Palliative Care Planning Framework

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Questions and Answers

Which entity is responsible for planning, funding, and managing healthcare systems?

Federal, Provincial, and Territorial Governments (correct)

Liverpool Care Pathway

Gold Standards Framework

First Nations Health Authority

Which group is taking greater control over healthcare services in their communities?

Provincial Governments

Territorial Governments

First Nations (correct)

Federal Governments

What is the impact of palliative care on caregivers?

Both physical and emotional challenges (correct)

No challenges

Only physical challenges

Only emotional challenges

What is the role of caregivers in palliative care?

To assume significant roles to support the patients Signup and view all the answers

What is the purpose of caregivers' coping attitudes in palliative care?

To add life and cheer to the days of cancer patients Signup and view all the answers

What is the outcome of caregivers' coping attitudes in palliative care?

Enhanced relationships between caregivers and cancer patients Signup and view all the answers

What is compassion fatigue also referred to as?

Secondary traumatic stress disorder Signup and view all the answers

Which of the following is a characteristic of compassion satisfaction?

Sense of fulfillment from helping others Signup and view all the answers

What is the primary cause of compassion fatigue?

Exposure to traumatic events Signup and view all the answers

Which profession is most affected by compassion fatigue?

Nurses Signup and view all the answers

What is the result of compassion fatigue on healthcare providers?

Reduced empathy towards patients Signup and view all the answers

Which of the following is a symptom of compassion fatigue?

Emotional exhaustion Signup and view all the answers

What is the purpose of system interventions in compassion fatigue?

To reduce symptoms of compassion fatigue Signup and view all the answers

Which of the following is a consequence of compassion fatigue?

Decreased quality of care Signup and view all the answers

What is the relationship between compassion fatigue and anxiety?

Compassion fatigue increases anxiety Signup and view all the answers

What is the goal of reimagining a theory of secondary traumatic stress?

To understand the mechanisms of secondary traumatic stress Signup and view all the answers

What is the inverse relationship of compassion satisfaction?

Compassion fatigue Signup and view all the answers

What is the primary goal of developing a better understanding of the relationship between compassion satisfaction and compassion fatigue?

To provide more insight into palliative nursing care Signup and view all the answers

What is the current gap in the literature regarding compassion fatigue and compassion satisfaction?

The theoretical connection between the two concepts Signup and view all the answers

What is one way to support palliative care nurses?

All of the above Signup and view all the answers

What is the term for feelings of deep sympathy and sorrow for another?

Compassion Signup and view all the answers

What is the definition of fatigue?

A feeling of tiredness or exhaustion Signup and view all the answers

What is the consequence of not addressing compassion fatigue?

Burnout and decreased quality of care Signup and view all the answers

What is the purpose of developing programs that encourage appropriate engagement activities?

To decrease professional stressors Signup and view all the answers

What is the relationship between compassion fatigue and compassion satisfaction?

They are inversely related Signup and view all the answers

What is the focus of palliative care?

To provide comfort and support Signup and view all the answers

Study Notes

The Need for a System-wide Shift

Dying is part of living, and 90% of people will require care and support at the end of life.
Only 15% of Canadians will need complex hospice palliative care services provided by specialists.

An Integrated Palliative Approach to Care

Recognizes that dying is part of living and that the healthcare system must acknowledge this.
Focuses on active comfort-focused care, reduces suffering, and promotes understanding of loss and bereavement.
Offers a viable alternative to the traditional healthcare approach.
Can transform the healthcare system by providing better care and reducing costs.

Benefits of an Integrated Palliative Approach

Associated with positive effects on emotional wellness, less suffering, and greater longevity.
Can lead to fewer emergency room visits and hospital stays, reduced use of intensive care services, and lower health costs.
Examples from studies in the United States and Canada show a net cost saving of $4,855 per patient.

The Role of Governments

Federal, provincial, and territorial governments are critical partners in developing and implementing an integrated palliative approach to care.
Strong leadership can come from governments, which can develop policies and support the system to make a change.
Examples from England and Australia show that governments can develop national strategies and guidelines for palliative care.

Developing an Integrated Palliative Approach

Examples of integrated palliative approaches to care include the Gold Standards Framework and the Liverpool Care Pathway for the Dying Patient.
Developing an integrated palliative approach requires strong leadership, support from governments, and a commitment to changing the healthcare system.

Federal Government Websites

Federal government websites often end in .gov or .mil.
Ensure you're on a secure site by checking for https:// and a lock icon in the address bar.

NLM Database and Open Access Journal

NLM provides access to scientific literature.
Inclusion in an NLM database does not imply endorsement or agreement with the content.
The journal is open access, and articles are distributed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License.

Study on Stress and Coping among Caregivers

The study aims to assess stress and coping among caregivers of cancer patients on palliative care.
A mixed-method approach was used, combining quantitative and qualitative data.
The study was conducted among 80 caregivers in selected villages.

Demographic Characteristics of Caregivers

74% of caregivers were female, and 30% were between 51-60 years old.
54% were Hindu, and 40% were unemployed.
62% of patients were dependent on caregivers for all daily activities.

Stress and Coping among Caregivers

82% of caregivers had moderate stress, and 18% had severe stress.
Caregivers adopted both positive and negative coping strategies.
There is a significant negative correlation between stress and coping.

Patient Characteristics

Cancer is a leading cause of death globally, with 8.8 million deaths in 2015.
In India, there were 14.5 lakh new cancer cases in 2016, expected to rise to 17.3 lakh by 2020.
Cancer affects not only the patient but also their entire family.

Palliative Care

Palliative care improves the quality of life of patients and their families.
It focuses on early identification, assessment, and treatment of pain and providing physical, psychological, and spiritual care.
Palliative caregiving is stressful, multidimensional, and a 24-hour responsibility.

