Sumber gambar: https://www.closingthegap.ca/wp-content/uploads/2019/04/Palliative-Care-03-03.jpg
FILE PRESENTASI PELATIHAN PERAWATAN PALIATIF AKHIR HAYAT
Di STIKES TELOGOREJO SEMARANG, 19-21 SEPTEMBER 2022
Unduh:
https://drive.google.com/drive/folders/1FI28swbg9470LgI20AU7DkrQ38QJ-Bk4?usp=sharing
Bagaimana saya tahu berapa lama saya akan hidup?
Sulit untuk menebak kapan orang akan mati. Beberapa gejala yang dapat membantu dalam mencari tahu berapa lama seseorang mungkin harus hidup meliputi:
Menit ke jam : periode lama tidak bernapas selama lebih dari 30 detik pada suatu waktu
Jam ke hari : pernapasan tidak merata; bintik-bintik berwarna berbeda pada kulit; tekanan darah atau kadar oksigen yang sangat rendah; lengan dan kaki yang membiru
Hari ke minggu : tidak ada asupan cairan atau tidak ada buang air kecil
Minggu ke bulan : stopping treatment for a progressive illness, which is an illness that gradually gets worse (for example, cancer), in people who can't get out of bed.
Months to a few years: spending more and more time in bed because of exhaustion and symptoms of the illness
As your quality of life gets worse, it is important to set new goals. This is especially important if medical treatments are not working or are causing side effects. Make sure that medical treatments are helping you or your loved ones achieve your goals.
https://web.archive.org/web/20211113132944/https://www.aafp.org/afp/2009/0615/p1059-s1.html
https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.29602
SYNDROME OF IMMINENT DEATH
Stages of actively dying:
• Early
+ Bed bound
+ Loss of interest and/or ability to drink/eat
+ Cognitive changes: increasing time spend sleeping and/or delirium
• Middle
+ Further decline in mental status to obtundation (slow to arouse with stimulation; only brief periods of wakefulness)
• Late
+ Death rattle – pooled oral sections that are not cleared due to loss of swallowing reflex
+ Coma
+ Fever – usually from aspiration pneumonia
+ Altered respiratory pattern – periods of apnea, hyperpnea, or irregular breathing
+ Mottled extremities
https://www.mypcnow.org/wp-content/uploads/2019/01/FF-3-Imminent-Death.-3rd-ed.pdf
During the one year Palliative Medicine Fellowship,
fellows will gain expertise in the following domains:
🦋 Communication
🦋 Ethical and legal decision making
🦋 Pain in cancer and non-cancer patients
🦋 Management of non-pain symptoms
🦋 Medical co-morbidities and complications in populations with life threatening diseases
🦋 Neuro-psychiatric co-morbidities in populations with life-threatening diseases
🦋 Psychosocial and spiritual support
🦋 Death and dying
🦋 Bereavement
🦋 Quality improvement in populations with advanced illnesses
🦋 The hospice and palliative approach to care
🦋 Interdisciplinary team work
https://web.archive.org/web/20211015030204/https://static.medicine.iupui.edu/divisions/Palliative/content/Palliative_Medicine_Fellowship_Curriculum_-_Goals_and_Objectives.pdf
End-of-life care is provided to people who have a medical condition that means they are likely to die within the next 12 months. Care services include physical, spiritual and psychosocial assessment, and care and treatment delivered by health professionals and ancillary staff.
End-of-life care should be core business for residential aged care providers but the quality of end-of-life care in residential aged care is patchy at best. Too often, people are transferred back and forth between hospitals and aged care facilities, as aged care facilities lack palliative care expertise and qualified staff to administer pain relief.
“This guidance is not attempting to answer the question ‘how long have I got?’ but more in answer to the question ‘what can we do?’ and is in response to the common way of thinking ‘Hope for the best but prepare for the worst’.
Three triggers for Supportive/ Palliative Care are suggested - to identify these patients we can use any combination of the following methods:
1. The surprise question - ‘Would you be surprised if this patient were to die in the next 6-12months’ - an intuitive question integrating co-morbidity, social and other factors. If you would not be surprised, then what measures might be taken to improve their quality of life now and in preparation for the dying stage. The surprise question can be applied to years/months/weeks/days and trigger the appropriate actions. The aim is to enable the right thing to happen at the right time. Some clinicians find it easier to ask themselves ‘Would you be surprised if this patient were still alive in 6-12 months?’
