Palliative Care is the combination of active and compassionate therapies.
It strives to meet physical, psychological, social and spiritual needs while remaining sensitive to personal, cultural and religious values.
“ The person who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing or healing, and face with us the reality of our own powerlessness that is the person who cares”
Henry Nouman
Needs (rights) of the dying person:
-to be free of pain, yet alert
-to have the companionship of family and friends
-to be accepted as the person they have always been
-to maintain their individuality
-not to die alone
-not to be a burden to their family or caregivers
-to be cared for and remembered with love and respect
-to have familiar things around them
-to have their family be alright, to know they will continue living and loving after clients death
ENCOURAGEMENT!
“TO FILL WITH COURAGE”
Positive Reframing
“ We can’t cope any longer “
“ I’m terminal “
“ I hate complaining “
“ He’s giving up “
Relaxation Tips
-Visualization
-music
-healing hands
-video
-humor
“Harold”
Coping Strategies
“ We cope as we have historically coped with lives challenges “
Power of Metaphors
“ If you were visiting a country which fell under siege AND could be taken away at any moment, what would you say to your ______?
WHAT DOES THE DYING PERSON FEAR?
WHAT COULD THE CAREGIVER FEAR?
COMMUNICATION SKILLS TO BENEFIT CLIENT, THEIR FAMILY AND YOU.
BeS ______
O ______
L ______
E ______
R ______
Be aware of verbal and non-verbal distancing
“ Some questions have no answers”
Honesty and Trust are crucial
CHILDREN AND GRIEF
Suggested Reading: Eda LeShan
“Learning to Say Goodbye”
PHYSICAL SYMPTOMS OF GRIEF
-95% sleep disturbance
-80% diarrhea or constipation
-50% nausea, irregular heart beat or other cardiac dist.
-80% wake early
Other: menstrual changes, sexual disfunction, depression, weight loss or gain.
PSYCHOLOGICAL SYMPTOMS OF GRIEF
-80% guilt or feelings of futility
-75% edgy, easily irritated
-70% cry often
-90% poor concentration, indecisive
-60% poor memory
*5 times higher death rate for bereaved during 1st year
Mouth Care
3 Common Challenges
1-Dry Mouth
2-Sore Mouth
3-Coated Tongue
Tips:
- avoid glycerine swabs for long term need
-observe and report white spots on red tongue (thrush)
-skin lesions, cracks
-swab tongue & mouth with fresh pineapple juice (unsweetened ) or diluted hydrogen peroxide
-Rx ice chips, juicicles
-Diluted mouthwash or 1tsp baking soda in 1 cup of warm water
Skin Care and Positioning
Prevention of Concerns:-bedding and other aides
-positioning
-gentle care
Observations and Reporting:- #1 observe! Know the clients status
Comfort Measures:Rx:
Odour Control / Body Wastes
Challenges occur from…
Precautions for Staff
Tips…..
NAUSEA & CONSTIPATION
CAUSE
PREVENTION
Rx
“ If you can keep your clients bowels active,
it’s like you can walk on water.”
PAIN ISSUES
“ Pain is typically well controlled in 85% of cases, 5% of the remaining 15% can be a real challenge “
Total pain is the sensation of pain combined with emotional feelings. The # 1 psychological component of pain is FEAR!
Pain is subjective- it is whatever the client perceives it to be.
Your role…….
Factors that INCREASE a clients pain threshold
-adequate sleep/rest
-pain Rx
-symptom control
-trust
-spiritual support
-relaxation Rx
-a sense of purpose
-being cared for and allowed to care for others
(support privacy – not seclusion)
Factors that DECREASEone’s pain threshold
-anger, sadness
-anxiety
-boredom
-discomfort
-guilt
-fatigue
-insomnia
-family disturbances
-remembering past pain
-anticipating future pain
CARE OF THE BODY
**Defer to policy of the operator
-Remove all pillows except one under head
-Bath the body
-Leave dentures in place
-Close eyes, but do not press on the eyeballs
-Keep body flat with arms and legs straight
-Move body gently to avoid bruising
-Check with family regarding the removal of jewelry that client may be wearing
-Any tubes or catheters will be removed only by staff qualified to put them in
RECORD IN THE CLIENT NOTES
-time of death
-circumstances leading up to death
-client terminal state ( no respiration, no pulse, no blood pressure )
-the instructions received from the nurse
-the nature of care given to client and the family
-All notification i.e. physician, funeral home, family….
-disposition of valuables
-Transfer of body to funeral home
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