Palliative care aims to improve quality of life for patients facing life-threatening illness by preventing and relieving suffering through early identification and treatment of pain and other physical, psychosocial, and spiritual problems. It can be provided alongside curative treatment or on its own. The document discusses definitions of palliative care, differences between palliative care and hospice care, common diseases treated with palliative care, principles of palliative care, and benefits found in studies.

1. Muh. Putra Basah BN
Muhammadiyah University of
Surakarta

2. What is Palliative Care?
 The World Health Organization describes palliative care as
"an approach that improves the quality of life of patients
and their families facing the problems 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."

3. DEFINITION
 Palliative care adalah sebuah pendekatan unuk
memperbaiki kualitas hidup pasien dan
keluarganya dalam menghadapi penyakit yang
mengancam jiwa, melalui tindakan pencegahan
dan pengobatan dari berbagai masalah yang
terdiagnosa termasuk fisik, psikososial dan
spiritual
http://www.who.int/cancer/palliative/definition/en/

4. Lebih jauh lagi
 Secara umum, istilah keperawatan palliatif
bisa mengacu pada
“setiap perawatan yang meredakan gejala, apakah ada
atau tidak ada harapan penyembuhan”
 dengan demikian, perawatan paliatif dapat digunakan
untuk meringankan effects samping perawatan kuratif
seperti mengurangi rasa mual yang
berhubungan dengan kemoterapi.

5.  Orang bisa memulai perawatan paliatif sege
ra setelah klien didiagnosis dengan
penyakit yang serius, bahkan
jika mereka masih berharap dapat disembuh
kan, kataThomas Smith, direktur medis perawatan
paliatif di Virginia Commonwealth UniversityMassey Can
cer Center di Richmond.

6. Penerapan pengobatan paliatif
 Gambaran paliatif di negara maju
 Negara berkembang
palliatif
Pengobatan
kuratif
kematian
Pengobatan
kuratif
palliatif
kematian

7. Jenis jenis penyakit
1. Cancer
2. Chronic and progreessive pulmonary disorder
3. CHF
4. HIV / AIDS
5. Progressive neurological conditions
6. Renal disease

8. WHO Definition of Palliative Care
Palliative care:
 provides relief from pain and other distressing
symptoms;
 affirms life and regards dying as a normal process;
 intends neither to hasten or postpone death;
 integrates the psychological and spiritual aspects of
patient care;
 offers a support system to help patients live as actively
as possible until death;

9. cont…
 offers a support system to help the family cope during the
patients illness and in their own bereavement;
 uses a team approach to address the needs of patients and
their families, including bereavement counseling, if
indicated;
 will enhance quality of life, and may also positively
influence the course of illness;
 is applicable early in the course of illness, in conjunction
with other therapies that are intended to prolong life, such
as chemotherapy or radiation therapy, and includes those
investigations needed to better understand and manage
distressing clinical complications.

10. PRINSIP PALIATIF CARE
Palliative care:
• tindakan pengobatan dari nyeri serta gejala2 lainnya yg
timbul akibat penyakit yg diderita;
• pemahaman bahwa kehidupan dan proses menjelang ajal
adalah normal;
• kematian bukanlah hal yang bisa dipercepat ataupun
ditunda;
• penggabungan antara keperawatan terhadap psikologi dan
spiritual pasien;
• memberi support sistem kepada pasien seefektif mungkin
sampai meninggal
• Menawarkan support sistem untuk membantu keluarga
selama masa sakit p asien dan dalam masa2 kematian

11. Continue...
 Menggunakan pendekatan team untuk menggali
kebutuhan dari pasien dan keluarga termasuk
counseling thd perpisahan thd pasien bila terdapat
indikasi
 Akan meningkatkan kualitas kehidupan
 Dapat di gunakan pada awal dari peerjalanan
penyakit atau sejalan dengan pemberian terapi
yng di tujukan untuk memperpanjang kehidupan
seperti kemotherapi atau terapi radiasi

12. Fokus Tujuan
1. Mengurangi penderitaan
2. Perawatan thd nyeri dan kondisi yang
menyebabkan timbulnya stress
3. Perawatan psikologi dan layanan keagamaan
4. Pemberian support sistem yang membantu
pasien bisa beraktifitas seaktif mungkin
5. Pemberian support system yang mendukung
dan bisa memulihkan keluarga pasien

13. Masalah yang meliputi pasien palliatif
 Nyeri
 Mual
 Kecemasan
 Sesak nafas
 Kehilangan peran sosial
 Ketergantungan
 Perubahan kepercayaan
atau agama
 Kesedihan
 Depressi
 Denial
 Masalah finansial
 Dst.

