Palliative Care Subject - Advance Nursing Practice

1. Palliative Care
Subject-ADVANCED NURSING PRACTICE
Miss. Jaice Mary Joy
M.sc Nursing Previous
GCON, Jodhpur

2. INTRODUCTION
The word ‘palliate’ comes from the Latin word ‘palliare’ means ‘to cloack’ or ‘to
cover’.
Palliative care is an approach that improves the quality of life of patients and their
families facing the problems associated with life threatening illnesses, through the
prevention and relief of suffering by addressing physical, psychosocial and spiritual
issues.
DEFINITION
Palliative care is an approach that improves the quality of life of patients and their
families facing the problem 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. (WHO 2002)
At the core, palliative care, whether it is practiced in hospital, community or
hospice is a patient and family centered approach which makes use of the
different skills of the palliative care team, a team which needs to include family
members as well as health care professionals. The standard of quality to judge
palliative care is simple.
PRINCIPLES OFPALLIATIVE CARE
 Affirms life and regards dying as a normal process
 Neither hastens nor postpones death
 Provides relief from pain and other distressing symptoms
 Integrates the psychological and spiritual aspects of care
 Offers a support system to help patients live as actively as possible until death
 Offers a support system to help patients' families cope during the patient's illness
and in their own bereavement
ESSENTIALCOMPONENTSOFPALLIATIVE CARE
 Symptom control

3.  Support for the family
 Support for the patient
SERVICES PROVIDED BYPALLIATIVE CARE
 Interdisciplinary team care- nursing services, medical, social, pastoral
counselling, home health aide.
 Bereavement counselling
 Dietary counselling
 Physical therapy
 Occupational therapy
 Speech therapy
 Investigations and drugs
 Durable medical equipment and supplies.
THE PALLIATIVE CARE APPROACH
The Palliative Care approach aims to promote physical, psychosocial and spiritual
well-being. It is a vital and integral part of all clinical practice, whatever the illness or
its stage, informed by a knowledge and practice of palliative care principles.
ELEMENTS OF PALLIATIVE CARE
1. Primary goal
2. Patient population
3. Patient and family centred care
4. Timing of palliative care
5. Comprehensive care
6. Interdisciplinary team
7. Communication skills
8. Skill in care of the dying and bereaved
9. Continuity of care across settings
10. Equitable access
11. Quality improvement

4. ADVANCED CARE PLANNING
ACP is a process of discussion between an individual and their care providers
irrespective of discipline. The difference between ACP and planning more generally
is that it usually takes place in the context of an anticipated deterioration in the
individual’s condition in the future, with attendant loss of capacity to make decisions
and/or ability to communicate wishes to others.
With the individual’s agreement, discussions should be:
 Documented
 Regularly reviewed
 Communicated to key persons involved in their care.
 If the individual wishes, their family and friends may be included.
Examples of what an ACP discussion might include are:
 The individual’s concerns
 Their important values or personal goals for care
 Their understanding about their illness and prognosis, as well as particular
preferences for types of care or treatment that may be beneficial in the future
and the availability of these.
ETHICAL ISSUES IN PALLIATIVE CARE
Four cardinal principles of medical ethics:
The four cardinal principles of medical ethics provide a frame work for decision
making in difficult situations. They are-
1. Respect for patient’s autonomy
2. Beneficence or ‘do good’
3. Non malficence or ‘do no harm’
4. Justice or fare use of available resources
SYMPTOMATIC MANAGEMENT
1. Pain management
2. Management of nausea & vomiting
3. Stomatitis (sore mouth)
4. Constipation

5. 5. Dyspnoea
6. Palliative management of secretions
7. Delirium in palliative care
PALLIATIVE CARE EMERGENCIES
 Delirium
 Sepsis in neutropenic patients
 Spinal cord compression
 Superior vena cava obstruction
 Convulsions
 Hypercalcemia
PALLIATIVE CARE NURSING
 Palliative care nursing reflects a “whole person” philosophy of care implemented
across the lifespan and across diverse health settings. The patient and family is
the unit of care.
 The goal of palliative nursing is to promote quality of life along the illness
trajectory through the relief of suffering, and this includes care of the dying and
bereavement follow-up for the family and significant others in the patient’s life.
 This is the essence of skilled palliative nursing care—to facilitate the “caring”
process through a combination of science, presence, openness, compassion,
mindful attention to detail, and teamwork.
Reflects whole aspects care. It combines the humanistic approach with a scientific
approach.
 Physical wellbeing: Free of pain and discomfort, functional ability etc.,
 Psychological well being: free from anxiety/fears, ability to experience happiness
etc.,
 Social well being: Purposeful life role, free from financial burden.
 Spiritual well being: feelings of hope, meaning to life.
Palliative care competencies / skills
 Communication skills

6.  Physical skills
 Psychosocial skills
 Teamwork skills
 Intrapersonal skills
 Life closure skills
ORGANIZTIONS IN INDIA FOR PALLIATIVE CARE
Indian Association of palliative care
 It is the national organisation for palliative care in India.
 Formed in 1994 in consultation with WHO and GOI
 Aimed at the care of people with life limiting illnesses such as cancer ,AIDS,
and end stage chronic medical diseases.
 Mission: to promote affordable and quality palliative care across the country
through networking and support to palliative care institutions
Pallium india
Pallium India is a national registered charitable trust formed in 2003 with the
following vision and mission:
Vision- An India in which palliative care is integrated in all health care so that every
person has access to effective pain relief and quality palliative care along with
disease–specific treatment and across the continuum of care.
Mission- To catalyze the development of effective pain relief and quality palliative
care services and their integration in health care across India through delivery of
services, education, building capacities, policy, research, advocacy and information.
Cansupport
Cancer survivor Ms Harmala Gupta founded Cansupport in 1996. It is working
towards a caring and supportive society where people with cancer and their families
live with dignity, hope and comfort. Mission is to enable these people to make
informed choices while receiving appropriate physical, emotional, social and spiritual
support.

7. BIBLIOGRAPHY
1. CCEPC_Handbook.pdf [Internet]. [cited 2018 Nov 21]. Available from:
http://palliativecare.in/wp-content/uploads/2014/09/CCEPC_Handbook.pdf
2. WHO | WHO Definition of Palliative Care [Internet]. WHO. [cited 2018 Nov 20].
Available from: http://www.who.int/cancer/palliative/definition/en/
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Future Needs. Indian J Palliat Care. 2012;18(3):149–54.
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nursing. Edition 13. Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins; 2014. 213–234 p.
5. Hall S, Kolliakou A, Petkova H, Froggatt K, Higginson IJ. Interventions for
improving palliative care for older people living in nursing care homes. Cochrane
Pain, Palliative and Supportive Care Group, editor. Cochrane Database Syst Rev
[Internet]. 2011 Mar 16 [cited 2018 Nov 28]; Available from:
http://doi.wiley.com/10.1002/14651858.CD007132.pub2