c



 ’p mhe     
 are both included in the
care plan and emotional, spiritual and practical
c
   support is given based on the patient͛s wishes and
family͛s needs.
Introduction

c ’p mrained volunteers can offer respite care for family

members as well as meaningful support to the
’p cospice is a concept of care that provides support patient.
for the terminally- ill patient and the family
allowing the patient to live as fully as possible until ’p cospice is a concept of care designed to provide
death. comfort and support to patients and their families
J

 









’p It is centrally administered program of palliative 





.
and supportive services which provides physical,
psychological, social and spiritual care for dying ’p c
  





 care because
persons and their families. it is not designed to cure illness or lengthen life but
emphasizes the management of all symptoms of a
’p ervices are provided by a medically supervised disease, with a special emphasis on controlling a
inter- disciplinary team of professionals and patient͛s pain and discomfort.
volunteers.
’p cospice deals with the emotional, social, and
’p cospice is a special kind of care designed to provide spiritual impact of the disease on the patient and
sensitivity and support for people in the final phase the patient͛s family and friends.
of a terminal illness.
’p cospice care is defined
 


 
’p cospice care seeks to enable patients to carry on an  
 
 
 ,
alert, pain- free life and to manage other symptoms
so that their last days may be spent with dignity
and quality at home or in a home- like setting.
’p cospice is a concept of caring derived from
medieval times symbolizing a place where
travellers, pilgrims and the sick, wounded or dying
could find rest and comfort.
’p mhe contemporary hospice offers a comprehensive
program of care to patients and families facing a
life threatening illness.
’p c

 
pain management, and emotional and spiritual
support directed at fulfilling patient͛s needs and
wishes at EOL (end of life)(National cospice and
Palliative Care Organization, 2008).
’p cospice care is one option for people with life
limiting cancer when curative therapy or control of
the disease is no longer realistic.
’p cospice programs provide holistic care at EOL. With
an emphasis on meeting the patient͛s goals of
comfort and quality of life.
  
  
 
 ’p mhe hospice model of care uses an interdisciplinary
 . approach to provide nursing, medical, social,
spiritual, nutrition, volunteer, and bereavement
’p It emphasizes 

      services. (Carlson, Morrison, colford, and Bradley,
  , 
        
. 2007).

’p mhe dying are comforted. Professional medical care

is given, and sophisticated symptom relief 
provided.

 c$

 1.p @ying is a normal process.

’p mhe terminally- ill patient is one in whom, following
accurate diagnosis, the advent of death is certain
and not too far distant and for whom

2.p When cure is not possible, care is still needed.
3.p Pain and other symptoms of incurable disease can
be controlled.

 4.p Not all persons need or desire palliative care.

  





  5.p mhe amount and type of care provided should be


 
  related to client and family needs.
6.p When a patient and family are faced with 
terminal


 !
disease, stress and concerns may arise in many
 aspects of their lives.
 7.p Personal, philosophic, moral or religious belief
systems are important to patients and families who
"#$ !c%&
are facing death.
’p It originally started as -!$' in the 8.p Continuity of care (services and personnel) reduces
community by well innovative carers. the patient͛s and the family͛s sense of alienation and
fragmentation.
’p [rom the 4th to the 16th century, these homes 9.p [amilies experiences significant stress during the
were called -c' where the sick were looked terminal illness of one of their members.
after in religious hospices. 10.p [amily participation in care giving is an important
part of palliative care.
’p In 1538, with the $c
( these homes 11.p Not all patients have a family member available to
were ordered closed. take on the responsibility of giving care.
12.p [amily needs continue after the death of one of their
’p In the 19th century, the 
) reopened members.
and the name hospice was adopted as homes for 13.p Patient and family needs may arise at any time.
the dying patients ran by the Catholics, *+ 14.p No one individual or profession can meet all the
and the $, needs of terminally- ill patients and families all the
time.
’p

 ! started 
 


 15.p Persons giving care to others need to be supported




 and since then the and replenished in order to continue to give care.
hospice movement has extended from the hospice
to hospital wards and the homes, embracing all
kinds of needs and care: emotional, spiritual,
physical and the cultural.
’p By covering these needs, open communication
flows between families, carers and the dying. mhis
removes the fear of death- makes dying time- time
of spiritual renewal and reunion with loved ones.
16.p mhe need for quality assurance in health care
requires the establishment of standards for practice
and program operation.
17.p Optional utilization of services and resources is an
important goal in the administration and
coordination of patient care.
18.p Attention to physical comfort is central to palliative
care.
19.p Medical Care is a necessary element of palliative
care.
20.p mhe physical environment and setting can influence
a patient͛s response to care.
21.p mhere is a continual need to improve the techniques
of palliative care and to disseminate such
information.
22.p @ocumentation of services is necessary and
desirable in the delivery of quality care.

