
Everyone working in a service that provides health and social care to persons with life limiting conditions is obliged to understand and provide a level of palliative care using a palliative care approach
A palliative care approach:
Utilises the philosophy and principles of palliative care
All professionals can use it
Is available to all persons with malignant and non-malignant terminal disease
Principles should be appropriately applied by all healthcare professionals (National Advisory Committee on Palliative Care ,2001)
What is a palliative care approach?
Open sensitive communication with the person, family and colleagues
Provides effective symptom control
Holistic approach including life experiences and current situations
Concerned with promoting quality of life
Care for dying person and those who matter to them and bereavement support to family
Contrast EOL Care / Palliative Care
Palliative Care is not time confined but ‘Goal-oriented’
Palliative Care helps people ‘Live until they die’ – whenever that occurs
HSE (2012) Glossary of terms, Palliative Care Programme, Clinical Strategy and Programme Directorate
Aims/Goals of Palliative Care
The achievement of the best quality of life for patients and their families facing the problems 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 (WHO, 2002)
If families are not included it is not palliative care (Eliz Kubler- Ross)
Specialist Pallitive Care Services:
In-patient Palliative Care Unit/ Hospice
Day Hospice
Palliative care specialists in general hospitals
Home Care : Aim to provide an advisory and support service to G.P’s PHN, Residential care staff, and other health care professionals, families and patients
Barriers to palliative care:
Not recognising end stage
Not identifying and addressing symptoms
Lack of information about the person’s wishes
Poor Care Planning
Pressure for inappropriate care
Illness not recognised as a terminal illness
National Quality Standards for Residential Care Settings for Older People in Ireland (2009)

Standard 16 – End of Life Care :
16.1: Residents palliative care needs are assessed, documented and regularly reviewed
When should a Palliative Care needs assessment take place?
At diagnosis of a life-limiting condition
At episodes of significant progression or exacerbation of disease
At significant change in the person’s family/social support
At significant change in functional status
When the person of family make a request
At end of life (HSE Palliative Care Needs Assessment Guidance)
Multidisciplinary team:
Definition of Teamwork:- Group of people with diverse but related skills and knowledge who associate for the purpose of directing, coordinating and developing the separate parts as well as the sum total of their expertise
(Cox & James 2004)
Teams should establish formal channels of communication so as to ensure that all team members have an opportunity to contribute to the decision making process and are informed of developments at the earliest opportunity.
(Report of the National Advisory Committee on Palliative Care 2001)
What is the multi-disciplinary team?
It is a fundamental principle of palliative care that no one individual or discipline possesses the range of skills necessary to comprehensively meet and address the varied needs of patients and their families. A good palliative care team should be composed of members of multiple disciplines, representing a variety of areas of expertise.
(Report of the National Advisory Committee on Palliative Care 2001)
Each team member should recognise the limits of their own expertise and should refer to other sin a timely appropriate manner
(Report of the National Advisory Committee on Palliative Care 2001)
The role of the support worker
Your role:
Is under the supervision, direction and guidance of the Public Health Nurse
Your role: As a Health Care Assistant, you should:
Appreciate the role of the health care assistant in addressing physical, psychological, social, cultural and spiritual issues in individuals receiving palliative care and their families.
Anticipate comfort needs and within the context of your role initiate appropriate interventions to meet those needs
Facilitate a sense of security and support the person with a life limiting condition and his/her family at this time
Encourage timely referral of people with life-limiting conditions and their families to specialist palliative care services, so as to maximise comfort and quality of life
(HSE Palliative Care Competence Framework, 2014)
Different attitudes to death & dying
Dying a good death:
Dame Cicely Saunders
Total Pain includes:-
Physical Pain
Social Pain
Emotional Pain
You must consider what is going on underneath for that person
Any robot can give care – It’s how you give care that matters
Applying a person-centred approach
Dame Cicely Saunders
Emphasised that effective individualised pain management is promoted through attention not only to the physical, but also to the psychological, social, and spiritual dimensions of distress, which are inter-twined in the fabrics of holistic care
“You matter because you are you. You matter to the last moment of your life and we will do all we can not only to help you die peacefully but to live until you die”
Communication strategies central to the work in palliative care
Working effectively and with great sensitivity
Responding appropriately
Using a range of skills
3 Levels of Palliative Care:
Palliative Care Approach – all health care professionals should be able to give this
General Palliative Care – Special interest in Palliative Care. Delivered outside specialist palliative care service in general healthcare settings. Team members may have palliative care knowledge or training – not all to Specialist Level
Specialist Palliative Care – Specialist palliative Care is characterised by a high level of specialist training in palliative care and the ability to provide support wherever the person happens to be – e.g. at home, in hospital, or in a Hospice (National Advisory Committee on Palliative Care 2001)
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