PALLIATIVE CAREPalliative Care Team

Heart of England NHS Foundation Trust

AIMS:-• To define what we mean by palliative care• To define what we mean by end of life

care• To identify the needs of patients that are

dying• To highlight what the needs of the family

are when a patient is dying• To identify the role of the HCA in caring

for patients at end of life and their families

• To identify factors that lead to a ‘good’ or ‘bad’ death

OBJECTIVESAt the end of the session HCA’s should be

able to:-• Define what we mean by palliative care• Define what we mean by dying• To enable HCA’s to recognise signs that a

patient may be dying• Identify the most important aspects of

care for a patient at end of life• Appreciate the needs of the family and

their main concerns at end of life

>4,000 Patient Deaths at HoEFT

per Year!

Aim of palliative Care

The goal of palliative care is the achievement of the best possible quality of life for the patients and their families.

(WHO 1990)

DEFINITION OF PALLIATIVE CARE

………to achieve the best quality of life for individuals with any advanced, progressive illness, and their families, by the management of their physical symptoms and the provision of psychological, social and spiritual support.

World Health Organisation 2002

End of Life Care Strategy50% of complaints are related to end

of life care in some way.Of 50 cases looked at relating to end

of life care the complaints were around poor communication, lack of basic comfort, privacy and psychological care, and late or no referral to palliative care

Relatives are often the 1st to notice a patient is dying!

DoH 2008

DEFINITION OF DYING

‘If the patient has a progressive incurable disease, if reversible causes of deterioration have been excluded (eg infection, hypercalcaemia) and if they are very weak and drowsy and getting weaker every day, then they are dying.’

(Kaye 1999)

Recognising a Dying Patient

End of Life Care-a daunting prospect ! !

REMEMBER

“all the care she received before meant nothing, because she died the way she died”

Husband of 43yr old lady who died in hospital

“There is little time and only one chance to

get it right”

Common End of Life Symptoms

• Pain• Agitation / terminal restlessness• Nausea / Vomiting• Moist Chest

How does focus of care change?

• Investigations become irrelevant.• Aiming to prolong life becomes

irrelevant.• Patient comfort takes priority.• Increased support for the family is

needed.(Kaye 1999)

Other considerations• Maintaining patient privacy and

dignity• Ensuring patients wishes are

respected• Support of family.• Place of death.• Spiritual requirements of patient.• Staff support

Cultural and Social Issues

• Social taboos• Social denial of death• Materialism • Role of religion• Experience of loss in the family• Expectations of health and life

HCA ROLE• Maintaining privacy and dignity • Provision of good essential nursing care• Respecting wishes of patients and families • Listening to patients and families • Spending time with patients and their

families• Communicating with patients and families• Communicate with other team members• Recognising your own limitations and

areas of concern

What do we mean by Essential Nursing Care

• Meeting patients hygiene needs• Providing good oral care• Monitoring of micturition• Maintaining regular bowel pattern• Regular visual observation• Appropriate pressure relief/skin careNB:- Think of caring for that person as

you would wish a loved one to be cared for!

CommunicationWith dying patients and their

relatives

Barriers perceived by patients

• Perceive Doctors/nurses as too busy

• Believe Doctors/nurses primarily concerned about physical care

• Don’t want to burden them with their worries

• Think their perspectives may depend on treatments so don’t want to complain

Continued . . .• Think their

worries are silly or trivial or that professionals will think that.

• Fear of admitting being unable to cope, breaking down, losing control.

• Not being able to find the words to explain how they feel.

• Anxiety about having their worse fears confirmed.

Barriers to communicationby Staff

Being frightened of– - upsetting the patient– - causing more harm than good– - being asked difficult/unanswerable

questions– - saying the wrong thing

Continued. . .

Feeling that – - there is not enough time– - cannot handle the emotions of patient or

themselves– - not knowing enough– - not being part of their job– - not being able to do anything about the

situation/helplessness

Skills Required forGood Communication

• Listening• Body language• Clinical skills/knowledge base• Awareness of family dynamics• Self awareness

• Managing time, boundaries, endings• Empathy• Advocacy• Touch• Responding appropriately

Non-verbal• Eye contact• Nodding• Sit down• Close door/pull curtain across• Switch off mobiles• Plan time for talk

Verbal• Checking• Respond to emotional distress• Use open questions• Ask directly how they are ‘feeling’,

(psychological state)• Make supportive comments

Words to tryWhen you think you

want to say:• You are going to be just

fine.

• Don't talk like that! You can beat this!

• I can't see how anyone can help.

• What do the doctors know? You might live forever.

• Don't be glum. You will get well.

Try this instead:• Are there some things

that worry you?

• This must be hard to come to terms with

• We will work with you.

• Do you think the doctors are right? How does it seem to you?

• It must be hard. Can I just sit with you for a while.

Key Points• Ensure patients privacy and dignity

are maintained at all times.• High quality essential nursing care

is a priority• Good communication with both

patients and relatives is essential• Recognising spiritual needs of

patients is important