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Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC When People Are Dying: Palliative Care By Pamela Parrish, RN, CHPN Clinical Consultant.

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Presentation on theme: "Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC When People Are Dying: Palliative Care By Pamela Parrish, RN, CHPN Clinical Consultant."— Presentation transcript:

1 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC When People Are Dying: Palliative Care By Pamela Parrish, RN, CHPN Clinical Consultant School of Nursing, University of Pennsylvania Diane Stillman, RN, MSN Clinical Consultant School of Nursing, University of Pennsylvania Neville Strumpf, PhD, RN, C, FAAN Edith Clemmer Steinbright Professor in Gerontology School of Nursing, University of Pennsylvania In collaboration with Genesis ElderCare and the University of Pennsylvania School of Nursing with funding from the Robert Wood Johnson Foundation

2 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Objectives Direct care staff will be able to:  Distinguish between palliative care and hospice  Describe the domains of palliative care  Describe the process of advance care planning  Discuss approaches to relieving emotional and physical symptoms  Discuss roles of various staff and services, including team functions, in social and emotional support 2

3 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Definitions of Palliative Care  Study and management of persons with progressive, far advanced disease for which the prognosis is limited and the focus of care is on quality of life  World Health Organization: Active, total care of persons whose disease is no longer responsive to curative treatment 3

4 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Palliative Care Distinctions from Hospice:  Focuses on end-stages of chronic illness  Targets people earlier in disease process  Is not linked to reimbursement or prognosis  Has greater flexibility to accommodate individual and family wishes  Is complementary to hospice care 4

5 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Domains of Palliative Care  Advance care planning  Physical and emotional comfort  Social, bereavement, and spiritual support 5

6 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Advance Care Planning Understand Values of the Person  What makes life worth living  Quality vs. prolongation of life  Concerns over illness, suffering, control, alertness, family, death  Religious or spiritual concerns Understand Legal Requirements  Statutes and requirements vary by state 6

7 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Process of Advance Care Planning Step 1: Introduce the Topic  Define ACP process and philosophy, determine comfort level with discussion, determine competence and desire to name an agent Step 2: Structure Discussions  Discuss preferences and wishes and explore any inconsistencies Step 3: Document Preferences  Document thoroughly and review frequently  Update as needed 7

8 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Assessment & Management of Symptoms Physical symptoms may include pain, nausea/vomiting, diarrhea, constipation, itching, shortness of breath, lack of appetite, and others  Attend to self reports and behavioral cues  Manage symptoms  Assess frequently and communicate with appropriate professionals  Develop an ongoing plan of care focused on maximizing comfort 8

9 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Assessment & Management of Symptoms Emotional symptoms may include depression, anxiety, agitation, irritability, and others  Assess frequently  Communicate with primary care provider(s) and, if appropriate, psychiatrist, therapist, or clergy  Develop an ongoing plan of care focused on minimizing patient and family distress 9

10 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Social, Bereavement, and Spiritual Support Meeting the needs of the dying person  Offering hope  Providing comfort  Assuring community  Maintaining meaning  Sustaining dignity  Limiting fears of abandonment 10

11 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Social & Spiritual Support Nursing  Assist with hygiene, dignity, and privacy; maintain open communication with individual and family; encourage family involvement in care Social Services  Coordinate family support; engage community services; assure wishes are congruent with advance directives and resolve any conflicts Dietary  Arrange meals for family; provide comfort foods; liberalize diet; provide extra fluids for person 11

12 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Social & Spiritual Support Activities  Offer pet therapy, reminiscence, aromatherapy, music therapy, gardening, and visits from children as desired PT/OT  Assist in maintenance of independence and comfort; consult on positioning, safety issues, and pressure ulcer care Community  Involve hospice, local clergy, and volunteers 12

13 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Moment of Death  Develop approaches to ensure that death does not occur alone  Maintain on call system-- family, staff, and volunteers to spend time with those actively dying  Support family members at time of death  Assume care of and show reverence for the body 13

14 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Bereavement Support for Survivors  Sympathy cards  Pamphlets on grief and loss, referral to community services  Memorial services  Bedside services  Flowers and cards in reception area  Angel tree, memorial garden, or other remembrance area  Follow-up call or letter to family 14

15 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC “I knew I could count on you to listen to my fears, and I often ran them by you…I always knew I could tell my wife anything, but I worried about her anguish over my suffering. You never stopped fighting for my comfort, and you never forgot that my pain was her pain. Thank you for that.” “I knew I could count on you to listen to my fears, and I often ran them by you…I always knew I could tell my wife anything, but I worried about her anguish over my suffering. You never stopped fighting for my comfort, and you never forgot that my pain was her pain. Thank you for that.” A husband writing to his late wife’s caregiver 15

16 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Objectives Review Can you now:  Distinguish between palliative care and hospice?  Describe the domains of palliative care?  Describe the process of advance care planning?  Discuss approaches to relieving emotional and physical symptoms?  Discuss roles of various staff and services. Including team functions, in social and emotional support? 16

17 Delaware Valley Geriatric Education Center TLCTLC TLCTLC LTCLTC LTCLTC Thank you for your attention! The End 17


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