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Role of a nurse in palliative care

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Learn about Network Nursing Agency can provide the right palliative care services for your loved ones.

Learn about Network Nursing Agency can provide the right palliative care services for your loved ones.

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  • 1. ROLE OF A NURSE IN PALLIATIVE CARE
  • 2. 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).
  • 3. 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
  • 4. PALLIATIVE CARE
    Affirms life
    Promotes quality of life
    Treats the person
    Supports the family
  • 5. EVOLVING MODEL OF PALLIATIVE CARE
    Death
    Cure/Life-prolonging Intent
    Palliative/Comfort Intent
    Bereavement
  • 6. 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
  • 7. PALLIATIVE CARE SETTINGS
    any
    ANYWHERE!
  • 8. 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.’
  • 9. PALLIATIVE CARE COMPETENCIES
    Communication skills
    Physical skills
    Psychosocial skills
    Teamwork skills
    Intrapersonal skills
    Life closure skills
  • 10. 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
  • 11. 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 .
  • 12. 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.
  • 13. PSYCHOSOCIAL SKILLS
    An ability
    work with families,
    Anticipating their needs,
    Putting them in touch with services and
    Supporting them when appropriate
  • 14. 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.
  • 15. 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
  • 16. PALLIATIVE NURSESROLE
  • 17. 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
  • 18. MULTIDIMENSIONALITY OF SUFFERINGS
  • 19. COMMON SYMPTOMS
    Fatigue
    Pain
    Nausea
    Vomiting
    Insomnia
    Dyspnoea
    Pyrexia
  • 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
  • 25. 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
  • 26. HANLING ANXIETY
    Types include situational anxiety, drug related anxiety. Organic anxiety and psychological anxiety.
    • Multidisciplinary assessment
    • 27. Treat the reversible causes
    • 28. Non pharmacological therapy
    • 29. Spiritual support
    • 30. Short term psychotherapy
    • 31. Short term psychotherapy
    • 32. Tranquilizers for severe anxiety
  • NOURISHING AND HYDATING
    Suggest small meals and liquid supplements
    Treat the symptom that may cause decreased appetite
    Administer appetite stimulants
    Employ infusions and hypodermoclysis
  • 33. Potential Palliative Care Interventions
    Generally
    Not Palliative
    Variable CPR
    Transfusions Ventilation
    Infections Highly
    Hypercalcemia burdensome
    Tube Feeding Interventions
    Dialysis
    Palliative
    Support
    Control of
  • 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
  • 39. 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
  • 40. 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
  • 41. 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
  • 42. ADVANCED CARE PLANNING
    Living wills
    Health power of attorney
    A completed patient values history
  • 43. 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
  • 44. Education
    Public Awareness
    • Raise awareness and expectations
    • 45. Improve “death culture”
    • 46. Empower in decision making
    • 47. Core competencies
    • 48. Curriculum in undergrad and post-grad in all involved disciplines
    • 49. Continuing education
    IMPROVING PALLIATIVE CARE
    Professional Practice
    • Stds of practice for symptom management, availability, responsiveness, communication
    • 50. Certain palliative interventions held to higher scrutiny and rigour – eg. Palliative sedation
    • 51. Specialty area for nursing