Principles and Practices

of Palliative Care

R.A.N.D.Ranaweera
BSc.Nursing (Hons) KDU
Study Outline
• To Define Palliative Care
History of Palliative Care
• The modern hospice movement started in England in 1967, through
the work of Dame Cicely Saunders (who was trained as a nurse, a
social worker and a physician) and colleagues at St. Christopher
Hospice in London.
• Hospice care was the first to evolve, but it was limited to patients who
have life span of 6 or less months.
• Patients with chronic debilitations were unable to receive hospice
care.
• The palliative care model evolves from the traditional hospice
movement to concern the quality of life of patients living for a
prolonged period with active, progressive and far-advanced diseases.
Definition by the World Health Organization
Palliative care is an approach that improves the quality of life of
patients and their families facing the problems 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.
Targeted Population of Palliative Care
Patients who are suffering with an Active, Progressive and
Far-Advanced disease
• Cancer
• HIV/AIDS
• Neurodegenerative Diseases – Dementia, Alzheimer's disease,
Parkinson’s
• Congestive Heart Failure
• COPD (Chronic Obstructive Pulmonary Disease )
• Kidney Failure (end stage)
Goals of Palliative Care
• To provide relief from pain and other physical symptoms
• To maximize the quality of life
• To provide psychosocial and spiritual care
• To support the family during the patient’s illness and bereavement
Why palliative Care is so important ?
According to WHO 2018,
9.6 million people world wide are estimated to have died of
cancer to which can be added the numbers of patients dying with
AIDS and other diseases who might benefit from palliative care.
300,000new cases are diagnosed each year among children
between 0- 19 years.
Many people die with unnecessary and untreated pain.
patients developing diseases above discussed are living and
dying with unrelieved pain, uncontrolled physical symptoms,
unresolved psychological and spiritual problems, fear and
loneliness
Why palliative Care is so important ?
(cont..)
• There are two instances where it mentioned that palliative care must
be included in every country’s health profile
1. WHO – 1990
2. Barcelona declaration – 1996
• The relief of suffering is an ethical imperative
Classification of the cause of Suffering
• Pain
• Other physical symptoms
• Psychological
• Social
• Cultural
• Spiritual
The importance of Multidisciplinary
Approach
pain treatment of pain
other physical symptoms treatment of other physical symptoms
psychological problems treatment of psychological problems
social difficulties treatment of social difficulties
cultural issues treatment of cultural issues
spiritual/existential concerns treatment of spiritual/existential
concerns
Total Suffering Multidisciplinary Palliative Care
Importance of multidisciplinary and inter-
professional care
The ideal multidisciplinary team requires
• Patient
• Family Members
• Care givers
• Medical staff
• Nursing staff
• Social worker
• Physiotherapist
• Occupational therapist
• Member of Clergy depending their religious beliefs
Importance of multidisciplinary and inter-
professional care
Very useful, but not essential, are
• Dietician
• Psychologist (or liaison psychiatrist)
• Clinical pharmacist
• Music and art therapists
• Volunteers
• Other personnel, as required
Principles of Palliative Care
Palliative care includes the whole spectrum of care
combining the medical, nursing, psychological, social,
cultural and spiritual components. A holistic approach,
incorporating these wider aspects of care, is good
medical practice and in palliative care it is essential.
Principles of Palliative Care
• Attitude to Care
• Communication
• The Care
• Advance Care Planning
 Attitude to Care

• Caring attitude – Sensitivity, Empathy and Concern

Holistic view on the problem apart from the medical
aspect
Do not prejudice on behalf of the religion, race,
beliefs, personality or intellect
• Commitment
• Consideration of individuality – though the patients are categorize
according to the underlying medical condition keen attention must be
given to psychosocial conditions. That way all the patients are unique
and the care must be planned individually
Attitude to Care
• Cultural considerations – There may be varied ethnic, racial and
cultural factors that may influence patient
suffering. These cultural differences must be respected
and treatments must be provided accordingly with the
cultural sensitivity.
• Consent – Huge responsibility lies with the nurse, she has to make
sure whether the patient (family members if the patient is not
in a condition to understand)understood what the physicians
& nurses explained were understood by the patient.
Patients like to share their decision with their family
members as well as with the nurses and physicians
Educate them on what is appropriate what is not
appropriate
Adequately informed patients tend to be more compliant
Attitude to Care
• Choice of site of care – patient and family members must decide what
is the place that he/she should be treated.
patients with terminal illness should be
managed in the home setup as much as possible.
Communication
• Good communication should be maintained among the health care
professionals
• It should be maintained with the patients and their family members
as well.
The Care
• Care should be provided with a tem comprised of interproffessional
and multi disciplinary