Study Findings

Caregivers experienced physical, emotional, and psychological strain while providing palliative care.
They adopted various coping strategies, including faith, prayer, and support from family, friends, and the palliative care team.
The study highlights the need for health professionals to provide support, guidance, and education to caregivers of cancer patients on palliative care.### Correlation between Stress and Coping among Caregivers
There is a significant negative correlation (r = −0.722, P = 0.005) between stress and coping among caregivers of cancer patients on palliative care.
This correlation is supported by a similar study that found a negative correlation (r = −0.6, P = 0.005) between caregivers' burden and coping.

Caregivers' Burden and Coping

68% of caregivers had a moderate burden, and 32% had a severe burden.
22% of caregivers had minimal coping, and 78% had moderate coping.

Coping Methods among Caregivers and Cancer Patients

Caregivers mainly used the "acceptance" method among emotional coping methods.
Cancer patients utilized dysfunctional coping methods and denial among subgroups.

Lived Experiences of Caregivers

Caregivers experienced a phenomenon of "caring companionship to palliative care" with six themes:
- "adaptation to life"
- "pillars of support"
- "trusting relationship"
- "shield of strength and courage"
- "stress and strain"
- "living with fear and uncertainty"
These themes had 24 subthemes.

Caregivers' Experiences

Caregivers' experiences comprised of six categories:
- "being committed for life to spouses"
- "enhancing spouse's comfort"
- "being a cosufferer"
- "readjusting themselves"
- "appreciating people's support"
- "being gratified with self-development and marital life growth"
Caregivers of persons with advanced cancer living in the community experience multiple, concurrent transitions.
The transitions were reflected in five overlapping themes:
- environmental
- roles and relationships
- physical and mental health
- spirituality
- priorities
Caregivers dealt with the transitions through the processes of:
- coming to terms
- connecting with others
- redefining normal

Compassion Fatigue in Palliative Care Nurses

Compassion fatigue in nurses can impact job satisfaction, patient outcomes, and lead to nurses leaving a profession already plagued by staffing shortages.
Compassion fatigue has been seen in diverse nursing settings and is associated with caring, a foundational component to nursing.
Identification of symptoms is important for reducing occurrences of compassion fatigue, improving patient care, and retaining nurses.

Characteristics of Compassion Fatigue

Three stressors contributing to compassion fatigue:
- Discomfort with patient's illness or treatment plan, inadequate preparation or training, or external distractions from outside life.
- Patient health decline or non-compliance with treatment plan.
- Practice issues such as poor staffing and resources.
These stressors are distinct to the palliative care discipline and are associated with struggles in finding a balance between intimacy and empathy in the working relationship.

Concept Analysis

The concept analysis was guided by the method of Walker and Avant.
The method included eight stages: choosing the concept, outlining the purpose, determining uses of the concept, describing its attributes, examining a model case, illustrating additional situations, identifying antecedents and consequences, and establishing empirical indicators.

Antecedents and Consequences

Antecedents for compassion fatigue: ability to experience compassion and empathy, exposure to suffering, and repeated exposure to stressors.
Consequences of compassion fatigue:
- Professional or intellectual domain: doubt of ability, anxiety regarding work, callouts due to illness, poor endurance, poor hygiene, and frequent mistakes.
- Physical domain: nausea, chest pain, headache, poor sleeping habits, and overall exhaustion.
- Personal domain: nurse closes themselves off from coworkers and family, refuses to assist others, or is having relationship issues.

Case Studies

A borderline case of compassion fatigue: a nurse who is frustrated, resentful, and makes mistakes at work, but still has some empathy for patients.
A nurse who has developed a special bond with a patient, becomes preoccupied with caring for them, and starts to experience nightmares and make mistakes at work.

Palliative Care and Hospice Nursing

Palliative care is an approach that improves quality of life for patients and their families facing life-threatening illnesses.
The focus of palliative care is comprehensive, and palliative nurses witness patient and caregiver suffering on multiple levels, including physical, psychological, social, emotional, and spiritual.
Hospice care is a type of palliative care where the disease is identified as terminal or end-stage, with a prognosis of 6 months or less.

Compassion Fatigue

Compassion fatigue is a state of exhaustion and biological, psychological, and social dysfunction that results from prolonged exposure to compassion stress.
It is a concept that is inversely related to compassion satisfaction.
Antecedents for compassion fatigue include the ability to experience compassion and empathy, exposure to suffering, and repeated exposure to stressors.
Signs of compassion fatigue include physical complaints, poor endurance, poor hygiene, frequent mistakes, and withdrawal from others.

History of Palliative Care and Hospice Nursing

The movement for end-of-life care and bereavement services began with Dame Cicely Saunders, a registered nurse from the United Kingdom.
She opened the first hospice in England in 1967 and saw the need for extended support during the dying process.
The hospice philosophy eventually came to the United States and became a Medicare benefit during the 1980s.

Palliative Care Nurses

Palliative care nurses are focused on delivering quality health care to their patients and caregivers as they approach the end of life.
They experience three stressors unique to this discipline: personal factors, exposure to suffering, and repeated exposure to stressors.
Palliative care nurses may be prone to compassion fatigue due to the nature of their work.

Importance of Compassion Fatigue Awareness

Understanding compassion fatigue is crucial for palliative care nurses to maintain quality and health in their own lives.
Developing a better understanding of the relationship between compassion fatigue and compassion satisfaction could provide more insight for palliative nursing care.
Assessing staff and developing programs that encourage appropriate engagement activities, offering specialized education, self-care resources, and individualized staff bereavement programs may decrease professional stressors.

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Description

This quiz assesses your understanding of a framework for integrated palliative care planning, including steps to be taken at various levels and settings.