Nursing & Health Survival Guide: Palliative Care

Heather Campbell

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317905837
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

This easy-to-use guide provides a quick reference to the principles of palliative and end-of-life care for adults, to help you enable your patients to not only die peacefully but also live until they die.

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What is palliative care?

The term palliative is derived from the Latin verb palliare which means ‘to cloak’.

Reference / Regnard, C.F.B. and Kindlen, M. (2002) Supportive and Palliative Care in Cancer. Abingdon: Radcliffe Medical Press.

The most widely recognised definition is that of the World Health Organization (WHO 2002) and examines the needs of the adult patient:

Palliative care is 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.

Palliative care:

• Provides relief from pain and other distressing symptoms
• Affirms life and regards dying as a normal process
• Intends neither to hasten nor 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
• Offers a support system to help the family cope during the patient’s illness and in their own bereavement
• Uses a team approach to address the needs of patients and their families, including bereavement counselling, 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

Reference / http://www.who.int/cancer/palliative/definition/en/

■ When does Palliative Care Begin?

Reflection

Consider a situation where palliative care may be used for a patient who may not have a diagnosis of a life-limiting illness.

Support from the palliative care team may sometimes be needed for pain management postoperatively or to provide psychological support for patient and family in the event of a sudden unexpected death.

However, palliative care is part of the longer term support that should be offered to patients and families with life-limiting illness when care rather than cure is the emphasis:

• Supportive care
• End of life care
• Care in the last few days of life

They contribute to providing a seamless pathway and share the following characteristics:

• Enhancing quality of life
• Enabling autonomy and control in decisions
• Ensuring holistic care and symptom management

• Encouraging a multidisciplinary approach
• Extending to include family care

Summary

• Palliative care aims to improve quality of life when cure for a life-limiting condition is generally no longer an option
• It is part of a broader approach to care to support patient and family on their illness journey
• It includes care at the end of life and after death

‘Palliative care is about putting life into a patient’s days not days into their lives.’

Nairobi Hospice

■ National Policy

Key points

• Policy that has influenced palliative care initially started with cancer
• Policy identified the importance of patient choice
• Policy recommended the importance of integrated health and social care
• Policy recommended the use of systems and processes to optimise care

End of Life Care Strategy

The End of Life Care Strategy (Department of Health 2008) evolved from the End of Life Care programme. In summary it:

• Emphasised the importance of patient choice particularly around place of care at end of life
• Promoted the increased use of end of life care tools
• Recognised the need for all those with life-limiting illness to receive appropriate support and care
• Recognised the need to work towards enabling a good death

It anticipated that this could be achieved by developing an end of life care pathway with six key steps (see p. 6).

Reference / Department of Health (2008) End of Life Care Strategy – Promoting high quality care for all adults at the end of life. London: DH Publications.

Reflection

What do you notice about the steps of the pathway?

You may have noticed a number of things but the start of the pathway rests with having conversations about the future and the timing of these.

End of Life Care Strategy, DH 2008, with six key steps

Determining end of life may not always be straightforward because each life-limiting condition has its own disease trajectory. A disease trajectory is a recognised general pattern of how certain life-limiting conditions progress over time. Some chronic conditions like end-stage heart failure and respiratory disease have acute episodes which are often interspersed with long periods of stability which mean that estimating when patients are at end of life may be more difficult.

The cancer trajectory, however, has been described as a steady progression but then a steep decline which usually ends in death and a point where end of life may be estimated.

Action

Read more about disease trajectories and prognostic indicators at www.goldstandardsframework.org.uk

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Table of contents

• Cover
• Title
• Copyright
• contents
• INTRODUCTION
• WHAT IS PALLIATIVE CARE?
• THE PATIENT JOURNEY
• ROLE OF THE NURSE
• COMMUNICATION IN PALLIATIVE CARE
• HOLISTIC ASSESSMENT
• SYMPTOM MANAGEMENT
• PAIN MANAGEMENT
• NAUSEA AND VOMITING
• BREATHLESSNESS
• CONSTIPATION
• FATIGUE
• CARE AT END OF LIFE
• SYMPTOMS AT END OF LIFE
• A GOOD DEATH
• CARE IN THE LAST FEW WEEKS, DAYS, HOURS
• SUPPORTING FAMILY AND CARERS
• LOOKING AFTER SELF
• USEFUL WEBSITES