2. Choice / Need - The patient with advanced disease makes a choice for comfort care only, not ‘curative’ treatment, or is in special need of supportive / palliative care eg refusing renal transplant
3. Clinical indicators – General and Specific indicators of advanced disease for each of the three main end of life patient groups - cancer, organ failure, elderly frail/ dementia.”
DEATH AND DYING ARE INEVITABLE
How we care for the dying is an indicator
of how we care for all sick
and vulnerable people”
(National End of Life Care Strategy 2008)
Palliative and end of life care must be a priority.
The quality and accessibility of this care
will affect all of us
and it must be made consistently better
for all of us.
The needs of people of all ages
who are living with dying, death and bereavement,
their families, carers and communities must be addressed,
taking into account
their priorities, preferences and wishes.
https://web.archive.org/web/20210122075739/http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-for-Palliative-and-End-of-Life-Care.pdf
‘PRINCIPLES OF A GOOD DEATH’,
are:
• to have an idea of when death is coming and what can be expected
• to be able to retain reasonable control of what happens
• to be afforded dignity and privacy
• to have control of pain and other symptoms
• to have access to necessary information and expertise
• to have access to any spiritual or emotional support required
• to have access to ‘hospice style’ quality care in any location
• to have control over who is present and who shares the end
• to be able to issue advance directives to ensure one’s wishes are respected
• to have time to say goodbye and to arrange important things
• to be able to leave when it is time and not to have life prolonged pointlessly.
Effective Palliative Care can ensure these principles are maintained and followed.
https://web.archive.org/web/20130411073516/http://www.grampiansml.com.au/resources/gp_doc_bag_270411_1_.pdf
PATIENTS ARE ‘APPROACHING THE END OF LIFE’
when they are likely to die within the next 12 months.
This includes patients whose death is imminent
(expected within a few hours or days)
and those with:
(a) advanced, progressive, incurable conditions
(b) general frailty and co-existing conditions
that mean they are expected to die within 12 months
(c) existing conditions if they are at risk of dying
from a sudden acute crisis in their condition
(d) life-threatening acute conditions caused by
sudden catastrophic events.
https://web.archive.org/web/20210516170456/https://www.gmc-uk.org/-/media/documents/treatment-and-care-towards-the-end-of-life---english-1015_pdf-48902105.pdf?la=en&hash=41EF651C76FDBEC141FB674C08261661BDEFD004
https://www.gmc-uk.org/search-results?searchText=end%20of%20life
WHAT DOES END OF LIFE MEAN?
End of life isn’t a period of time limited
to the final days, hours or weeks of life,
but a period when the person,
their family or healthcare professionals
recognise that the person might be
in the last phase of their life.
This will vary for different people.
https://web.archive.org/web/20210528013852/https://www.ucl.ac.uk/epidemiology-health-care/sites/epidemiology-health-care/files/demenita_rot.pdf
END OF LIFE CARE
End of life care is provided to a person
who is thought to be in the final months of life
and aims to help people live well until they die.
Good end of life care allows a person to die
with dignity when the time arrives,
and also ensures appropriate support is
provided to families and carers
before and after death.
End of life care
is not just for cancer sufferers
but for any condition
from which a person will not recover,
like dementia
or chronic obstructive pulmonary disease (COPD),
and those who are nearing the end of their life
as a result of age and frailty.
It also includes children and young people
with a terminal or life limiting illness.
In July 2013,
NHS Improving Quality collaborated with
the Association of Ambulance Chief Executives (AACE)
to publish a six step pathway for
the delivery of end of life care.
