The document discusses end-of-life care, including palliative care, hospice care, and spiritual care. It defines end-of-life care as care for patients with advanced, progressive, and incurable conditions. The goals of end-of-life care are to provide comfort, improve quality of life, and ensure a dignified death. Palliative care focuses on relieving suffering and improving quality of life for patients with serious illnesses, while hospice care provides support to terminally ill patients and their families. Nurses play a key role in providing holistic care to address physical, emotional, and spiritual needs at the end of life.

1. ENDOFLIFECARE
Presented By: -
Mr. Madan
Mohan Gupta,
Assistant
Professor,
Faculty Of
Nursing, Rama
University,
Kanpur

2. Introduction
• Life and death is the two main stages in a
human beings life where we come across
many challenges, diseases and other
problem. It refer to health care not only of
patients in the final hours or days of their
lives, but more broadly care of all those
with a terminal condition that has become
advance, progressive and incurable.

3. The time at the end of life is different for each
person. Each individual has unique need for
information and support. Knowledge about
end of life decision and principles of care is
essential to support patient during decision
making and in end of life closure in ways that
recognize their unique response to illness to
support their values and goals.

4. Definition
It is concluding phase of normal life span
although life can end at any age.

5. Disease progress bereavement
Disease Death
Life-prolonging
and
restorative
treatments Palliative
care
Hospice
care

6. Goal
• Provide comfort and supportive care during
process.
• Improve the quality of remaining life.
• Help to ensure dignified death.

7. Principles
• Respecting patient goals, preferences, and
choices.
• Attention of the medical, emotional, social, and
spiritual needs of the dying person.
• Using strengths of interdisciplinary resources.
• Acknowledging and addressing care giver
concerns.
• Building mechanism and system of support.

8. Technology and end of life
care
• Technological advances in health care have
extended and improved the quality of life
for many, abilities of technology to prolong
life beyond the point that some would
considered meaningful has raised
troubling ethical issues.

9. Changes at end of life
1. Physical changes-
• Sensory changes
• Hearing and touch
• Taste and smell
• Integumentary system
• Cardiovascular system
• Respiratory system
• Urinary system
• GI system
• Musculoskeletal
system

10. 2.Psychological changes: Variety of feelings
and emotions affect the dying patient and
family at the end of life.
GRIEF: - It is the emotional and behavioral
changes to loss. It is positive coping
mechanism which also helps in individual
well being.

11. Stages of grief:-
D- denial
A- anger
B- bargaining
D- depression
A- acceptance

12. Legal documents used in end of
life care
1. Advance directives
2. Durable power of attorney
3. Medical power of attorney
4. Directives to physicians
5. Directives to physicians
6. Organ and tissue donation
7. Euthanasia
8. Resuscitation

13. Different care at the end of life
Palliativ
e care Hospice
care
Spiritual
care

14. Hospice care
• Hospice word HOSPES meaning HOST.
• Hospice refers to a shelter or way station
for weak travelers on a pilgrimage.
• Hospice is a concept of care that provides
compassion, concern, and support for the
dying.

15. Core aspect of Hospice Care
• Patient/family focused
• Interdisciplinary
• Provides a range of services:
•Interdisciplinary case management
•Pharmaceuticals
•Durable medical equipment Supplies
•Volunteers Grief support

16. Cont…..
Hospices offer additional services, including:
•Hospice residential care (facility)
•Inpatient hospice care
•Palliative care
•Complementary therapies
•Specialized pediatric team
•Caregiver training classes

17. Principles of Hospice
• Death must be accepted.
• Total care managed by multidisciplinary
team.
• Pain and other symptoms of terminal
illness must be managed.
• Patient and family views as a single unit of
care.
• Home care of dying necessary.
• Bereavement care to family members.

18. Hospice Care Focus
• Focuses on the whole person
• Mind
• Body
• Spirit
• Support and care
• Patients
• Family and caregivers
• Continues after death of a loved one

19. Eligibility for Hospice Care
• Advance disease with life expectancy of 6
month or less given natural course of
disease.
• Poor functional/ nutritional status.
• High morbidity / mortality markers.
• Patient or family must give consent.
• Payment sources.

20. Hospice Care Members
• The patient's personal physician
• Hospice physician (medical director)
• Nurses
• Home health aides
• Social workers
• Clergy or other counselors
• Trained volunteers
• Speech, physical, and occupational
therapists

21. Hospice settings
• Freestanding
• Hospital
• Home health agencies with home care
hospice
• Home
• Nursing home or other long-term-care
settings

22. Care includes
• Manages pain and controls symptoms
• Assesses patient and family abilities to
cope
• Identifies available resources for
patient care
• Recognizes patient wishes
• Assures that support systems are in
place

23. Function of hospice team
• Develops the plan of care
• Manages pain and symptoms
• Attends to the emotional, psychosocial
and spiritual aspects of dying and care
giving
• Teaches the family how to provide care
• Advocates for the patient and family
• Provides bereavement care and counseling

24. PALLIATIVE CARE
“Palliative care is an approach to care that
improves the quality of life of patients and
their families facing 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, psychological and
spiritual”.

25. • Palliative care is the active holistic care of
patients with advanced, progressive
illness. Management of pain and other
symptoms and provision of psychological,
social and spiritual support is paramount.

26. Goal
The goal is to improve the quality of life for
individuals who are suffering from severe
diseases.
Palliative care offers a diverse array of
assistance and care to the patient.