-!$c !$
 !, who
founded the world-renowned
,.c
!:
1.p @eath must be accepted.
2.p mhe patient͛s total care is best managed by an
interdisciplinary team whose members
communicate regularly with each other.
3.p Pain and other symptoms of terminal illness must be
managed.
4.p mhe patient and family should be viewed as a single
unit of care.
5.p come care of the dying is necessary.
6.p Bereavement care must be provided to family
members.
7.p Research and Education should be ongoing.
c+c
  c
/,p c& &
,
’p Ander the direction of a physician, hospice
uses sophisticated methods of pain and
symptom control that enable the patient to
live as fully and comfortably as possible.
u,p c(!,




or the place they called
’p mhe interdisciplinary hospice team is made
up of professionals who can address the
medical, emotional, psychological, and
spiritual needs of the patients and their
loved ones.
Î,p c01 ($
,
’p cospice neither hastens nor postpones
death: it affirms life and regards dying as a
normal process. mhe hospice movement
stresses human values that go beyond the
physical needs of the patient.
r,p c!(2 
(- ,'
’p Patients and their families are included in
the decision- making process, and
bereavement counselling is provided after
the death of their loved one.
5. c! !
ur !(&!3+#
),
’p [or hospice patients and their loved ones
help is just a phone call away. Patients
routinely receive periodic in-home services
of a nurse, home health aide, social worker,
volunteer, and other members of the
hospice interdisciplinary team.
Is Caring for the patient at home the only place
hospice care can be delivered?
’p No. Although 90% of hospice patient time
is spent in a personal residence, some
patients live in nursing homes or hospice
centers.
cc- hospice care provided while a patient
continues
home at the time of enrolment. mhe family or
significant others are generally able to handle the
needs and care of the patient, with assistance
from the hospice team, including a hospice nurse.
c- hospice care provided 24 hours
per day in a facility (hospital, hospice residence,
or nursing home) for symptoms or crises that
cannot be managed in the patient͛s home.
!)- is distinguished from
multidisciplinary practice in that the former is
based on communication and cooperation among
the various disciplines, each member of the team
contributing to a single integrated care plan that
addresses the needs of the patient and family.
 % !- refers to participation of
clinicians with varied backgrounds and skill sets
but without coordination and integration.
&

’p is an approach to care for the seriously ill that has
long been a part of cancer care.
’p Increasingly, palliative care is being offered to
patients with non-cancer chronic illnesses, where
comprehensive symptom management and
psychosocial and spiritual support can enhance the
patient͛s and family͛s quality of life.
’p A comprehensive, person- and family- centered
care when disease is not responsive to treatment.
’p mhe active, total care of patients whose disease is
not responsive to treatment (WcO,1990).
’p Not care that begins when cure- focused treatment
ends.
’p mhe goal is to improve the patient͛s and family͛s
quality of life, and many aspects of this type of
comprehensive, comfort- focused approach to care
are applicable earlier in the process of life-
threatening disease.
’p It emphasizes management of psychological, social,
and spiritual problems in addition to control of pain
and other physical symptoms.
’p Palliative care is sometimes called hospice care.
 


,c
 5c6 defines hospice palliative care in terms of
 its aim to relieve suffering and improve the quality of
’p Palliative care is closely associated with hospice
care, this type of care is not just for the dying.
’p Palliative care is sometimes confused with hospice
care since one of the main goals of hospice care is
comfort and most hospice patients are dying.
c


’p [ocus is on pain and symptoms management
’p Patient has a terminal diagnosis with life
expectancy of less than six (6) months
’p Not seeking curative treatment
Ëp In both hospice and palliative care, the focus is on
quality of life of the patient.
Ëp mhe goal for both types of care is to address any
adjustment to illness or end of life issues.
Ëp !, the clarity concerning these differences
was also taking shape.
&c
YE, the principles are the same.
’p cospice means different things in different
countries- it is variously used to refer to a philosophy
of care, to the buildings where it is practiced, to care
offered by unpaid volunteers, or to care in the final
days of life.
’p It is better to adopt and use the term palliative care.
(mhe IAcPC Manual of Palliative Care, 2nd Edition)
’p It is recorded that ͞ !  !$
$ $, ͞'!&͟ are no
longer recognized as separate entities. cospice
Palliative Care is now widely accepted in Canada.
’p mhe !c&
living and dying.
’p Care is positioned as that which occurs at the time
of life- threatening diagnosis is identified and
becomes progressively the focus of concern as
curative treatments prove ineffective.
44
"  


c
 -c!&
 
 

c
 


’p [ocus is on pain and symptom management
1.p Patient centered
’p Patient does not have to be terminal 2.p [amily oriented
’p May still be seeking aggressive treatment 3.p colistic
4.p Active
 5.p Aniversally accessible c 

