HOSPICE & PALLIATIVE CARE:

PRINCIPLES OF PALLIATIVE CARE

Group 1: BSN III
Elective Course I
DEFINITION &
INTRODUCTION
WORLD HEALTH ORGANIZATION
DEFINITION OF PALLIATIVE CARE NURSING

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. (WHO)
1. AFFIRMS LIFE AND REGARDS
DYING AS A NORMAL PROCESS
“Palliative care affirms life and regards dying as a normal process. It offers
a support system to help patients live as actively as possible until
death.” (WHO)

Affirming life means to appreciate a life well-lived and to

treasure the time alive the patient has until their death.

To reassure them that everyone will experience death and it is

not something to be afraid of.

We need to help patients live out the rest of their days in peace,
contentment and acceptance.
I. AFFIRMS LIFE AND REGARDS DYING
AS A NORMAL PROCESS (CONT.)
From Ambercity Hospice, a hospice and palliative care healthcare facility in California, U.S.A.,
as of June of 2017:

“…our aim is to provide comfort and improve the quality of patient’s remaining life so he or she can
enjoy time with family and friends at home or in a home-like environment. In fact, our company takes
on the mission to enhance the quality of our patients’ life by allowing them to retain as much comfort
and dignity as possible.”

In order to properly affirm the lives of our patients whom we provide palliative care
towards, we must make sure that each of their remaining days alive are lived out
with the least amount of dreadful feeling about the impending time of their death.

We must provide assurance that death will come, but their living days must be
treasured and they must also be at peace with themselves, their lived life thus far
and eventually, its end.
I. AFFIRMS LIFE AND REGARDS DYING
AS A NORMAL PROCESS (CONT.)
“All dying patients will experience times of sadness as a normal part of
coming to terms with life drawing to a close. Approximately 25% of all
cancer patients, however, will experience severe depressive symptoms,
with the prevalence increasing with higher levels of disability, advanced
illness, and pain” (Chochinov, 2006)

As healthcare workers and providers of palliative care, we must

acknowledge the probability that terminally ill or chronically ill
patients will most likely experience depression or depressive
episodes. We must therefore be able to help them cope with this
grief and attain a relatively more stable state of mind of acceptance.
II. NEITHER HASTENS NOR
POSTPONES DEATH
“By definition, palliative care does not hasten death, but supports dying
as a natural life process.” (Herx, 2015)

Anything that makes death quicker, for the reason of ending

chronic pain or abiding with the patient’s wishes, goes
against the principle of palliative care.

Palliative care helps the patient accept their limited time and
helps them accept death as an inevitable, normal
occurrence.
II. NEITHER HASTENS NOR
POSTPONES DEATH (CONT.)
“(A)…connection between hopelessness and suicidal thinking begins to reveal the experiential
landscape of people approaching death. Besides its connection with depression, loss of hope—
however that might be experienced by someone facing a life-limiting illness—seems closely
aligned with a wish to die.” (Chochinov, 2006)

Depression and hopelessness are normal feelings of the terminally ill, suffering or
chronically ill patients. It is our job to help them maintain a stable outlook and positive
perspective and provide realistic expectations, reassurance and ensure the integrity and
legitimacy of any feelings of despair they may express.

Depression and hopelessness also has a strong correlation with patients wanting to have a
hastened death, a predictable mechanism during this mental state because they may believe
death to be better than suffering during their remaining days. As healthcare workers we
must assure them that their remaining days are to be treasured, that we will help lessen
their mental and physical pain, and death is an inevitable and need not be rushed.
III. PROVIDES RELIEF FROM PAIN AND
OTHER DISTRESSING SYMPTOMS
Palliative care is “…relief of suffering by means of early identification
and impeccable assessment and treatment of pain and other
problems, physical, psychosocial and spiritual.” (WHO)

Pain, especially if it is chronic, hinders and lowers the quality of

life of an individual. The mind is not at peace if there is
prominent presence of pain.

By providing relief from pain or lessening the pain the patient

experiences, we help them establish an easier way of being able
to live out their days in peace.
III. PROVIDES RELIEF FROM PAIN AND
OTHER DISTRESSING SYMPTOMS (CONT.)

Figure 1: The four dimensions of total pain (Saunders, 2007)

IV. INTEGRATES THE PSYCHOLOGICAL, ETHICAL,
LEGAL AND SPIRITUAL ASPECTS OF CARE

“Regarding psychological aspects, current reviews showed small to large effects in the
reduction of depression and anxiety symptoms through cognitive behavioral-based
interventions, mindfulness-based interventions, and meaning-based interventions.
Meaning-based or dignity-based approaches were also used for targeting spiritual
aspects or existential distress.”

- from “Psychological Interventions in Palliative Care (von Bllackenburg P, Leppin N.)

Psychological and spiritual aspects of palliative care can be done through

mindfulness, behavioral or meaning-based interventions.