14. The History of Palliative Care
 Started as a hospice movement in the 19th century,
religious orders created hospices that provided care for
the sick and dying in London and Ireland.
 In recent years, Palliative care has become a large
movement, affecting much of the population.
 Began as a volunteer-led movement in the United
states and has developed into a vital part of the health
care system

15. Cont…
 The first US hospital-based palliative care programs
began in the late 1980s at a few establishments
including the Cleveland Clinic and Medical College of
Wisconsin. Since then there has been a dramatic
increase in hospital-based palliative care programs,
now numbering more than 1400.

16. Hospice Care
 Hospice care is intended for people who are nearing
the end of life.
 Hospice care services are provided by a team of health
care professionals who maximize comfort for a
terminally ill person by reducing pain and addressing
physical, psychological, social and spiritual needs.
 Unlike other medical care, however, the focus of
hospice care isn't to cure or treat the underlying
disease. The goal of hospice care is to provide the
highest quality of life possible for whatever time
remains.

17. Palliative vs. Hospice Care
 Division made between these two terms in the United
States
 Hospice is a “type” of palliative care for those who are
at the end of their lives.

18. Palliative Care vs. Hospice Care
 Meskipun Istilah "perawatan paliatif" erat terkait
dengan hospice care,jenis perawatan paliatif tidak
hanya untuk yang sekarat.
 Memang Pengertian Perawatan paliatif kadang-
kadang membingungkan dengan hospice care
karena salah satu tujuan utama hospice care
adalah kenyamanan juga dan kebanyakan pasien
hospice care adaalah yang sekarat.
 Berikut adalah perbedaan antara perawatan paliatif
dan hospice:

19. Berikut adalah perbedaan antara perawatan
paliatif dan hospice:
 paliatif care
fokus pada manajemen nyeri dan gejala yang timbul
pasien tidak harus terminal
mungkin masih mencari pengobatan agresif
hospice care
fokus pada manajemen nyeri dan gejala yang timbul
pasien memiliki diagnosis terminal dengan harapan
hidup kurang dari enam bulan
tidak mencari perawatan kuratif

20.  Hospice difokuskan pada penyediaan layanan
berkualitas kepada orang-orang dibulan-bulan
terakhir hidup yangtelah memutuskan untuk berhenti
pengobatan yang dimaksudkan untuk menyembuhkan
mereka.
 Perawatan paliatif di
sisi lain dapat diberikan dari waktu pertama
diagnosis. Anda dapat menjalani perawatan paliatif
sekaligus sebagai pengobatan yang sifatnya kuratif.

21. Cont…
Dalam hospice care dan perawatan paliatif, fokusnya
adalah pada kualitas hidup pasien.
Tujuan untuk kedua jenis perawatan : untuk
menangani dengan penyesuaian apapun terhadap
segala sesuatu yang berhubungan
dengan penyakit atau isue tentang akhir hidup

22. Conclusion
 hospice services and palliative care programs share
similar goals of providing symptom relief and pain
management.
 Non-hospice palliative care is appropriate for
anyone with a serious, complex illness, whether
they are expected to recover fully, to live with
chronic illness for an extended time, or to
experience disease progression.
 In contrast, although hospice care is also palliative,
the term hospice applies to care administered
towards the end of life

23. dimana perawatan hospice di
berikan?
 Hospice care Kebanyakan disediakan di rumah -
dengan anggota keluarga biasanya berfungsi
sebagai pengasuh utama. Namun, hospice
care jugabisatersedia di rumahsakit,panti jompo
dan fasilitas rumah sakit khusus.

24. PALLIATIVE CARE ORGANISATION
 1973 International Association for the Study of Pain,
founded Issaquah, Washington, USA
 1976 1st International Congress on the Care of the
Terminally Ill, Montreal, Canada
 1977 Hospice Information Service, founded at St
Christopher’s Hospice, London, UK.
 1980 International Hospice Institute, became
International Hospice Institute and College (1995) and
International Association for Hospice and Palliative Care (1999)
 1982 World Health Organization Cancer Pain Programme
initiated
 1988 European Association of Palliative Care founded in
Milan, Italy
 1998 Poznan Declaration leads to the foundation of the
Eastern and Central European Palliative Task Force (1999)