 4
8% %%9% 
6.p Complementing disease modifying therapy 
7.p @elivered by an educated and regulated 4&5%%6
interprofessional team 1.p Evaluation
2.p Explanation
3.p Management


  % 
 4 
7 4.p Monitoring
 5.p Attention to @etail
a. ymptom Control
b.p Effective Communication
c.p Rehabilitation /,& 
d.p Continuity of Care mp elf- reporting instruments are most accurate
e.p merminal Care
f.p upport in Bereavement u,:
g.p Education mp Explanation about care and treatment options is vital
h.p Research to the delivery of effective care and empowers
patients and carers to be involved as equal partners
,p
8% %   
 
mp ymptom management is a fundamental aspect of
palliative care (WcO, 2003).
mp It is the primary therapeutic goal of service delivery
and is aimed at subjective well- being (de Conno and
Martini 2001).
mp It is estimated that 90% of patients who access
palliative care services have a diagnosis of cancer (
Bruera & Portenoy, 2001), governments worldwide
are now committed to ensuring that palliative care is
available to all who need it, including patients
diagnosed with incurable non-malignant diseases
(Armstrong,2001, cottish Executive, 2001, WcO,
2003).

6
%$
 the missing of details by health professionals can
1.p In implementing any intervention or treatment
related to the management of symptoms, the
preferred choice of the patient should be at the
forefront of the minds of practitioners.mhis
includes agreeing to non- treatment as an option.
in the decision- making process.
Î,%$
mp Management builds on the assessment process.
mp mhe first stage is to identify the cause and determine
what is reversible and treatable.
mp cealth professionals should work in partnership with
the patient.
mp mhe patient͛s priorities must be considered and
realistic goals set in conjunction with the patient and
then documented in the management plan.
r,%$
mp Will not only determine the efficacy of interventions
but also facilitate regular reassessment of the
severity of the symptom and impact on the patient.
·,
mp throughout the process of symptom management,
have dire consequences.



",p 44 
 %%-  

2.p Open communication involving not only patients


and family members but also all relevant health  %%-  
professionals will facilitate informed decision- 
making. mp 6ey aspect of the role of the nurse.
mp Buckman (1993) proposed that effective symptom
3.p Listening to the patient͛s own story, including past control is impossible without effective
and present life experiences, will assist the communication.
professional to understand the impact of
symptoms from the patient͛s perspective. )&+ 7

1.p @istancing or blocking tactics.
mp
 ! ! 2.p Ignoring cues
$)&! 3.p [alse Reassurance
)!$ , 4.p Avoidance tactics

’p In order to communicate effectively with patients
and their families, nurses must be supported in the
workplace.
’p mhis can be achieved through clinical supervision
(ceaven, (2001).
1.p Most authors agree that effective
communication in palliative care incorporates
effective listening skills and appropriate non-
verbal communication; counselling skills, such
as reflection, clarification and empathy;
supportiveness; and, above all, self-
awareness.
"
mp A trained volunteer, clergy member, or professional
counselor provides support to survivors through
visits, phone calls, and/ or letter contact, as well as
through support groups.
mp mhe hospice team can refer family members and
care- giving friends to other medical or professional
care if needed.
mp "&& are often provided for ) 
 after the patient͛s death.
% !$!+5u /67
u,p [aulkner & Maguire (1994) note that, in order 
  & +, 1.p Care of the family.
 ! 2.p Information giving and receiving
#(!$! 1  3.p Care of the deceased.
(!$+$!!(! 4.p upporting ritual and mourning customs.
&!$ ! &, 5.p Legal and medical interventions.
 6.p [uture care and support.
Î,p  $&&&
&!$!+
7
 9
 
-  9 c"

7

1.p Able to make decisions about care
2.p Initiate discussions about end- of- life
care when the patient can actively
participate
3.p [acilitating discussions with patients
and their families in a supportive and
compassionate manner.
/,p Looking after yourself as you look after the needs of
the bereaved.
u,p cigh- quality pain and symptom control in the run-
up to the patient͛s death.
Î,p Assessing risk and identifying current and future
social support network.
r,p Referring on to other members of the multi-
professional team for more specialist support.
,p
-  "
%  ·,p Mood quality information and communication at all
 points in the bereavement journey.
mp upporting those who face loss or have experienced
loss presents one of the challenging dimensions of
palliative care.

è  
mp mhe time of mourning after a loss.

c
mp Asually begins when the patient has :5;6
& and ends with the family 5/6
!,

"
% 

mp Continuation of care for the family after the death.

mp mhe hospice care team works with surviving loved

ones to help them through the grieving process.