Through these interventions, the patient will have a more stable state of mind/
psyche and their spiritual needs as an individual will be met.
IV. INTEGRATES THE PSYCHOLOGICAL, ETHICAL,
LEGAL AND SPIRITUAL ASPECTS OF CARE (CONT.)
According to the National Health and Medical Research Council (NHMRC) Guidelines (Aus):

“(Palliative care)…outlines four key ethical principles:

Clinical integrity- care of the whole person

Respect for persons- the patient is the best person to make decisions
about their care, in keeping with their values and beliefs

Justice- taking into account the needs of all concerned in the care of
the patient, including family, carers and others

Benefit to the person- recognizing the patient’s changing needs as the

illness progresses and ensuring that treatment achieves benefit for
the patient”

Ethical palliative care for the patient requires these four ethical principles in order for them to
accept their remaining days and eventual passing away in death in peace and contentment. By
following these principles, we, as healthcare providers are able to provide care that has no
unethical issues that are deemed controversial or unjust towards the dying patient.
IV. INTEGRATES THE PSYCHOLOGICAL, ETHICAL,
LEGAL AND SPIRITUAL ASPECTS OF CARE
(CONT.)

“Spirituality in palliative care focuses on the psychological and spiritual

aspects of care, helping to relieve the physical, emotional,
social and spiritual distresses of the patient, family members
and healthcare professionals, produced in such conditions.” (Rego,
Nunes, 2016)

By caring for the spiritual state of mind of the patient and helping
them make peace with their situation and life, we help the patient
attain peace, acceptance and contentment.
IV. INTEGRATES THE PSYCHOLOGICAL, ETHICAL,
LEGAL AND SPIRITUAL ASPECTS OF CARE
(CONT.)

“Legal aspects and human rights give the fundamental protections that
allow equal participation and individual justice in a society.[4] It means ‘no
one ought to harm another in his life, health, liberty or
possessions’.” (“Ethics in Palliative Care” Mohanti, 2009)

The legal aspect, and perhaps even the ethical aspect, of palliative
care is that, to its core, palliative care is to provide as much care
and avoid harm during the limited time the patient still has to live.

By doing so, we are respecting their remaining days alive and help
them during the process of overcoming any despair towards their
imminent end.
V. OFFERS A SUPPORT SYSTEM TO HELP PATIENTS
LIVE AS ACTIVELY AS POSSIBLE UNTIL DEATH

According to the National Institute of Clinical Excellence (NICE) (U.K.), 2015:

Supportive care can be defined as “…(helping) the patient and their family to cope
with their condition and treatment of it – from pre-diagnosis, through the process of
diagnosis and treatment, to cure, continuing illness or death and into bereavement.”

If a patient has a terminal or life-threatening illness, supportive care should be

holistic, in depth and supportive care should be treated with equal importance
alongside medicinal or surgical care.

Supportive care helps the patient cope and live out their days as well and as
actively as they can. The quality of their remaining days, therefore, are not
hindered by the diagnosis and its effects, and their spirit stays strong because of
a support system.
VI. OFFERS A SUPPORT SYSTEM TO HELP
PATIENT’S FAMILIES COPE DURING THE PATIENT’S
ILLNESS AND IN THEIR OWN BEREAVEMENT

“Palliative care is a person-and family-centered approach to care for

people with serious illness.This type of care is focused on providing relief
from the symptoms and stress of a serious illness.The goal is to improve
quality of life for both the patient and the family.” National Consensus
Project Clinical Practice Guidelines for Quality Palliative Care, June 2018.

By involving both the patient and the family in palliative care

interventions, we establish coping mechanisms for the family for
the time after the patient has died and help them have certain
expectations. We, therefore, improve quality of life for the patient
and their family.
BIBLIOGRAPHY
Boulay du S (2007) Cicely Saunders: the founder of the modern hospice movement. Society for Promoting Christian Knowledge, London.

Breitbart W, Bruera E, Chochinov H, et al. Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. J Pain
Symptom Manage 1995;10:131–141.

Bukberg J, Penman D, Holland J. Depression in hospitalized cancer patients. Psychosom Med 1984;46:199–212.

Chochinov HM, Wilson KG, Enns M, et al. Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold
judgments. Am J Psychiatry 1994;151:537– 540.

Herx, L. (2015, April). Physician-assisted death is not palliative care. Retrieved February 26, 2019, from ncbi.nlm.nih.gov website: https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC4399615/

Hospice Affirms Life Hastens Postpones Death. (n.d.). Retrieved February 26, 2019, from ambercityhospice.com website: http://
www.ambercityhospice.com/hospice-affirms-life-hastens-postpones-death

Mohanti, B. K. (2009, Jul-Dec). Ethics in Palliative Care. Retrieved February 26, 2019, from ncbi.nlm.nih.gov website: https://www.ncbi.nlm.nih.gov/
pmc/articles/PMC2902121/

Palliative Care Explained. (2015). Retrieved February 26, 2019, from ncpc.org.uk website: https://www.ncpc.org.uk/palliative-care-explained

von Blanckenburg, P., & Leppin, N. (2018, September). Psychological interventions in palliative care. Retrieved February 26, 2019, from
ncbi.nlm.nih.gov website: https://www.ncbi.nlm.nih.gov/pubmed/29985177

WHO Definition of Palliative Care. (2019). Retrieved February 26, 2019, from who.int website:https://www.who.int/cancer/palliative/definition/en/

Wilson KG, Lander M, Chochinov HM. Diagnosis and management of depression in palliative care, in Chochinov HM, Breitbart W, eds. Handbook of
Psychiatry in Palliative Medicine. New York: Oxford University Press; 2000: 25–44.