Role of a nurse in palliative care
- 1. ROLE OF A NURSE IN PALLIATIVE CARE
- 2. FLORENCE THE FIRST PALLIATIVE CARE NURSEFlorence Nightingale herself stated: ‘I use the word nursing for want of a better.’She went on to say:‘The very elements of nursing are all but unknown’ (Nightingale, 1860).
- 3. DEFINING PALLIATIVE CARE ‘Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, though the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, physiological and spiritual.’WHO
- 4. PALLIATIVE CAREAffirms lifePromotes quality of lifeTreats the personSupports the family
- 5. EVOLVING MODEL OF PALLIATIVE CAREDeathCure/Life-prolonging IntentPalliative/Comfort IntentBereavement
- 6. PALLIATIVE CARE GOAL Its goal ismuch more than comfort in dying; palliative care is aboutlivingthrough meticulous attention to control pain and other symptoms, supporting emotional, spiritual, and cultural needs, and maximizing functional status
- 8. VIRGINIAS DEFINITION OF NURSINGThe most succinct and relevant to palliative care is Virginia’s definition of nursing;‘Nursing is primarily assisting the individual in the performance of those activities contributing to health and its recovery, or to a peaceful death.’
- 9. PALLIATIVE CARE COMPETENCIESCommunication skillsPhysical skillsPsychosocial skillsTeamwork skillsIntrapersonal skillsLife closure skills
- 10. COMMUNICATION SKILLSThe abilityTo field and respond to sometimes profound or rhetorical questions about life and deathTo know when to say nothing, because that is the most appropriate response;To use therapeutic comforting touch with confidence;To challenge colleagues who may wish to deny patients information; and, perhapsTo discuss the imminent death of a relative with families
- 11. TEAM WORK SKILLSThe growth of the nursing role within these teams has been dramatic and continues to represent a much admired model of working .
- 12. PHYSICAL CARE SKILLSThe knowledge and skills necessary to deliver active, hands-on care in whatever setting throughout a long period of illness.Observational skills and the intuitive ability to recognise signsAdvising doctors of the appropriate prescription and dosage to manage painThe advocacy role nurses have towards patients at a time of extreme vulnerability.
- 13. PSYCHOSOCIAL SKILLSAn abilitywork with families,Anticipating their needs,Putting them in touch with services andSupporting them when appropriate
- 14. INTRAPERSONAL SKILLS Nurses need to recognise and attempt to understand personal reactions that occur as a natural consequence of working with dying and bereaved people and to be able to reflect on how this affects care given in sensitive situations. It is the most challenging of all competency areas and plays a significant part in the professional growth of those who choose to work in this field.
- 15. LIFE CLOSURE SKILLSThis area is concerned with nursing behaviours and skills that are crucial to patients’ and families; dignity, as they perceive it, when life is close to an end and thereafter.Such care has been described as a sacred work, in which the nurse enters into the patient’s intimate space and touches parts of the body that are usually private
- 17. PALLIATIVE CARE PLANPalliative care plan includes:Care goalsSymptom managementAdvance care planningFinancial supportSpiritual careFunctional status support and rehabilitationCo morbid disease management
- 21. Dry mouth
- 22. Constipation
- 23. Diarrhoea
- 24. Fever MANAGING PAINAsses the multi dimensions of pain and determine the type of painEmploy a assessment scaleUse WHO ladderAdminister around the clock doses and break through dosesSeek the help of appropriate alternative therapiesContinue evaluating pain control and pain status
- 25. DYSPNEAAddress the anxiety with assurance and relaxation techniquesMaintain saturation above 90% with supplemental oxygenSuctioning is generally not indicatedAdminister 5-10mg morphine q4h if the patient is not on opioids
- 26. HANLING ANXIETY Types include situational anxiety, drug related anxiety. Organic anxiety and psychological anxiety.Multidisciplinary assessment
- 27. Treat the reversible causes
- 32. Tranquilizers for severe anxietyNOURISHING AND HYDATINGSuggest small meals and liquid supplementsTreat the symptom that may cause decreased appetiteAdminister appetite stimulants Employ infusions and hypodermoclysis
- 33. Potential Palliative Care InterventionsGenerallyNot PalliativeVariable CPRTransfusions VentilationInfections HighlyHypercalcemia burdensomeTube Feeding InterventionsDialysisPalliativeSupportEmotional
- 34. Spiritual
- 36. Dyspnea
- 37. Nausea
- 38. VomitingFUNTIONAL STATUS SUPPORTAssess ability to perform ADL & IADLFind and rule out underlying reversible causes of functional impairmentRefer to rehabilitation evaluation as appropriateOptimize and maintain functional status with physical, occupational and complementary therapies
- 39. PALLIATIVE SEDATIONIntermittent sedation for relief of the intractable symptoms when they are not controlled even with aggressive measures.It is different from assisted death as it is not intended for death yet often foreseenSedative dose is not killing does
- 40. SPIRITAUL CAREAssess the desire for spiritual counselling and supportObtain information regarding significant religious rituals, beliefs and practicesEncourage their practice to the extent possible Foster the insightsSpiritual coping strategies enhance self empowerment
- 41. SUPPORTING FAMILYAssess family structure, functioning, strengths and weaknesses, knowledge deficitsEncourage communication among family membersRespect their privacy and accept the coping stylesConduct meetings to review the goals and decisions Teach care giving skills to the primary caregiverAssist throughout grieving process and in bereavement
- 42. ADVANCED CARE PLANNINGLiving willsHealth power of attorneyA completed patient values history
- 43. ETHICAL DECISION MAKING Nurses can seek the help of the ethical standards of decision making. Shared decisions should be made after,Considering what is known of the patients wishes and preferences given the current conditionBalancing the burdens and benefits of each option in terms of quality of life and Achieving a consensus among decision makers
- 44. EducationPublic AwarenessRaise awareness and expectations
- 46. Empower in decision making
- 48. Curriculum in undergrad and post-grad in all involved disciplines
- 49. Continuing educationIMPROVING PALLIATIVE CAREProfessional PracticeStds of practice for symptom management, availability, responsiveness, communication
- 50. Certain palliative interventions held to higher scrutiny and rigour – eg. Palliative sedation
- 51. Specialty area for nursing