PALLIATIVE CARE

MICHAEL OKUMU
SCHOOL OF NURSING
OUTLINE
By the end of the session, you will be able to
Define palliative care
Describe the benefits of palliative care
Describe the principles of palliative care
Describe the palliative care services
PALLIATIVE CARE
• A patient and family centered care that optimizes quality of life by
active anticipation, prevention and treatment of suffering. It
emphasizes the use an interdisciplinary team approach throughout
the continuum of illness, placing critical importance on the building of
respectful and trusting relationships.
• Palliative care addresses physical, intellectual, emotional, social and
spiritual needs.
• Facilitates patient autonomy, access to information and choice
PRINCIPLES OF PALLIATIVE CARE
Access to care
• Is the right of every individual and a critical component of the Kenya
essential package for health.
• Patients and their families shall access holistic care-physical,
psychosocial and spiritual needs
• Shall be referred to appropriate levels of health care delivery system
PRINCIPLES OF PALLIATIVE CARE
Multidisciplinary Team Approach
• Shall be provide by a multidisciplinary team
• In the absence of the team, a core team shall be oriented on palliative
care to ensure all needs are met
• Team members shall communicate and network the care of patient
and family through regular meetings to discuss their experiences
PRINCIPLES OF PALLIATIVE CARE
Service Delivery Model
• An appropriate model shall be developed
• Developed as a comprehensive and public health approach
• Integrated within the existing health care delivery system in both
public and private set up to scale up care for chronic and life
threatening illnesses
• Tailored to the specific cultural and specific contest
PRINCIPLES OF PALLIATIVE CARE
Ethical and Legal Aspects of Care
• The goal is to improve the quality of life of patients. Care should
therefore be offered in a manner that benefit the family and causes
no harm
• Goals , preferences and choices of patients shall be respected
according to the existing laws
• Rights and ethical consideration for palliative care shall be observed
as guided by the available principles
PALLIATIVE CARE SERVICES
Palliative care plan
• An individual requiring this form of care shall have a proper
assessment care plan developed by the care provider in consultation
with the family in order of priority
Pain control
• An important aspect of palliative care and covers physical,
psychological, social and spiritual aspects of pain.
• Involves the use of pharmacological and non-pharmacological aspects
PALLIATIVE CARE SERVICES
Pain Control Cont;
Pharmacological- Follows the WHO guidelines to management of all
types of pain
• All medication to be administered on time
• Prescription and supply shall follow the appropriate protocols
• Prescription of opioids shall follow the existing laws
Non-Pharmacological pain relief-management of pain without drugs
Strategies include
• Education to the patient and care giver
PALLIATIVE CARE SERVICES
Non-Pharmacological Pain Relief Cont
• Psychosocial care/therapy-music, companionship and complementary
pain relief
• Physical care-Exercises, heat/cold application, occupational therapy,
physiotherapy
• Spiritual care-meditation, prayers
• Palliative surgery and chemotherapy
PALLIATIVE CARE SERVICES
SYMPTOM CONTROL
• Assessment for cause and severity of the symptom
• Anticipating multiple symptoms-physical , social, spiritual
• Treatment of reversible conditions
• Family involvement in management of pain
• Initiation of disease/symptom specific medicines and non-drug
measures
PALLIATIVE CARE SERVICES
Medicines and Supplies
• Medication for symptom control including those of opportunistic
infections shall be available in each health facility
• Medicines, equipment and consumables shall be made available as
outlined in essential palliative care list
PALLIATIVE CARE SERVICES
Nutrition
• Reduces physical deterioration of the disease, improves quality of life
and prevents emotional effects
• Patients shall be educated on aspects of essential nutrition
• Use of locally available foods highly recommended
• Management shall include assessment and counselling on specific
needs
• Counselling on feeding based on stage of the illness shall be provided
PALLIATIVE CARE SERVICES
Infection Prevention and Control
• Care shall be provided based on available guidelines .Core interventions
shall include
Hand hygiene
PPEs
Isolation precautions
Aseptic techniques
Cleaning and disinfection
Sterilization
PALLIATIVE CARE SERVICES
Care of Caregivers
• Care team assisted to recognize the difficulties they encounter,
personal limitations and effective coping strategies
• Adequate resources need to be provided for care givers
• Supervision, training and support should be provided continuously
based on needs
PALLIATIVE CARE SERVICES
Psychosocial Care of Patients and Their Families
Psychosocial interventions-anxiety, depression, care of children,
finances
Psychosocial care of palliative team-
Spiritual care-Being a compassionate presence in the face of suffering
Helping patients deal with meaning and purpose of life, meaning of
family and relationships
Need to foster relationships with GOD/creator, others and the world
around them
PALLIATIVE CARE SERVICES
End of Life Care
• Family shall be prepared on impending death
• Need for honesty among team members
• Comfort measures on the presence of impending death
• End of life concerns discussed honestly
• Discussing advanced directives-wills
• Guided by medical-ethical principles of autonomy, beneficence, non-
maleficence and justice
PALLIATIVE CARE SERVICES
Grief and Bereavement
• Risk assessment done routinely throughout
• Care providers shall offer a safe, comforting place to the bereaved to
enable expression of feelings, thoughts and needs
• Customary and religious rituals need to be respected to help the
family cope with death