This document summarizes a seminar on collaboration in palliative care given on June 13, 2020. It discusses how palliative care in Indonesia is currently at an early stage of isolated provision. Effective palliative care requires an interdisciplinary team approach and collaboration between medical professionals. Barriers to palliative care implementation include misunderstandings about its role and a lack of information sharing. The seminar emphasized the importance of addressing patients' physical, psychosocial and spiritual needs through a palliative approach involving symptom management, family support and advance care planning.

1. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Selamat Datang
di Yuminar
(Zoom Seminar)
KULIAH ONLINE MST KEPERAWATAN POLTEKES
- Collaboration in Palliative Care -
13 JUNI 2020

2. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
dr. Ika Syamsul Huda MZ, MPH, SpPD
Ketua Tim Perawatan Paliatif
RSUP dr. Kariadi Semarang
KOLABORASI
PADA PERAWATAN PALIATIF

3. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Mapping levels of palliative care development in 198 countries:
the situation in 2017
Prof. David Clark, dkk 2017
INDONESIA:
Isolated Palliative Care Provision

4. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
A country in this category is characterized by the development of palliative
care activism that is still patchy in scope and not well-supported; sources of
funding that are often heavily donor-dependent; limited availability of
morphine; and a small number of palliative care services that are limited in
relation to the size of the population.
INDONESIA:
Isolated Palliative Care Provision
Prof. David Clark, dkk 2017

5. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
ICD-10 Version:2019
https://icd.who.int/browse10/2019/en#/Z51.5

6. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Isu Aktual

7. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
http://www.who.int/en/news-room/fact-sheets/detail/palliative-
care
PALLIATIVE CARE IS REQUIRED
FOR A WIDE RANGE OF DISEASES
35.50% 34%
10.30%
5.70%
4.60%
9.90%

8. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Perawatan Paliatif
PALLIATIVE, END OF LIFE AND BEREAVEMENT CARE
http://www.jpalliativecare.com/articles/2010/16/3/images/IndianJPalliatCare_2010_16_3_107_73639_f1.jpg

9. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

10. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
http://www.who.int/cancer/palliative/definition/en/
WHO Definition of 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,
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.

11. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
TOTAL PAIN
Total pain recognises
pain as being
physical,
psychological, social
and spiritual.
Dame Mary Cicely Saunders
INTERDISCIPLINARY
TEAMWORK IN PALLIATIVE CARE
Dame Mary Cicely Saunders
(22 Juni 1918 - 14 Juli 2005)
Hospice care movement

12. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
DO NOT FORGET
THAT PAIN
IS NOT ALWAYS
PHYSICAL
https://www.hospicetaranaki.org.nz/media/1069/generalistguidelineshti-march-2014.pdf

13. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

14. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Palliative care can focus on:
 controlling symptoms
 independence
 emotional, spiritual and cultural wellbeing
 planning for the future
 caring for patient's family and carers
https://www.health.qld.gov.au/news-events/news/what-is-palliative-care-Queensland

15. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

16. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
People are ‘approaching the end of life’
if they are likely to die within the next 12 months.
People “at the end of life”
people who are imminently dying and might be in
the last few hours or days of life.
https://www.dyingmatters.org/sites/default/files/user/10Questions.pdf
Masa Akhir Kehidupan
Saatnya menjelang ajal

17. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
The clinical care domains for end of life
include:
 Advance care planning
 Recognise end of life
 Assess palliative care needs
 Provide palliative care
 Work together
 Respond to deterioration
 Manage dying
 Bereavement

18. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
INTEGRASI PERAWATAN PALIATIF
PASIEN
TIM
PALIATIF
KELUARGA
DAN
PERUMAT(CAR
E GIVER)
MASYARAKAT
DAN
KOMUNITAS
MANAJEMEN
DAN
FASILITAS
DPJP
(CURATIVE
CARE)
KERJASAMA TIM
PALLIATIVE CARE

19. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
TIM PERAWATAN PALIATIF RUMAH SAKIT
• Dokter
• Perawat
• Fisioterapis
• Rohaniawan
• Pekerja sosial
• Farmasis
• …
Multidisipliner
Kolaborasi
Koordinatif
Pelayanan perawatan yang terintegrasi

20. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Delivered by an
interdisciplinary team,
palliative care adds an extra
layer of support by addressing
the physical, emotional,
psychosocial and spiritual
concerns associated with
serious and chronic
conditions.
https://csupalliativecare.instructure.com/courses/1005/pages/what-is-palliative-
care?module_item_id=52419

21. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Palliative care involves an interprofessional
collaborative approach in working with
patients and their families and caregivers by
providing patient-centered and individualized
pain relief compassion, caring, and overall
minimization of symptom severity.
https://austinpublishinggroup.com/palliative-care/fulltext/apc-v1-id1006.php

22. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Interprofessional collaboration occurs when
health professionals from different disciplines
work together to identify needs, solve problems,
make joint decisions on how best to proceed,
and evaluate outcomes collectively.
https://pubmed.ncbi.nlm.nih.gov/20925291/

23. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

24. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Interprofessional collaboration
supports patient-centred care and
takes place through teamwork.
https://pubmed.ncbi.nlm.nih.gov/209
25291/

25. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Providing good psychosocial care comes down to good
communication skills, both verbal and non-verbal.

26. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Barriers to palliative care implementation, include:
• corporate power (“PC must remain in our service…”);
• denial (“we are already doing so…”);
• personal (resistance to accept end-of-life care);
• misunderstandings (PC seen as death or euthanasia);
• competition (“we have been doing so much better over
many years”); and
• conflict
https://www.uicc.org/sites/main/files/atoms/files/Gomez-Batiste_X_Connor_S_Eds._Building_Integrated_Palliative_Care_Programs_and_Services._2017.pdf

27. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
In particular, the limits of information
sharing have been pointed out as
important barriers to the quality of
inter-professional collaboration
https://www.oatext.com/inter-professional-communication-in-palliative-care-
general-practitioners-and-specialists-in-switzerlandc.php#gsc.tab=0

28. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
PROVIDING A PALLIATIVE APPROACH TO CARE

29. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
INFORMATION
BREAKING BAD NEWS
FAMILY SUPPORT
ADVANCED CARE PLANNING

30. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
1. Pain
2. Anorexia
3. Nausea and vomiting
4. Constipation
5. Diarrhoea
6. Dyspnea
7. Fatigue
8. Delirium
9. Depression
10. Anxiety
11. Respiratory tract secretions
11 SYMPTOMS

31. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

32. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

33. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

34. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
WITHHOLD & WITHDRAW
Tidak memberikan dan Menghentikan
Obat-obatan, Tindakan dan Pemeriksaan
mungkin perlu dipertimbangan untuk tidak
diberikan, dan yang sudah diberikan tidak
diberikan lagi.

35. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Stopping unnecessary medications
Decisions about which medications to stop should be made by balancing the likely
prognosis from the palliative care diagnosis, with short, medium, and long-term
risks associated with stopping medications to manage co-morbidities.
https://www.caresearch.com.au/caresearch/ProfessionalGroups/NursesHubHome/Clinical/MedicationManagement/PalliativeMedications/tabid/1554/Default.aspx

36. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
deprescribing

37. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
PALLIATIVE CARE

38. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Rumah sakit menetapkan proses untuk mengelola
ASUHAN PASIEN DALAM TAHAP TERMINAL.
Proses ini meliputi
a) intervensi pelayanan pasien untuk mengatasi nyeri;
b) memberikan pengobatan sesuai dengan gejala dan
mempertimbangkan keinginan pasien dan keluarga;
c) menyampaikan secara hati-hati soal sensitif seperti autopsi
atau donasi organ;
d) menghormati nilai, agama, serta budaya pasien dan keluarga;
e) mengajak pasien dan keluarga dalam semua aspek asuhan;
f) memperhatikan keprihatinan psikologis, emosional, spiritual,
serta budaya pasien dan keluarga.
http://www.pdpersi.co.id/kanalpersi/manajemen_mutu/data/snars_edisi1.pdf
STANDAR NASIONAL AKREDITASI RUMAH SAKIT
(Edisi 1)

39. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Team interactions
require trust,
confidence and
an equal effort by
all team
members.
https://symbiosisonlinepublishing.com/palliative-
medicine-care/palliative-medicine-care16.php

40. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
Nama:
Prof. Raden Sunaryadi Tejawinata,
dr. SpTHT(K-Onk), FICS, FAAO, PGD,
Pall.Med.(ECU)
Lahir:
Cirebon, 23 Agustus 1934
Prof. Sunaryadi
BAPAK PALIATIF INDONESIA

41. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
DEKLARASI
PERDOPIN
(Perhimpunan
Dokter Paliatif
Indonesia)
Surabaya, 22 Februari 2014

42. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
AMAN - LANCAR - SELAMAT
SAMPAI TUJUAN

43. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
THANK YOU
Palliative Care Indonesia (PCI)
https://bit.ly/palliativecareindonesia

44. KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF
KULIAH KOLABORASI PADA PERAWATAN PALIATIF
Download materi:
https://bit.ly/kolaborasiperawatanpaliatif