%
-99
 
 c
-   c"

 £,p !!&<  !,
/,p !2 !$
+,
mp Allow people to grieve in a way that suits
them.
mp mhere is no right or wrong to grieve.
mp Part of this involves giving the person
permission to express the unhappiness they
are feeling at that moment in time.
u,
+.!
$,
mp Ase good listening skills.
Î, !+,
mp ilence is often a productive time during
which the bereaved may experience new
insights about themselves and the situation
they now find themselves in.
r,
 + +$) !!
!$,





mp @ifferent cultures, religions and ethnic
groups may have different views, values,
rites and rituals around the dying process
and death.
mp As a nurse it is imperative that you find out
what these are to ensure the appropriate
care.
mp It also help you to understand the patient͛s
and family͛s reactions to their situation.
mp You may need to seek an interpreter to aid
with communication but you must ensure
that (except emergency) the interpreter is
not a family member but properly qualified,
external interpreter who is acceptable to
the patient.
å,+$
$,
mp Vary from day to day and depend on what
the person is facing, their personality, belief
system, cultural background, age, life
experience and loss history.




 



J 
 mp c"   




!

" mp   - 8 4
a.p You need to maintain an awareness of mp %
your own reactions to death, personal
experiences, and vulnerabilities. 
-  
b.p stay focused on addressing their
experience, needs, and challenges.
c.p If the situation has made you feel angry,
helpless or sad it is worth checking out
with the individual how they feel. mo
ensure that you are working with their
feelings and not yours.
·,  )!.
  !,
-͞YOA @I@ EVERYmcINM YOA COAL@͟
;,p  $)+
&, especially in the months ahead, when
they will be confronted with the gaps left by their
loved ones.
ÿ,p
.#$, affect each us.
mp mhis and other emotions are likely to be part
of the grief process. 
mp It is important to keep calm and to try and
understand the cause, always ensuring that

mp As healthcare is constantly developing and changing, so
education plays an important role in keeping all
professionals updated and informed of new practices in
order that patients can benefit from these innovations.
mp Palliative care is no exception, indeed, you may have
seen some television programmes highlighting the need
for improvements in supporting those faced with a life
limiting illness.
mp mhis has shown publicly how palliative care is rapidly
advancing.
mp Advancement means an even greater need to enlighten
and inform, not just healthcare professionals, but also
the public, it is after all an issue which will at some point

c
you are safe in the situation. -

 
mp If there is escalation then you should remove 
yourself and seek help /,p &!$!
u,p !&
Î,p  
r,p )&

 c-

 -
 %-
7
/,p 

9
 
 1.p Be willing to model, and teach the desired
u,p 

  behaviours, must be sincere when dealing with
 clients.
-

 


 
2.p Also demonstrate interest and caring in the welfare
1.p Protects patients rights. of others.
2.p Works on patient behalf. 3.p Be very inventive.
3.p Makes sure the patient is an active participant in 4.p cave a great sense of humor.
deciding what type of treatment he/ she will have. 5.p cave a very flexible attitude.
4.p Protects the patients right to have the treatment he/
 c -  c
 7
she have chosen.
5.p Recognize the significance of the meaning of the illness a.p A client may not be willing to help themselves- no
and the death for the family. one to guide them in bettering themselves.
b.p Clients would come back to the healthcare system
-c+! with no improvement of themselves- no one was
+&,' there in the first place to guide them properly.
-As a person is dying, the nurse advocate acting as a
supporter can provide much- needed comfort and r, "  
 
reassurance to the family members as they try to
-collaborate with other providers to give consistent
make sense of their impending loss and a future
information.
without their loved one.



5ÿ6 -
9"c
 -

=% 4c -
   c 

 4  
5
$5/åå/6
c   a.p Responding during the death sense.
b.p Providing comfort
An uninsured homeless man is being released from the c.p Responding to anger
hospital, but has no one to care for him and nowhere to go. d.p Enhancing personal growth
mhe nurse calls a social service organization and makes e.p Responding to colleagues
arrangements for his care. f.p Enhancing the quality of life during dying
g.p Responding to the family
Î,p  -
 
|

4  
 4 c-
 


-͞Any relationship in which one person is helping another 1.p upportive

person to better understand and solve some problem͟ 2.p Intensive caring, collaboration, continuous knowing
(CMR Canada (2003)). and continuous giving
-͞mhe process of helping a client recognize and cope with 3.p [ostering hope
stressful psychologic or social problems, to develop 4.p Providing comfort
improved interpersonal relationships, and to promote 5.p Providing an emphatic relationship
personal growth͟ (6ozier, Erb, and Blais, 1997). 6.p Clinical, consultative with teaching, leadership and
-mhe nurse in this role, is there to help a client to develop research functions
and see new feelings, behaviours and attitudes. 7.p Being there and acting on the patient͛s behalf
-mhis role require great communication skills. 
-mhe nurse in this role may have to lead group c68 -
8%-c>
counselling sessions, or one to one counseling and 
be very understanding.  4," , 

Jan. 15, 2011