Palliative care in nepal

1. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Welcome

2. Vinayak College Of Health Science
PCL Nursing 3rd Year 11th Batch

3. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Introduction
Supportive Care
Symptom Oriented Care
fatigue, pain, treatment of adverse
effects, psychosocial support
Patient & family oriented care
Upgrade quality of life by active
anticipation
Spiritual care
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4. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
History
 First palliative care was develop by wayne state
university school of medicine in 1985 in united
state.
 In nepal, palliative care was Started in 1991 in
pashupatinath.
 Established in Bir Hospital after radiotherapy
services for cancer patient.
 1999 – NGO - Maiti Nepal begun palliative care
service for non malignant chronic illness i.e
HIV/AIDS.
 Modern Palliative care for cancer patients in 2000AD
with 4 beds through Hospice Nepal.
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5. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
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• INCTR /NNCTR Nepal formed palliative
care group which was a landmark
moment in the development of palliative
care in Nepal.
• In 2005 committee the morphine is
legalized and in 2009 it was
manufactured in Nepal.

6. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
 2002 – 2007, Many other Palliative Care organization established i.e
Bhaktapur cancer Hospital, Maiti Nepal, Navakiran plus
 2005 – Patan Hospital begun essential palliative care course, Adopted by
Hospice Nepal from Princess Alice Hospice in UK

7. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
 Twinning Programme: Nepal’s Bhaktapur
cancer hospital twinned with Canada’s
Nanamio community hospice in 2010.
 Nepal’s Thankot Hospice twinned with
Physicians from South Korea in 2011.
 In 2012 Nepal’s BP Koirala Memorial Cancer
hospital twinned with Canada’s Victoria
hospice.
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8. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Definition
Palliative care (pronounced palle-uh-tiv)is specialized medical care with serious illness
which is focused providing relief from the symptoms and stress of a serious illness.
According to WHO
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”Palliative care is an approach that improve the quality of iife of patients and their
families facing the problems associated with life threatning illness, through the
prevention and relief of suffering by means of early identification and
impeccable assessment and treatment of pain and other problems, physical,
psychological, and spiritual”

9. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Palliative care Hospice care
Begins at diagnosis , no time frame
required.
Less than 6 months to live.
Hospital, Nursing home Home or as a facility.
Life prolonging measures. Doesn’t include curative or life
prolonging measures.
Terminal illness. May or mayn’t be terminal
No time restriction. Life limiting illness.
Administered in hospital extended care
facilities and nursing homes.
Reliance on family and visiting nurses
and care is usually provided at home.
It is a whole person care that relieves
symptoms of disease.
It is a palliative care for people who
have 6 months or less.
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10. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch

11. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Who gives palliative care?
Palliative care specialist work as a part of multi-disciplinary team to coordinate the palliative
care , team includes:
Doctors Nurses
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12. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch

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Dietician

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Purpose
 Support and care for dying patients.
 Enhance quality of life.
 Address the multidimensional need of
the dying client .
 Making Understand dying as a normal
process
 Provide relief from pain & other distressing symptoms
 Helps patient live as actively as possible until death.
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16. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Principle
 Patient centered care
 Management of symptoms
 Teamwork and partnership with support groups
 Appropriate ethical consideration
 Respect for patients autonomy, choice and adequate
access to information.
 High priority should be given to alleviation.
 Create respectful and trusting relationship
 Integrate and respect patients cultural values, belief,
customs
 Offer continuity of care.
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17. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Indication
It can be offered to people
of any age with serious,life
threatning illness, such as:
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18. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
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19. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Components
 Enhance the quality of life
 Relieving pain and other distress
 Providing practical emotional support
 Helping patient and family member to
organize their lives
 Facilitating a comfortable & dignified
death
 Maximizing human dignity.
 Decreasing burdensome transition
 Assessing & managing symptoms
 Offering grieve and bereavement support
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20. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Roles of nurse Promoting patient centered care
 Good communication
 Provide high quality services
 Improving the quality of life
 Identify needs, priorities and preferences
 Family support
 Collaboration with team members
 Relief for mental anguish and social
isolation
 Relief for physical symptoms
 Good death or dying well
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21. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
 Pain is an unpleasant sensory and emotional
experience associated with actual and potential
tissue damage. It is always subjective

22. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
ACUTE PAIN
 It is due to acute injury or illness.it has a definite onset and its duration is limited and predictable
.Treatment is directed with or without short term use of analgesic.
CHRONIC PAIN
 It is due to chornic pathological process.it has a gradual onset and may become
progressively more severe.
TYPES OF PAIN

23. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
NONCICEPTIVE PAIN
 Pain is produced by stimulation of specific sensory receptor.
There are 2 types: Somatic pain and visceral pain.
NEUROPATHIC PAIN
 It is caused by peripheral or central nervous system injury .A
burning sensation, tingling sensation ,shooting pain. It is less
responsive to non opoid and opoid analgesic.
Such as headache, abdominal pain, peripheral neuropathy,
esophageal pain, skin pain, chest pain etc.

24. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Assessment of pain
 Determine the cause, time and site of the pain.
 What makes it better or worse? Descibe it.
 Determine the type of pain
 Is there a psychological or spiritual component?
 Grade the pain by number of fingers or pointing on a ruler or
other methods
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25. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
TREATMENT OF PAIN
Analgesic
Reassess need for pain
medication and other
intervention frequently
Repeat grading of pain
Investigate any new problems
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26. Vinayak College of Health Science PCL Nursing 3rd Year 11th Batch
Treatment is done in two way
1) PHARMACOLOGICAL
Mild pain:
Non opoids: Paracetamol, aspirin, ibuprofen
Moderate pain:
Opoids: tramadol, codine
Severe pain:
Strong opoid: Morphine, Hydromorphone, Fentanyl, Oxycodone,
Methadone
Adjuvants: antideeprasants
Radiation therapy

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2 )NON PHARMACOLOGICAL
1)Positioning
2)Massage
3)Heat and cold application
4)Music
5)Prayer
6)Distraction
7)Aucupunture
8)Meditation

28. Music

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Accupunture Distract Therapy

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