Chapter 12 Palliative Care PDF

Chapter 12 Palliative Care Copyright © 2019 by Elsevier, Inc. All rights reserved.  Hospice  Interprofessional approach to EOL care  Aggressive pain and symptom control  Spiritual and psychological care  Patient a...

Chapter 12 Palliative Care Copyright © 2019 by Elsevier, Inc. All rights reserved.  Hospice  Interprofessional approach to EOL care  Aggressive pain and symptom control  Spiritual and psychological care  Patient and family are the unit of care  Symptom control rather than curative treatment  The disease is considered end stage with progression to death Copyright © 2019 by Elsevier, Inc. All rights reserved. 2  Palliative Care  Supports the best quality of life during the time of diagnosis, treatment, and life with serious illness  Unlike hospice, patients can receive curative treatment; improves QOL for patients/families with life-threatening illness (WHO, 1990)  Early identification of pain or other physical, psychological, and spiritual problems (Sepulveda, Marlin, Yoshida et al., 2002) Copyright © 2019 by Elsevier, Inc. All rights reserved. 3  HPNA Standards of Practice for Palliative Care Nurses  Provides age-appropriate culturally, ethically, and spiritually sensitive care and support  Maintains a safe environment  Educates patients/family to identify appropriate settings and treatment options  Assures continuity of care and safe transitions to the next appropriate setting  Coordinates care across settings and among caregivers  Manages information and protects confidentiality  Communicates promptly and effectively Copyright © 2019 by Elsevier, Inc. All rights reserved. 4  The Natural Course of Serious Illness  With initial diagnosis, palliative care can help guide therapy  With disease progression to an end stage condition, hospice is an option of care  As aggressive therapies are no longer effective and comfort care increases, hospice care and bereavement services can be introduced Copyright © 2019 by Elsevier, Inc. All rights reserved. 5  Prognostication  Based on laboratory findings and diagnostic test results  After gathering data, a meeting with the patient and family is imperative  Tools  Palliative Performance Scale (PPS)—a tool that identifies functional decline and scores it  Karnofsky Scale—appropriate for patients with a cancer diagnosis Copyright © 2019 by Elsevier, Inc. All rights reserved. 6  Hope  For a cure  For more time  For no pain  For a good death Copyright © 2019 by Elsevier, Inc. All rights reserved. 7  Triggers for Palliative Care Consult  Asking the surprise question: “Would I be surprised if this patient died within 6 months to a year?” and getting a positive response would be a trigger  Patients with multifaceted care such as ventilator support, feedings, and assistance with functional needs  A patient’s place of residence is a long-term care facility (nursing home) Copyright © 2019 by Elsevier, Inc. All rights reserved. 8  Triggers for Palliative Care Consult (Cont.)  The age of the patient  Cognitive impairment  Metastatic cancer  Current or past enrollment in hospice care  A patient without an advance care plan Copyright © 2019 by Elsevier, Inc. All rights reserved. 9  End of Life Nursing Education Consortium (ELNEC)  Core curriculum  Nursing care at the end of life  Pain management  Symptom management  Ethical/legal issues  Cultural considerations  Communication  Loss/grief/bereavement  Final hours Copyright © 2019 by Elsevier, Inc. All rights reserved. 10  National Consensus Project (NCP)  Task force of organizations striving to improve palliative care  American Academy of Hospice and Palliative Medicine (AAHPM)  Center to Advance Palliative Care (CAPC)  Hospice and Palliative Care Nurses Association (HPNA)  National Hospice and Palliative Care Organization (NHPCO) Copyright © 2019 by Elsevier, Inc. All rights reserved. 11  NCP Practice Domains  Domain 1: Structure and Processes of Care  Domain 2: Addresses Physical Aspects of Care  Domain 3: Psychological and Psychiatric Aspects of Care  Domain 4: Social Aspects of Care Copyright © 2019 by Elsevier, Inc. All rights reserved. 12  NCP Practice Domains (Cont.)  Domain 5: Spiritual, Religious, and Existential Aspects of Care  Domain 6: Cultural Aspects of Care  Domain 7: Care of the Patient at the End of Life  Domain 8: Ethical and Legal Aspects of Care Copyright © 2019 by Elsevier, Inc. All rights reserved. 