25. Cont..
 1999 Foundation for Hospices in sub-Saharan Africa
founded in USA
 2000 Latin American Association of Palliative care
founded
 2001 Asia Pacific Hospice Palliative Care Network founded
 2002 UK Forum for Hospice and Palliative Care Worldwide
founded by Help the Hospices Hospice Information Service
re-launched as Hospice Information – a joint venture between
Help the Hospices and St Christopher’s Hospice
 2004 African Palliative Care Association founded
 2005 First World Hospice and Palliative Care Day (11
October)

26. Pelaksana paliatif care
1. Petugas medis :
 Perawat
 Manajer kasus
 Dokter, fisioterapis, nutrisionis
2.Keluarga pasien
3.Petugas sosial komunitas : lay support
petugas LSM

27. TEAMWORK
 Perawatan dasar : keluarga, teman dan tetangga
 Layanankeperawatan: perawat umum dan perawat spesialis
 Perawatanmedis: dokterumum spesialis di kedokteran spes
ialis paliatif
 Perawatan Sosial : pekerja sosial
 Perawatan Spiritual : penasehat iman,ulama
 Terapis: ahli okupasi terapi, fisioterapi (terapi fisik),ahli
 Terapi bicara dan bahasa, seni, drama,ahli musik
 PerawatanPsikologi : konselor, psikolog klinis kesehatan,
psikiater
 Staf Spesialis : ahli gizi, apoteker
 staf pendukung : asisten perawat, administrasi, tukang
kebun,transportasi, dan pekerja lain staf Relawan

28. Permasalahan yang di alami oleh
pearwat paliatif
 Kadangkadang perawat bisakewalahan oleh peker
jaan dan merasa tidakmampu melaksanakan
tugasnya, ini disebut 'burn-out'. kebosanan

29. Tanda tanda nya
 ■ Kelelahan
■ Kurang konsentrasi
■ Kehilangan minat dalam pekerjaan
■ Pengabaian tugas
■ Sifat lekas tersinggung
■ Kemarahan
■ Withdrawal - menghindari pasien dan rekan
■ Perasaan tidak mampu, tidak berdaya dan rasa bersalah
■ Depresi - kurangnya kesenangan, tearfulness

30. solusi
■ Pastikan setiap orang mempunyai waktu libur yang
teratur.
■ Ketika seorang pasien meninggal, luangkan waktu untuk
merenungkan, mengakui bahwa kehilangan dapat
menimbulkan stess yang tidak terhindrkan
■ Membuat waktu untuk bersantai bersama - sambil
minum teh, atau makan bersama.
■ memberikan penghormatan tuk seseorang dalam upaya
pemberian perawatan yang baik untuk pasien
Mendorong satu sama lain ketika ada
yang dilakukan dengan baik.

31. Cont...
 ■ Membuat waktu
yangteratur untuk membahas pasien dan masalahnya.
■ Pastikan setiap orang tahu bagaimana cara
untuk mendapatkan bantuan (misalnya
bagaimana relawan dan keluarga dapat menghubungi
seorang petugas kesehatan untuk backup).
■ pelatihan dan pengawasan secara continue
meningkatkan kepercayaan diri dan kompetensi.

32. CanSupport, Delhi, India
A cancer survivor starts a HBC programme
 CanSupport was started by a cancer survivor who
recognised a lack of support and information for
people diagnosed with cancer. She visited hospital
patients to offer advice and support, and a telephone
helpline was started. Together with a nurse she
developed a home care service visiting the poorer areas
of Delhi. Now five multidisciplinary teams cover the
city, and CanSupport has been granted its own license
for prescribing morphine.

33. CONTOH KASUS PALIATIVE
 . Imagine a young woman with three children… she
lives in a shanty town. Her husband died six months
ago and the neighbours say he must have had HIV.
Now she is becoming sick, has lost weight and she is
scared that she may also die

34. Cont…
Recently she developed a painful ulcerating swelling on
her leg which stops her sleeping. Some days she can
barely get out of bed to care for her children, but her
parents are far away in the village. The landlord is
asking for rent but she has no income since her
husband died. The neighbours are gossiping, saying
that the family is cursed, and she wonders if they are
right since she has prayed for help but none has come.

35. Cont..
 We can imagine that her illness is only one of her
many problems. Her greatest worry might be how to
put food on the table for her family, or what will
happen to her children if she dies. She has no financial
support, she is isolated and feels rejected by God.
Palliative care is about people rather than diseases and
seeks to address the problems which are of most
concern to the patient

36. The benefit of palliative care
 one study of 151 people finds:
Median survival:
Palliative care patients: 11.6 months
Standard care patients: 8.9 months
Percentage depressed:
Palliative care patients: 16%
Standard care patients: 38%
Source: The New England Journal of Medicine