The history of palliative care
- traditional “hospice” care;
- the role of religious women ‐ “hospice for the dying”: Mary Aikenhead;
- Australian developments;
- post‐war developments in medical technology
- rights for the dying – withdrawal from treatment.
- contemporary history
The history of palliative care – Victoria
- home care, not in‐patient care;
- rapid expansion over a short time;
- community lobbying and fundraising;
- late 1990’s, approximately 70 services in Victoria; widespread in Australia
- a developing system, responding to what was missing.
WHO‐ Definition of 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 & relief of suffering by means of early identification & impeccable assessment & treatment of pain & other problems, physical, psychosocial & spiritual
What does Palliative Care do?
provides relief from pain and distressing symptoms, affirms life, and respects dying as a normal process. It integrates psychological and spiritual aspects of patient care, offers a support system, and uses a team approach. It enhances quality of life and can be applied early in illness.
The Palliative Approach
The palliative approach in residential aged care aims to improve quality of life for individuals with life-limiting illnesses and their families by identifying, assessing, and treating physical, cultural, psychological, social, and spiritual needs early.
Interprofessional teams
SPECIALIST
- Specialist palliative care nurses, nurse practitioners
- Palliative care physicians
- Palliative care physiotherapists/OTs
- Bereavement Counsellors
- Loss & Grief counsellors
- Volunteers
- Welfare Officers
- Social Workers
Interprofessional teams
GENERALIST
- Generalist nurses
- Community nurses
- GPs
- Counsellors
- Physiotherapists; OTs
- Aged care health professionals
- Acute hospital health professionals
Elements of palliative care
Palliative care should be strongly responsive to the needs, preferences and values of people, their families and carers. A person and family-centred approach to palliative care is based on effective communication, shared decision-making and personal autonomy
Where is palliative care provided?
Community‐based
* People’s homes
* Residential aged care
*Accommodation for those experiencing mental illness
* Correctional facilities
* General Practices
* Community palliative care clinics and day centres
Hospital‐based
* Inpatient palliative care beds
* Other inpatient beds (acute; sub‐acute; other)
* Outpatient services
* Intensive care units
* Emergency departments
Nursing careers in palliative care
- Generalist nurse
- Specialist palliative care nurse
- Clinical nurse specialist palliative care
- Palliative care nurse consultant
- Nurse practitioner palliative care
The National Palliative Care Strategy
The Australian Government Department of Health has an over-arching strategy for the delivery of palliative care in Australia. One of the resources linked to the strategy is useful to share with patients and families. It gently explains palliative care and emphasises the positive outcomes supported by high-quality end-of-life care.
Trusted, Collaborative and Bold: Strategic Direction 2022-2024
Palliative Care Australia has released its latest strategic plan, Strategic Direction 2022-2024, revealing a renewed purpose, clear vision and the strong values that will guide us in addressing the three strategic palliative care priorities for the coming three years:
* Growing the health care, aged care and community care workforce
* Innovate in models of care, and
* Increase accessibility
Aim of care:
- Symptom alleviation / control
- Support & reassurance of patient as well as relatives– the relatives often suffer the symptoms with the patient and feel helpless
- Maximising quality of living.
Principles of symptom management
- Evaluation
- Explanation
- Discussion
- Individualised treatment
- Monitoring
- Dose escalation
Symptom assessment:
- Talk in a reassuring manner
- Ask is this a new symptom? If you have had it before what was it due to? What made it better or worse?
- Level of discomfort and /or distress caused by the symptom
– Ie. Mild, moderate or severe.
– On an agreed scale (numeric)
–how distressing is the symptom? - Assessment and re-assessment should be carried out regularly
– Should be done on admission as a baseline
– Every 4/24
– When there is a noticed change of condition
– After given medication or treatment
– to ensure effectiveness
Common Symptoms (other than pain)
- Anorexia/cachexia
- Dyspneoa
- Nausea and vomiting
- Dehydration
- Restlessness
- Disorientation
- Confusion
- Fatigue
- Constipation
- Diarrhoea
- Pruritis
- Spiritual distress
- Depression
- Xerostomia
Oral symptoms
- Xerostomia
- Stomatitis
- Mucositis
- Sialadentitis
- Candidiasis
- Ulcers
Dyspnoea/breathlessness
Usually caused by:
* disease of the lung,
* asthma,
* emphysema,
* chest infection,
* pressure from other body organs,
* anaemia
* anxiety.
Nursing Management:
- Reassurance, ‘being with the patient’
- Cool air – fan or open window
- Elevated position of comfort
- Plan activities
- Humidifiers or nebulised saline for thick secretions +/- effective
- Opioids (oral/IV/S/c) and also reduces anxiety
- Oxygen (individualised plan)
- Medications to reduce secretions no more effective than placebo
Changes in Breathing Patterns
- Changes in breathing pattern are common and indicate a decreased circulation in the internal organs.
- Breathing may consist of irregular, shallow respirations, or periods of no breaths for 5-30 seconds, followed by a deep breath &/or rapid shallow panting-type breathing.
- There may also be a ‘moaning’ sound on exhalation - this is not an indication of distress but the sound of air passing over relaxed vocal chords.
Congestion
- Gurgling sounds coming from the chest can become quite loud, and be distressing to hear. The patient is unaware of the process.
- Action: elevate the head and turn the patient on their side. Suction is ineffective.
- Drugs: Hyoscine Hydrobromide, Hyoscine Butylbromide and Glycopyrronium Bromide and even Atropine are used to help dry secretions – but research suggests largely no more effective than placebo.
