FLORENCE THE FIRST PALLIATIVE CARE NURSE Florence Nightingale herself stated: ‘I use the word nursing for want of a better.’ She went on to say: ‘The very elements of nursing are all but unknown’ (Nightingale, 1860).
DEFINING PALLIATIVE CARE ‘Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, though the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, physiological and spiritual.’ WHO
PALLIATIVE CARE Affirms life Promotes quality of life Treats the person Supports the family
EVOLVING MODEL OF PALLIATIVE CARE Death Cure/Life-prolonging Intent Palliative/Comfort Intent Bereavement
PALLIATIVE CARE GOAL Its goal ismuch more than comfort in dying; palliative care is aboutlivingthrough meticulous attention to control pain and other symptoms, supporting emotional, spiritual, and cultural needs, and maximizing functional status
VIRGINIAS DEFINITION OF NURSING The most succinct and relevant to palliative care is Virginia’s definition of nursing; ‘Nursing is primarily assisting the individual in the performance of those activities contributing to health and its recovery, or to a peaceful death.’
PALLIATIVE CARE COMPETENCIES Communication skills Physical skills Psychosocial skills Teamwork skills Intrapersonal skills Life closure skills
COMMUNICATION SKILLS The ability To field and respond to sometimes profound or rhetorical questions about life and death To know when to say nothing, because that is the most appropriate response; To use therapeutic comforting touch with confidence; To challenge colleagues who may wish to deny patients information; and, perhaps To discuss the imminent death of a relative with families
TEAM WORK SKILLS The growth of the nursing role within these teams has been dramatic and continues to represent a much admired model of working .
PHYSICAL CARE SKILLS The knowledge and skills necessary to deliver active, hands-on care in whatever setting throughout a long period of illness. Observational skills and the intuitive ability to recognise signs Advising doctors of the appropriate prescription and dosage to manage pain The advocacy role nurses have towards patients at a time of extreme vulnerability.
PSYCHOSOCIAL SKILLS An ability work with families, Anticipating their needs, Putting them in touch with services and Supporting them when appropriate
INTRAPERSONAL SKILLS Nurses need to recognise and attempt to understand personal reactions that occur as a natural consequence of working with dying and bereaved people and to be able to reflect on how this affects care given in sensitive situations. It is the most challenging of all competency areas and plays a significant part in the professional growth of those who choose to work in this field.
LIFE CLOSURE SKILLS This area is concerned with nursing behaviours and skills that are crucial to patients’ and families; dignity, as they perceive it, when life is close to an end and thereafter. Such care has been described as a sacred work, in which the nurse enters into the patient’s intimate space and touches parts of the body that are usually private
PALLIATIVE CARE PLAN Palliative care plan includes: Care goals Symptom management Advance care planning Financial support Spiritual care Functional status support and rehabilitation Co morbid disease management
MANAGING PAIN Asses the multi dimensions of pain and determine the type of pain Employ a assessment scale Use WHO ladder Administer around the clock doses and break through doses Seek the help of appropriate alternative therapies Continue evaluating pain control and pain status
DYSPNEA Address the anxiety with assurance and relaxation techniques Maintain saturation above 90% with supplemental oxygen Suctioning is generally not indicated Administer 5-10mg morphine q4h if the patient is not on opioids
HANLING ANXIETY Types include situational anxiety, drug related anxiety. Organic anxiety and psychological anxiety.
FUNTIONAL STATUS SUPPORT Assess ability to perform ADL & IADL Find and rule out underlying reversible causes of functional impairment Refer to rehabilitation evaluation as appropriate Optimize and maintain functional status with physical, occupational and complementary therapies
PALLIATIVE SEDATION Intermittent sedation for relief of the intractable symptoms when they are not controlled even with aggressive measures. It is different from assisted death as it is not intended for death yet often foreseen Sedative dose is not killing does
SPIRITAUL CARE Assess the desire for spiritual counselling and support Obtain information regarding significant religious rituals, beliefs and practices Encourage their practice to the extent possible Foster the insights Spiritual coping strategies enhance self empowerment
SUPPORTING FAMILY Assess family structure, functioning, strengths and weaknesses, knowledge deficits Encourage communication among family members Respect their privacy and accept the coping styles Conduct meetings to review the goals and decisions Teach care giving skills to the primary caregiver Assist throughout grieving process and in bereavement
ADVANCED CARE PLANNING Living wills Health power of attorney A completed patient values history
ETHICAL DECISION MAKING Nurses can seek the help of the ethical standards of decision making. Shared decisions should be made after, Considering what is known of the patients wishes and preferences given the current condition Balancing the burdens and benefits of each option in terms of quality of life and Achieving a consensus among decision makers