The key points that apply to the ambulance service are:
Step 1 – Discussions as the end of life approaches
Step 2 – Assessment, care planning and review
Step 3 – Co-ordination of care
Step 4 – Delivery of high quality care in an acute hospital
Step 5 – Care in the last days of life
Step 6 – Care after death.
https://web.archive.org/web/20210518212616/https://www.eastamb.nhs.uk/Policies/strategies/End-of-Life-Care-Strategy.pdf
Common causes of suffering in seriously ill:
Pain
Dyspnea
Nausea/vomiting
Weakness & fatigue
Insomnia
Anorexia +/-cachexia
Incontinence
Constipation
Agitation/Delirium
Anxiety
Depression
Sense of well-being
Uncertainty about future
Fear of disability
Fear of death
Hopelessness
Remorse
Loneliness
Loss of
- Meaning/Role
- Control
- Dignity
- Autonomy
ADVANCE CARE PLANNING
“While sudden changes in your life, such as you or a loved one being involved in an accident or becoming seriously ill, can be hard to prepare for emotionally, there are ways to ensure that you receive the type of compassionate care you want – when you need it most.” (https://coalitionccc.org)
- Advance Care Planning Resources | Advance Health Care Directive Coalition for Compassionate Care of California https://coalitionccc.org/tools-resources/advance-care-planning-resources/
- CACCC Home http://caccc-usa.org/
- Go Wish http://gowish.org/
- The Conversation Project - Have You Had The Conversation? https://theconversationproject.org/
- PREPARE https://prepareforyourcare.org/welcome
- Serious Illness Care - Ariadne Labs https://www.ariadnelabs.org/areas-of-work/serious-illness-care/
- Begin the Conversation: Healthcare planning http://www.begintheconversation.org/
- The Conversation Project - Introducing a Good Goodbye Weekly Radio Show https://theconversationproject.org/introducing-a-good-goodbye-weekly-radio-show/
- Product Reviews and Ratings - Consumer Reports https://www.consumerreports.org/cro/index.htm
- Aging with Dignity https://agingwithdignity.org/
- American Bar Association https://www.americanbar.org/
- Respecting Choices | Person-Centered Care https://respectingchoices.mystagingwebsite.com/
- Hello Game (Home Edition) https://commonpractice.com/products/hello-game
- Advanced Cancer Care Planning - advanced_cancer_care_planning.pdf https://www.cancer.net/sites/cancer.net/files/advanced_cancer_care_planning.pdf
- POLST: Portable medical orders for seriously ill or frail individuals https://polst.org/
- Advance Care Planning: Health Care Directives http://www.nia.nih.gov/health/advance-care-planning-health-care-directives
- Patients and Caregivers | NHPCO https://www.nhpco.org/patients-and-caregivers/
- Home https://acpdecisions.org/
- Effective Advance Care Planning Fundamentals - CSU Shiley Institute for Palliative Care https://csupalliativecare.org/courses/all-professionals/advance-care-planning/
COMPETENCY
Competency domains for physicians and nurses:
Physicians
1. Introduction to palliative care
History, philosophy and definitions
An approach to patients care in palliative care setting: whole patient assessment
Role of palliative medicine physicians in team approach
2. Palliative care system management
3. Communication
Principles of communication
Assess prognosis
Goals of care
4. Ethics in palliative care
Medical Futility
Physician assisted suicide
Advance care planning
5. Education and research
6. Physical care and treatment
Pain management
Cardiovascular & respiratory symptom
Gastrointestinal symptom
Urologic symptom
Psychological symptom
Other symptoms
Palliative emergency
7. Psychosocial care
8. Spiritual care
9. Care of dying patients and their family
10. Bereavement care
11. Pediatric & Adolescent care
Nurse
1. Pain management
2. Symptom management
3. Psychosocial care
4. Spiritual care
5. Communication
6. Care of dying patients and bereaved family
7. Management and quality assurance
8. Pediatrics & adolescent care
9. Psychological symptom care
10. Ethics in palliative care
11. Education
12. Research
Social worker
1. Advocacy, Ethics and Values
Ethics for hospice palliative care social worker
Empowerment and advocacy
2. Psychosocial care
Assessment
Care planning/intervention
Individual care
Group care
Family care
3. Community capacity building
Program development
Fund-raising and promoting
Access to community resource
Discharge planning
Supervise volunteers
4. Bereavement care
5. Evaluation, education and research
Evaluation and quality assurance
Education and research
Spiritual care providers
1. Communication
2. Ethics
3. Spiritual care
4. Religious care
A professional development model for nursing in palliative care
Okay kan, Bro!
IKA SYAMSUL HUDA MZ
