Class notes
NURS 4183 Chapter 9 Lecture Notes
- Course
- NURS 4183
- Institution
- Prairie View A&M State University
This is a comprehensive and detailed lecture note Ch. 9;Palliative Care at End of Life for NURS 4183.
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Ch. 9- Palliative Care at EOLPalliative Care
Any form of treatment that focuses on reducing the severity of disease symptoms
Goals: prevent and relieve suffering; improve quality of life for pts w/ serious life-limiting illness
Palliative care extends into the period of EOL care
Bereavement care follows the pts death
The care that relieves symptoms and emotional support to the pt, family, and significant others during the terminal phases is called
palliative care at the EOL
Palliative care can
o Improve quality of life for people who have chronic illnesses
o ↓ the associated economic cost for their healthcare
o Alleviate the burden of caregivers for those w/ chronic and terminal illness
Initiated after the dx of a life-limiting illness
What is driving the need for palliative care?
o Demographic changes (baby boomers)
o Health care technology = longer life and increased older adults
o Older adult have multiple illnesses = increase in using healthcare
o The palliative care team: physicians, nurses, social workers, pharmacists, chaplains
o Setting of palliative care: home; long-term and acute care; mental health facilities; rehab centers; prisons
Hospice Care
Included in palliative care before or at the EOL
Not a place but a concept of care that provides compassion, concern, and support for persons in the last phases of a terminal disease
Goals : assist the pt to live fully as comfortable as possible and die pain free and w/ dignity
Care emphasizes on symptom management, advance planning, spiritual care, and family support
Hospice care vs palliative care
o Palliative care allows a person to simultaneously receive curative and palliative tx
o Hospice care is provided when the physician determines a person has 6 months or less to live, and that person or health care
proxy decided to forgo curative tx
Often underutilized b/c people think you can only use it if someone is actively dying
, Majority of hospice programs include people over 65 and white
Most common dx for people in hospice care is cancer and heart disease
The current median length of stay is 21 days
Hospices can be hospital-based, community-based, or free standing
Setting of hospice care is similar to palliative care and a 24/7 in home service
Inpt allow the atmosphere to be at home-like as possible
Nurses role
o Must work w/ interprofessional team to provide holistic approach
o Educated in pain control and symptoms management, spiritual assessment, and assessment and management of family needs
o Meet pt and family needs, the hospice nurse needs excellent teaching skill, compassion, flexibility, cultural competence, and
adaptability
What makes hospice decisions so hard!
o Lack of information b/w families and HCPs
o Ethnicity and cultural views
Lack of awareness
Desire to continue w/ potentially curative therapies
Concerns about lack of minority hospice workers
o Physicians don’t give the referral b/c they view the pt's decline as their personal failure
o Some family members see it as giving up
Hospice care is covered by Medicare, Medicaid, and private insurance
Criteria for admission
o Pt must desire the services and agree in writing that only hospice care (and not curative care) can be used to treat the terminal
illness
Pt can w/draw from program at any time 9e.g., if their condition unexpectedly improves)
Can receive care from other health problems that are not rt the terminal illness, but may not be covered by hospice,
Medicare, Medicaid, or pt’s insurances
o Pt must be considered eligible for hospice
Require 2 physicians to determine the pt prognosis is terminal, less than 6 mo. To live
After initial certification, only 1 physicians needs to recertify
It is important to know that the physician who certified that a hospice pt is not guarantee death w/in 6 mos
, If pt survives beyond 6 months, Medicare and other reimbursement organizations will continue to reimburse for more
extended periods of tx if the pt still meet enrollment criteria
What if they get better?
o Pt may be discharged
o Decision may be made after review of tx plan and input from family members of the interprofessional hospice team
Death
Occurs when all vital organs and body systems cease to function; Irreversible cessation of cardiovascular, respiratory, and brain function
Brain death: irreversible loss of all brain function including those of the brainstem
o This is a clinical dx and occurs when the cerebral cortex stops functioning or is irreversibly destroyed
American Academy of Neurology diagnostic criteria for brain death:
o Coma or unresponsiveness
o Absence of brainstem reflexes
o Apnea
o Specific assessments by a physician are required to validate each of the criteria
Currently, legal and medical standards require that all brain function must cease for brain death to be pronounced and lie support to e
disconnected
End-Of-Life (EOL) Care
Refers to the final phase of a pt's illness when death is imminent
According to the Institute of Medicine define EOL as the period during which an individual copes w/ declining health from a terminal
illness or from the frailties associated w/ advanced age, even if death isn’t clearly imminent
EOL is used for issues and services r/t death and dying
EOL goals
o Provide comfort and support during the dying process
o Improve the quality of the pt's remaining life
o Help ensure a dignified death
o Provide emotional support to the family
Physical Manifestation
o Metabolism reduces and body gradually slows down until all functions end
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