Palliative and End-of-Life Care Notes

Chapter 10: Palliative and End-of-Life Care

Overview of Palliative Care

• Definition: Focuses on assessment and management of pain and symptoms, caregiver support, and care coordination.
• Goals:
  • Reduce health-related suffering.
  • Improve quality of life.

Importance of Palliative Care

• Benefits Observed:
  • Improves quality of life for chronic illness patients.
  • Decreases healthcare costs.
  • Eases caregiver burden.
• Can coexist with curative treatment.

End-of-Life (EOL) Care

• Extends support to patients and families, planning for EOL needs.
• Post-Death Support: Includes grief and bereavement care.
• Importance of Communication:
  • Essential with patients and families; involves interdisciplinary collaboration.

Goals of Hospice Care

• Focus:
  • Provide compassion and support in last phases of a serious illness.
  • Ensure comfort and dignity at death.
• Requirements for Admission:
  • Patients must have six months or less to live.
  • No further curative treatment is provided.

Models of Hospice Care

• Available in multiple settings:
  • Hospital-based
  • Home health
  • Community or free-standing programs
• Services available 24/7.

Domains of Palliative Care

1. Structure and Processes
   • Holistic, coordinated care with team support.
   • Nurses act as advocates, provide direct care, educate, and reassess needs.
2. Physical Aspects
   • Focus on symptom management: assess and reassess symptoms continuously.
3. Psychological and Psychiatric Aspects
   • Address emotional and existential distress with therapeutic interventions.
4. Social Aspects
   • Evaluate environmental and social factors impacting quality of life.
5. Spiritual, Religious, and Existential Aspects
   • Respect patient and family beliefs; assess spiritual needs.
6. Cultural Care
   • Acknowledge and respect cultural beliefs; utilize interpreters as needed.
7. End-of-Life Care
   • Focus on comfort, quality of life, and dignified death.
   • Start hospice discussions early and collaborate with community resources.
8. Ethical and Legal Aspects
   • Honor patient preferences; provide necessary information for decision-making.

Advance Directives

• Definition: Documents outlining patient wishes for treatment, including end-of-life decisions.
• Types of Orders:
  • Full Code: All interventions.
  • DNI (Do Not Intubate).
  • Chemical Code: Drugs but no CPR.
  • No Code (DNR/AND): Comfort measures only.

Organ and Tissue Donation

• Can be decided before or after death; vital to document and follow legal protocols.

Concepts of Euthanasia and Palliative Care

• Euthanasia: Deliberate act to hasten death (not aligned with nursing ethics).
• Physician-assisted suicide: Permitted in some states, involves self-administering medication.
• Palliative sedation: Utilized for pain relief in dying patients without hastening death.

Psychosocial and Physical Manifestations at EOL

• Psychosocial Manifestations:
  • Feelings of overwhelm, fear, powerlessness, fatigue during the dying process.
• Physical Manifestations:
  • Respiratory changes, cardiovascular irregularities, gastrointestinal changes, general deterioration of physical condition, sensory changes.

Grief and Bereavement

• Understanding grief as a normal response to loss; can involve psychological and physiological reactions.
• Kubler-Ross Model:
  • Stages of grief: Denial, Anger, Bargaining, Depression, Acceptance.
• Importance of support for survivors and consideration of personal coping resources.

Cultural Considerations in Palliative Care

• Acknowledge the influence of cultural beliefs on treatment and responses to death.
• Care should accommodate cultural practices, language, and dietary needs.

Nursing Role in Palliative and EOL Care

• Focus on patient comfort and dignity throughout the dying process.
• Develop care plans that address physical, emotional, and spiritual needs.
• Provide education and encourage open communication.

Conclusion

• Palliative and end-of-life care plays a crucial role in supporting patients and families through difficult times, emphasizing dignity, respect, and compassionate care.
• It's essential for caregivers to recognize their emotional needs and seek support for their own well-being during this challenging journey.