Professional Documents
Culture Documents
Trends and IssuesPasien Terminal Care
Trends and IssuesPasien Terminal Care
Content
Historical development
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Short Bio
Name Hana Rizmadewi Agustina, S.Kp, MN, PhD
Institution Department of Fundamental and Pediatric Nursing
Faculty of Nursing Universitas Padjadjaran
Formal Bachelor of Nursing (Universitas Padjadjaran)
education Master of Nursing (Monash University, Australia)
PhD in Nursing Studies (University of Nottingham, United Kingdom)
Training End of Life Care Nursing Education (ELNEC) - 2012
background Basic and Intermediate Palliative Care – 2014
Joanna Briggs Institute of Comprehensive Systematic Review Training - 2015
End of Life Care and Palliative Care Curriculum (EPEC) – 2019
Joanna Briggs Institute of Scoping Review Training - 2021
Research Nursing education, curriculum development, palliative care, end of life care,
interest quality of life
Professional Indonesia National Nurses Association (INNA) of West Java Province
organisation International Association of Hospice and Palliative Care (IAHPC)
Asia-Pacific Palliative and Hospice Care Network (APHN)
Life is pleasant
Death is peaceful
It’s the transition that’s
troublesome
(Isaac Asimov)
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Dying Trajectory
Siblings
After-care
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(Saunders, 1978)
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• Palliative care aims to improve the quality of life of people with life-limiting conditions and
their families, not only by treating their physical symptoms but also by attending to their
psychological, social and spiritual needs.
• Palliative care is applicable for people of any age and may be integrated at any point in the
disease trajectory from diagnosis through the continuum of care to bereavement (WHO,
2009)
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Model of Services
Terminal care
Time
Curative care/
Supportive care
Palliative care
Bereavement
Supportive, symptom-oriented
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• Information sharing
• Partnerships and
participation
Person
• Collaboration Collaboration
and Family
Centred
Information
sharing
Care
Partnerships
and
participation
Source: http://westernhealth.nl.ca/home/clients-patients-and-
visitors/person-and-family-centred-care-pfcc/
• Patient as a partner
• Uniqueness and
• Person-and individual preferences
• Family- • The climate of
• Centred ‘partnerships’
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Intervention
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Family and
relatives caring
for the dying and
Mortality rate:
dead.
infection (20%); Hospice and
degenerative bereavement
diseases, HIV/AIDS,
services do not
Cancer (70%);
formally exists.
injuries and others Nurses have low
(8%) score of palliative
care knowledge and
attitudes towards
caring for the dying
patients and their
Palliative care was families.
introduced in 2007,
but end of life care
has not become a
priority in health
care settings.
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Established core
competencies and
curricula from western
Educator needs to
countries may not reflect recognise the needs of
culture, beliefs, values and learners and their own
the actual needs of needs both theory and
stakeholders in non- practice of palliative
western countries. care.
Core Competencies
• Communication and interpersonal skills
• Holistic assessment and care
management
• Professionalism
• Cultural and spiritual sensitivity
• Patient focuses and family centered care
• Personal and professional development
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Curriculum issues
• There are several similarities between general competencies in national undergraduate
nursing curriculum and the international core competencies.
• The profile of undergraduate nursing students focuses on the role as a care provider,
educator, manager, advocator and researcher.
• No description about self-care management to prevent or manage themselves from any
potentials emotional problem and how it can impact their professional roles and
responsibilities.
• The term of ‘palliative care’. ‘end of life care’, ‘hospice care’ has reduce the possibilities of
rejections from family members.
• It is recommended to conduct gap analysis to explore the extent of core competencies are
translated into curriculum and how this could be achieved during academics and clinical
learning periods.
• Conducting a gap analysis is essentials in order to explore the extent of core competencies are
translated into curriculum and how this could be achieved during academics and clinical
learning periods.
• Institutions needs to identify consensus among nurse educators regarding core competencies
and curricular components that should be embedded in the generic curriculum.
Curriculum content
No. Domain of Competencies Sub Competency
Professional accountability
5 Communication Effective communication with dying patients, family, and other
health professionals.
6 Management of symptoms Care provision during the dying state
7 After death care Care provision after death
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• Learner centred
• Support
• Mentoring and
Professional Negotiated • Integration of
learning
supervision
• Boundaries
• Reflexivity
RElationship teaching and
learning
• Engagement in
learning
• Authentic
assessment
• Continuing
SUpport education
• Interprofessional
education
empowerment • Facilities and
access
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Practice Considerations
• Some things cannot be “fixed”
• Therapeutic presence
• Realistic views
• Early detection
• Reconceptualised ‘healing’
• Quality of life
• Interdisciplinary approach
• Personal and professional development
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COMPASSIONATE PRACTICE
• Compassion for patients and for
professionals’ self-care can be
trained and implemented top-
down (institutional policies) and
bottom-up (compassion
training).
• Compassionate communities’ is
an important emerging
movement that complements
regular healthcare and social
services with a community-level
approach to offer compassionate
care for people at the end of life.
Feeling ‘not good enough’ when delivering care Emphasises that the dynamics of
for end of life care the workplace play a major role in
a practitioner’s sense of wellbeing
Professional capacity – Knows how to and
when needs referrals (Crawford & Price, 2003)
https://www.mja.com.au/journal/2003/179/6/team-working-palliative-care-model-interdisciplinary-practice
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Benefits of PFCC
Hsu N-C, Huang C-C, Chen W-C, et al. (2019) Impact of patient-centred and family centred care meetings on intensive
care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan.
BMJ Open 2019;9: e021561. doi:10.1136/ bmjopen-2018-021561
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Conclusion
• Professional development
• Curriculum development
• Research and evidence-based practice
• Holistic approach
• Dignified and compassionate care
• Roles and responsibilities
• Communication and coordination
• Shared decision making
• Community empowerment
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Source: https://journalofethics.ama-assn.org/
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