13  Palliative Care Model  The family is the unit of care and the patient defines family  The role of the nurse as an advocate is vital to the care of patients and their families  Culture is honored as an important aspect of the patient/family  Palliative care further carries an important focus to special populations such as the vulnerable, the prisoner, or the substance abuser Copyright © 2019 by Elsevier, Inc. All rights reserved. 14  Palliative Care Model (Cont.)  Serious illness impacts all systems of care; put another way: where there are patients, there are patients who are suffering needlessly  Sensitivity to the reality of financial issues that impact quality of life is critical  Palliative care is not just confined to cancer and AIDS, but to all life-threatening illnesses  The interprofessional care of the patient/family is integral to high quality palliative care Copyright © 2019 by Elsevier, Inc. All rights reserved. 15  Unrelieved Pain  Provokes or exacerbate distress  Disturbs coping and adjustment  Augments a sense of vulnerability  Interferes with ability to eat, sleep, think, and interact with others  Correlated with fatigue in cancer patients Copyright © 2019 by Elsevier, Inc. All rights reserved. 16  Critical Thinking Question 2. Which of the following questions would be appropriate for a palliative care nurse to ask a patient? A. “Is your pain interfering with your ability to sleep?” B. “Why do you insist on being pain free?” C. “Why do you ask for pain medication so frequently?” D. “Do you understand how experiencing pain improves your ability to cope?” Copyright © 2019 by Elsevier, Inc. All rights reserved. 17  Benefits of Palliative Care  Relief of suffering  Optimization of function  Promotion of healing and comfort  Fostering of appropriate hope  Genuine coordination of care at times of transitions between health care providers  If anticipated, patient and family are given opportunity and assistance in exploring and preparing for hospice Copyright © 2019 by Elsevier, Inc. All rights reserved. 18  Suffering  “A state of severe distress associated with events that threaten the intactness of a person” (Cassel, 1982)  The experience of a person  Relief of suffering is central to the work of palliative care Copyright © 2019 by Elsevier, Inc. All rights reserved. 19  Strategies for Family Caregivers  Set realistic goals  Have difficult discussions  Find help  Negotiate expectations Copyright © 2019 by Elsevier, Inc. All rights reserved. 20  Barriers and Challenges  Barriers  Lack of a general understanding by health care professionals as well as the consumers of the role and nature of palliative care  Limited numbers of palliative care trained professionals  Payment for palliative care services  Communication  Challenges  Lack of a understanding by health care professionals as well as the consumers  Limited number of trained professionals  Payment for palliative care services  Communication Copyright © 2019 by Elsevier, Inc. All rights reserved. 21  Areas of Expertise for Hospice and Palliative Care Nurses  Clinical judgment  Advocacy and ethics  Professionalism  Collaboration  Systems thinking  Cultural competence  Facilitator of learning  Communication Copyright © 2019 by Elsevier, Inc. All rights reserved. 22  Certification  The generalist level is the CHPN designation— certified hospice palliative nurse  The palliative nurse administrator is the CHPA— certified hospice palliative administrator  The advanced level is the ACHPN—advanced certified hospice palliative nurse Institutional; Available through TJC  Voluntary certification  Recognition for high quality palliative care Copyright © 2019 by Elsevier, Inc. All rights reserved. 23 Quality Assessment and Improvement  National Hospice and Palliative Care Organization (NHPCO)—committed to the improvement of multiple areas of quality including:  patient-centered measures related to management of pain within 48 hours of admission  avoiding unwanted hospitalizations  avoiding unwanted CPR  patient safety  Center to Advance Palliative care (CAPC) Copyright © 2019 by Elsevier, Inc. All rights reserved. 24  Concerns  Ethical  Advance planning  Double effect  Palliative sedation  Medically futile care  Legal  Right to refuse treatment  Landmark cases Karen Ann Quinlan Nancy Cruzan Copyright © 2019 by Elsevier, Inc. All rights reserved. 25