palliative care

• palliative care: medical and nursing care that focuses on relieving pain and increasing the quality of life of those with chronic conditions
• palliative care is applicable to all age groups, crosses all healthcare settings, pts may still receive curative treatments, pt is the center of care and decisions
• hospice care: focuses care on pts who are predicted to have less than 6 months to live
• hospice care is mainly pain and symptom management (NO curative treatment)
• domain 1: plan of care is developed (pt goals, preferences, and values)
• domain 2: assess, treat, and document physical symptoms (pain, dyspnea, constipation, nausea)

  pt outcomes must also be documented
• domain 3: assess and document psychological symptoms (anxiety, depression, delirium, and coping by pt and family)
• domain 4: social aspects of care

  assessment of family and pt understanding of disease and treatment

  education and clarification of proposed treatment expectations

  collaborating with pts and family to determine goals and wishes
• domain 5: incorporating spiritual, religious, and existential concerns and practices into plan of care; everyone believes in something
• domain 6: assessment and recognition of cultural beliefs about care; how and who makes decisions, how or who information is disclosed, diet, family communication
• domain 7: care of the imminently dying

  symptom management, asses for signs of impending death, family support, good death, and postmortem care
• early stage of death: acceptance that death is approaching; pt may begin to withdraw, loss of interest in social contacts, loss of appetite, sleeping more
• middle stage of death: weeks before death; decline in mental status (more confused and disoriented), sleeping most of the time, decrease in body temperature and BP, pulse rate may become irregular, respirations become labored and rapid, speaking slows or ceases
• late stage of death: days or hours before death; very brief and limited surge of energy then coma ensues, extremities become cool and mottled, loss of ability to manage secretions, congestion in airways causing respirations to become loud and wet
• hearing is thought to be one of the last sense to go before death, so care should be taken as if the dying person is aware and able to hear even if they are unresponsive
• good death: appropriate pain and symptom management, avoiding a prolonged dying process, clear communication about decisions, adequate preparations for death by pt and loved ones, feeling sense of control, not being alone
• domain 8: ethical and legal aspects of care
• domain 9: ethical and moral distress
• moral distress: the inability to do the morally right thing d/t multiple different factors
• nurse self care: perform postmortem care together, sending the family a bereavement card, its okay to cry with the family, talk to other nurses, seek out employee support resources, and develop healthy coping skills
• key points:

  death occurs to everyone and all ages

  pts and families should be the center of decision making

  its not about you

  symptom management is very important for a good death

  self care is essential to continue to care for others