114 (Gabule PPT narrative)
care
Content:
- Physical care of older adults
- Long term, palliative care and its legal aspects
- Importance of advance directives and DNR in
relation to the patients care
- Concepts on the end-of-life care
LONG TERM CARE
- Variety if services designed to meet a person’s
health or personal care needs during a
short/long period of time.
- This service help people live independently and
safely as possible when they can no longer
perform everyday activities on their own.
- Variety of service which help meet both
medical and non-medical needs of people w
chronic illness or disability who cannot care for
themselves for a long period of time.
Prognostication
- Medical prognostication as prediction of future
medical outcome of a treatment or a disease
course based on medical knowledge of the
doctor.
- It is not a fortunetelling or a precognition
- DOCTORS DO NOT CREATE FUTURE EVENTS.
- Difficult for nurses and doctors to break the
bad news. “Patay naka next year ghorl” is not easy.
2 parts:
A. Formulation (foreseeing/anticipate)
B. Communication (foretelling)
- Communicate w relatives, patient
itself w compassion
PALLIATIVE CARE (PC)
- Care for pts w life threatening illnesses and
their families
- Care given in homes, HCs, hospitals, hospices
- Can benefit health systems by reducing and
unnecessary hospital admissions
- Helps relieve physical, psychosocial, and
spiritual suffering
- Can be provided by many types of
professionals and volunteers
- improves the quality of life of patients and
their families facing problem associated with
life threatening illnesses through the
prevention and relief of suffering.
- Quality palliative care addresses quality-of-life
concerns
- Increased knowledge is essential “being with”
(loved ones, environment that has + effect on
you)
- Importance of interdisciplinary approach to
Where is PC needed?
- Hospitals, clinics, mass casualty (vehicular
accidents, including pandemic, earthquake,
tsunami), nursing homes, homeless
Legal Aspects of PC:
The right to die
- An indiv. has the right to refuse med treatment
and the refusal of such treatment will cause
the pts death.
- But if they refuse, you must let them sign a
waiver
- Inform whatever might happen when they
refuse
- proper explanation should be given to the pt
and to the relatives
ADVANCE DIRECTIVES Purpose:
- Mechanism by which individual can exercise
control over their bodies
- Will provide guidance esp to the health care
professionals
- Provide immunity from civil and criminal
liability when certain stated conditions are met
Types of AD
A. Living will
- Documents specific in instructions to health care
providers about particular kinds of health care
treatment an individual would or would not
want to prolong life
- Used to give instruction about what kind of
treatment an individual wants to have
administered
- Provides clear and convincing standard of proof
to a allow individuals stated wishes to be
respected.
B. Durable power of attorney in health care
- Document that permits individuals to designate
another person to make health care decisions
for them should they lose decision-making
capacity.
- The person who is appointed by the pt to make
decisions is called a health care proxy, health
care agent, attorney, or a surrogate.
- Becomes effective only when it I determined
when and indiv is incompetent or lacks decision
making capacity
DO-NOT-RESUSCITATE ORDERS (DNR)
- For clients who are in stage of terminal illness,
irreversible illness, or expected death
- Generally, it’s a written when the client or proxy
has expressed the wish for no resuscitation in
the event of respiratory and cardiac arrest
Informed Consent
- Agreement by a client to accept a course of
treatment or a procedure after being provided a
complete information including the benefits and
the risks of the treatment, alternatives to the
treatment and prognosis if not treated by the
healthcare provider
Types of IC
A. Express consent – oral or written agreement
B. Implied consent – nonverbal behavior
3 elements of IC
A. Must be given voluntarily
B. Must be given by a client or an indiv. with the
capacity and competence to understand
C. Client must be given enough information to be
the ultimate decision maker
- Nobody should make decision for this client
- As much as possible the client will
make/signed the consent that if cognitively
stable/intact.
- If not, nearest keen will be given authority to
sign the consent
Exceptions
A. Minors – parents/guardian must give consent
B. Unconscious or injured – closest adult relative
will sign consent
C. Mentally ill persons – nearest keen
- Biopsy: before death
- Consent is a legal requirement
- Closest surviving fam member has the authority
to determine whether the autopsy is performed.
CONCEPTUAL CONFUSION AND DIFFICULT DECISIONS
IN END-OF LIFE CARE
From Letting Die to Assisted Dying
- Includes assisted suicide and voluntary active
euthanasia (not applicable in the PH)
Barriers to Quality Care at the End of Life
- Failure to acknowledge the limits of medicine
(even the doctors and nurses knows that the pt
doesn’t have hopes to be cured. They still
continue giving medications and diagnostic
examinations. Even meds can no longer cure the
patient)
- Lack of training for healthcare providers (newly
hired/grad nurse needs to be trained first before
giving an assignment on critical pts that needs
critical decision and critical thinking)
- Hospice/palliative care services are poorly
understood (at times they’re just bringing their
relatives at the hospice w/o even informing
their parents that they will be placed in the
hospice/palliative care. They must be informed
ahead of time. The relatives & children must
communicate w their parents. Most of the time,
parents in the hospice die alone w/o their
children w them huhu)
- Denial of death (we need to accept that
mangamatay ra tang tanan if muabot na ang
time duh)
ADD MORE INFO FROM INTERNET SOURCES

Death Certificate
- Prepared for each person who dies
- A physician’s signature is req on the certificate
- Nurse’s role: ensure the physician (or the one
who pronounced the death) has signed the
death certificate
Organ Donation
- Patients who express a wish to donate
functional organs such as heart, cornea, liver,
lungs and kidneys can fill out an organ donor
consent card
- Should be done on the hospital
Autopsy
- Examination of the organs and tissues of a
human body after death