27. Principles
• Focus on quality rather than quantity of
life
• Life affirming but death accepting
• Effective communication at all levels
• Respect for autonomy and choice
• Effective symptom management
• Holistic, multi-professional approach
• Caring about the person and those who
matter to that person

28. Key Issues
• Information needs
• Being treated as a human being
• Empowerment
• Physical needs
• Continuity of care
• Psychological needs
• Social needs
• Spiritual needs

29. Palliative team
• Consultant in Palliative Medicine
• 3 Clinical Nurse Specialists
• Clinical Specialist Occupational Therapist
• Secretary
• Clinical Specialist Dietician
• Clinical Specialist Speech and Language
Therapist
• Pharmacist

30. Function of palliative care
team
• Advise on management of symptoms
• Provide information on diagnosis,
investigations and treatments
• Offer emotional, spiritual and social
support
• Liaise closely with the whole health team
with the aim of improving the patients
quality of life
• Offers support via education to healthcare
staff

31. Palliative Care Approach
• Not a “one size fits all approach”
• Care is tailored to help the specific needs of the
patient
• Since palliative care is utilized to help with various
diseases, the care provided must fit the symptoms.
Delivered by the patient’s usual professional carers as
a vital and integral part of their routine care delivery
• For patients with low to moderate complexity of
need
• Focuses on the key principles of palliative care
(NCHSPCS, 2002)

32. Recommended for
• Patients with rapidly progressive disease
• Patients with disease presenting
unexpected, difficult to control, or rapidly
progressing symptoms
• Distressing symptoms, when no relief has
been achieved within 48 hours
• Psycho-social distress in patient or family
relating to the diagnosis or in facing
death
• Where reassurance of a second opinion is
sought by patient, family or other health
care professional.

33. Philosophy of palliative care
• Should be available to anybody with a life
threatening illness
• Focus of care is quality of life, with the
autonomy and choice of the patient being
upheld
• Care is extended to both the patient and
those who matter to him/her
• A whole system approach is made when
planning care with the patient

34. • Palliative care should be delivered by any
health/social care professional in care
setting of patient’s choosing
• Palliative care should begin at diagnosis of
life threatening condition, continuing
through to death/ bereavement
• Specialist Palliative Care is defined in terms
of core services, delivered using multi-
professional team with skills, knowledge and
experience in palliative care
• Specialist Palliative Care is needed by only a
minority of people with complex problems

35. Spiritual Care
• Spirituality means features of religiosity,
but the two concepts are interchangeable.
• Spirituality involve the search for meaning
and purpose in life and relatedness to a
transcendent dimensions.

36. Spiritual Assessment
• S- spiritual belief system
• P- personal integrity
• I- integration and involvement with others
• R- ritualized practice and restrictions
• I- implication for medical care
• T- terminal event planning

37. Aspects of End of Life Care
• Palliative care
• Preparation of end of life
• Care for terminally ill child
• Hospice care
• Advance directives
• Understanding CPR and DNR

38. Preparation of end of life
Despite a doctor best efforts and hard work,
disease treatment sometimes stop working
and a cure or long term remission is no
longer possible. The stage is called
1. Advanced
2. Terminal
3. End stage

39. Signs of approaching death and
care after death
• Progressive weakness
• Needing sleep or bed rest
• Weight loss and muscle wasting
• Loss of appetite
• Loss of interest
• Slow breathing
• Incontinence
• hallucinations

40. Cont….
• Decreased amount of urine
• Disorientation
• Cool skin on touch
• Decrease activity
• Physical restlessness

41. Barriers to Quality End-of-
Life Care
• Failure of healthcare providers to
acknowledge the limits of medical
technology
• Lack of communication among decision
makers
• Disagreement regarding the goals of care
• Failure to implement a timely advance
care plan

42. • Lack of training about effective means of
controlling pain and symptoms
• Unwillingness to be honest about a poor
prognosis
• Discomfort telling bad news
• Lack of understanding about the valuable
contributions to be made by referral and
collaboration with comprehensive hospice
or palliative care services

43. Pronouncement of death
• Absence of carotid pulses
• Pupils are fixed and dilated
• Absent heart sounds
• Absent breath sounds

44. Postmortem care
• Needs to be done promptly, quietly,
efficiently, and with dignity
• Straighten limbs before death, if possible
• Place head on pillow
• After pronouncement
Remove tube
Replace soiled dressings
Pad anal area

45. After pronouncement care:
• Gently wash body to remove discharge,
if appropriate
• Place body on back with head and
shoulders elevated
• Grasp eyelashes and gently pull lids
down
• Insert dentures
• Place clean gown on body and cover
with clean sheet

46. Follow principles acc. To
hospital policy
• Note time of death and chart
• Notify attending physician
• Chart any special directions
• Notify family member
• Allow time with loved one
• Gather eyeglasses and other belongings
• Prepare necessary paperwork for body
removal

47. Role of nurse
• Holistic view
Comprehensive
Effective
Compassionate
Cost effective

48. • Spend the most time with patients and their
family members at the end-of- life than any
other member of the healthcare team
• Provide education, support, and guidance
throughout the dying process
• Advocate for improved quality of life for the
person with serious illness
• Attend to physical, emotional, psychosocial,
and spiritual needs of the patient.
• Have appropriate supports in the clinical
setting
• Develop close collaborative partnerships with
hospice and palliative care service providers

49. • Attend to pain and symptom control
• Relieve psychosocial distress
• Coordinate care across settings with high-
quality communication between healthcare
providers
• Prepare the patient and family for death
• Clarify and communicate goals of treatment
and values
• Provide support and education during the
decision-making process, including the
benefits and burdens of treatment
• Are well educated.

50. • Must be confident in their clinical skills
• Are aware of the ethical, spiritual, and
legal issues they may confront while
providing end-of-life care
• Improves ability to meet holistic needs of
the patient and family
• Clarifies one’s own beliefs and values

51. Thankyou