1. Creating Context Palliative Care for Front-Line Workers in First Nations Communities

2. What is Palliative Care? World Health Organization (WHO) Definition of 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, 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.

4. Addresses all of these issues associated with illness and bereavement: Disease Management Physical Issues Psychological & Mental Issues Social & Practical Issues Spiritual Issues Management of the Passing Loss & Grief

5. The Philosophy of Palliative Care: (1 of 2) It is the individuals right to make informed decisions about their care Palliative care strives to meet physical, psychological, social, and spiritual needs of individuals and their families with sensitivity to their personal, cultural, and religious values Care should be delivered in a patient-focused, family-centred environment It is the individual’s right to access information and services from an educated interdisciplinary team of professionals and volunteers who receive continuing palliative care education

6. The Philosophy of Palliative Care (2 of 2) Palliative care uses a team approach because the help provided is very involved and be carried out by one person. The palliative care team is a group of people who work together with a common purpose to help the person. Each care provider is a valuable member of the team.

7. The Medicine Wheel and Palliative Care All quadrants of the medicine wheel are interrelated and depend on one another The four quadrants of the medicine wheel focus on physical, mental, emotional, and spiritual self Medicine wheel focuses on relationships Palliative care also emphasizes the relationships between body, mind and soul

8. Principles of Palliative Care Access Equal availability without discrimination Ethics Right to information Right to choice/empowerment Unit of care

9. How can palliative care benefit clients, their families, and the staff who care for them? Studies of individuals receiving palliative care show: Improved satisfaction with end-of-life care Improved pain control Decreased use of hospital transfers, tube feeding, and physical restraints

10. Attitudes towards end-of life (EOL) Attitudes towards passings are influenced by culture, community, family and past experiences. There are unspoken assumptions regarding meaning of health, illness, and passing which may hinder communication. Helpers and caregiver must be tolerant of differences and respect the beliefs of others.

11. Healthcare Providers Attitudes Our religious/cultural backgrounds influence our clinical practice Past experiences may also have profound influence on how we care for people who are passing

12. Needs of the Dying (1 of 2) Physiological  good symptom control Safety  a feeling of security Belonging  to be needed  to not feel a burden Love  expressions of affection, contact Understanding  opportunity to discuss dying  explanation about the disease and symptoms

13. Needs of the dying (2 of 2) Acceptance  regardless of mood and willingness to socialize Self-Esteem  involvement in decision- making, especially as physical dependence on others increases  opportunity to give as well as receive M. Downing, Medical Care of the Dying, 1989

14. Priorities may differ but individuals who are dying have similar desires To be pain free To be alert and aware of what is happening To have the companionship of their family and friends To be accepted as the person they have always been To maintain their individuality

15. Priorities may differ but individuals who are dying have similar desires… Not to die alone Not to be a burden on their family To have familiar things around them To be cared for To be remembered with love and respect To have their family continue living and loving after their death VanBommel (1989)

16. Tasks of the dying person Increased awareness and coping Preservation and maintenance Preparation Coping with anxiety Coping with losses Moos & Tsu, 1977; Rando, 1984

17. From the perspective of an individual who is dying, some ways to offer support: Social Physical Feelings Thoughts Spiritual Victoria Hospice Society, 1995

18. How to help…(1 of 2) Provide time and space for communication Communicate respect and acceptance of the dying person Avoid withdrawing prematurely from the individual who is dying Accept that dying may be very difficult

19. How to help…(2 of 2) Avoid telling untruths Provide a holistic assessment and treatment plan Communicate your commitment to provide care for the individual who is dying