Professional Documents
Culture Documents
Principles of Palliative and Hospice
Principles of Palliative and Hospice
Principles of Palliative and Hospice
It is reported that:
Nearly 50% of all patients going
through the dying process spend most
of their time in moderate to severe
pain.
Most Americans would prefer to die in
their own home, yet most die in
institutions.
Nearly 50% of dying patients in the
United States experience multiple
physical and emotional symptoms that
go untreated or are under-treated.
These patients also experience
decreased quality of life, often due to
symptoms such as pain, dyspnea,
depression, anxiety, delirium,
fatigue/weakness,
restlessness/agitation, and
Palliative Care
Definition of Palliative Care:
an approach that improves the quality of life of
patients and their families, facing the problems
associated with life-threatening illness, through them
prevention and relief from suffering, by means of early
identification, impeccable assessment, treatment of pain
and other problems - physical, psychosocial, and
spiritual (World Health Organization, 2002; Sepulveda
et al., 2002).
Principles of Palliative
Care
Hospice
Definition:
Hospice care is the support and care for persons in the final phases
of an incurable disease so that they may live as fully and
comfortably as possible (NHPCO, 2000). Hospice also supports the
surviving family through the dying and bereavement process (Egan
& Labyak, 2001). Hospice provides comprehensive palliative,
medical and supportive services across a variety of settings and is
based on the understanding that dying is a part of the normal life
cycle. Care can be provided in the home, in residential facilities,
long-term care facilities and other settings (i.e. prisons).
Principles of Hospice
Care
Advance Directive
(also called a Living Will)
An Advance Directive is a document that lets patients state their
wishes about medical care in the event that they develop a terminal or
irreversible conditions and can no longer make their own medical
decisions (TxPEC, 2009).
An Advance Directive (Living Will) becomes effective when
1. the patients physician certifies in writing that the patient
has a terminal or irreversible condition, and
2. after the patients physician writes a do not resuscitate
(DNR) order specifying the patients wishes to withhold
medical care.
3. The patient may revoke the Directive at any time.
Hospitals are required by Medicare Conditions of Participation and
JCAHO to inquire about Advanced Directive status upon the patients
admission and to instruct the patient about his/her option of having an
Advance Directive if so desired. If the patient has a Directive, the
hospital is required to make it part of the patients medical record.
However, hospitals are not required to make the patient create an
Advance Directive or Power of Attorney for medical care.
Nursing &
Advance Directives
Nurses have a unique opportunity to enact the federal
Patient Self-Determination Act through communication
with patients and by assisting them explore their values
and beliefs regarding the end of life. The nurse can
promote patient comfort with decisions concerning
advance directives. They can also be sure that the
entire healthcare teams is aware of the patients wishes
(Nevidjon & Sowers, 2000).
Note: Any problems/questions associated with Advance
Directives or Durable Power of Attorney should be
referred to the nurse in charge. Each organization has
its own policies about who can/cant witness a
signature.