Hospice & Palliative care

What does Hospice Care do?

* Support and care for persons in the last phase of an incurable disease so that they may live as fully and comfortably as possible.

Who does Hospice Care Supports?

Supports patient through dying process and survivors through bereavement.

What does Palliative care seeks?

Seeks to prevent, relieve, reduce, or sooth the symptoms of disease or disorder without effecting a cure

When is palliative care appropiate?

Appropriate at any point along an illness trajectory

Where do patients often transition after palliative care?

Hospice Care!

What is the role of the CNS in the management of this problem?

Demonstrates advanced clinical judgment and decision making, based on expert knowledge and skill in the assessment, diagnosis, planning, and management of complex human responses to life- limiting, progressive disease

What does Advocacy and Ethics incorporates to palliative care?

Incorporates ethical principles and advanced practice professional standards in the care of patients and families receiving palliative care, while advocating for patients' and families' rights and access to quality palliative care.

What does clinical Judgement demostrated as standards of Hospice and Palliative practice?

Demonstrated knowledge, skill, and attitudes that are consistent with the advanced Scope and Standards of Hospice and Palliative Practice and ANA Code of Ethics for Nurses.

What does Collaboration promotes?

Promotes an interdisciplinary health care team approach to providing advanced hospice and palliative care nursing to the patient, family, community, and environment related to the potential or actual disease process and treatments.

What does System Thinking do?

Manages and negotiates the health care delivery system to enhance quality of life for patients and families experiencing life-limiting, progressive illness and facilitate the provision of comprehensive, coordinated care within and across health care settings.

What does Cultural and Spiritual Competence Demostrates and promotes in palliative care?

Demonstrates and promotes culturally and spiritually competent care by respecting diversity, regarding culture, spirituality, gender, socioeconomic status, sexual orientation consistent with the advanced Scope and Standards of Hospice and Palliative Nursing Practice and ANA Code of Ethics for Nurses.

What does a Facilitator of Learning do in Palliative Care?

Demonstrates knowledge, skill, confidence and the application of adult learning principles when providing palliative care education to patients' families, health care professionals, and the community.

How is the Communication in Palliative care?

Communicates effectively with palliative care patients, families, and health care professionals by applying knowledge of community theory and principles.

How does Palliative Care uses Research?

Utilizes research to identify, examine, validate, and evaluate current theories and palliative care patients, families, and the community.

What are the three Major studies paint and grim picture of the experience of Dying in America?

1) SUPPORT, 1995; Different choice then.
2) Field & Cassel, 1997; IOM improving support.
3) Last Acts, 2002; health care professional lack knowledge.

How people died in the Past?

-Late 1800's.
-Early to mid 1900's.
* People died at home of Natural Death!

Why the Need for Improved Palliative Care?

Because 50% or > experienced Severe pain during Death.

What is the purpose of the POLST?

Physician Orders for Life Sustaining Treatment (POLST). Its purpose is to allow you and your doctor the opportunity to discuss your end-of-life decisions, put those choices in writing and make them enforceable through a physician's order.

What was the cause of Death in the Early 1900?

Infectious Diseases and Communicable disease.

What is the Current cause of Death ?

Chronic Illness.

What are some of the barriers to quality Care at the End of Life?

*Realities of life Limiting Diseases
-Failure to acknowledge the limits of medicine.
-Inapropiate use of aggressive curative treatment
-Difficulties with pronostication

What are other Barriers to Quality Care at the End of Life?

*Lack of adequate Professional Training.
-Little attention in end-of-life medical or nursing curriculum.

Why the Delayed Access to Hospice and Palliative Care?

-90% prefer to Die at home
-Most Die in Hospitals, LTC.
-Only 1 in 5 enroll in Hospice

What is the length of stay in hospice?

Average of 4 weeks (median 20 days)
Approximately 20%-35% Die within 1 week

What are the qualifications for Hospice?

6 moths or < Life Expectancy.

What are the principles of Hospice and Palliative Care?

Improve QOL for patients with incurable diseases.

What services does Hospice includes?

-Physician Services
-Nursing Care
-Medical appliances and supplies
-Drugs for symptom management and pain relief
-Short term impatient and respite care (5 days)

What other services does Hospice includes?

-Homemaker and home health aid
-counseling
-Social Work Service
-Spiritual Care
-Volunteer Participation
-Bereavement Services

What are the hospice Medicare Benefit Eligibility Criteria?

-The patient's doctor and the hospice medical director use their best clinical judgment to certify that the patient is terminally ill with life expectancy of six months or less, if the disease runs its normal course.
-The Patient chooses to receive hospice care rather than curative treatment for their illness.
-The patient enrolls in a Medicare-approved hospice program.

Who does Hospice reimbursement?

-Medicare pays a per Diem rate intended to cover all expenses related to the terminal illness.

What are the four Level of Care that Medicare Hospice benefits provide?

1) Routine Home Care
2) Continuous Home Care
3) Impatient Respite Care
4) General Impatient Care

How much is the Hospice reimbursement?

-Per Diem is Approximately $120 per day.
-Cost of New drugs and treatments have risen faster than Hospice benefit reimbursement rates.

What does Medicare Certified hospices must offer?

All services even if the patient is not covered by Medicare and does not have the ability to pay.

What should you re-address all the time in Hospice and Palliative Care?

Changes in Goals of Care.

What are the focus of General Principles of Palliative Care?

-Patient and family as unit of care
-Attention to physical, psycholoical, social, and spiritual needs
-Interdisciplinary team approach

What other focus of General principles?

-Education and support of patient and family
-Extend accross illnesses and settings
-Bereavement support

What are the Palliative Care Across Settings and Specialties?

-ED, Prisons, NICU, ICU, L&D, Pediatrics, Ambulatory care, OR, Oncology, Acute Care, LTC, Homecare, City Streets.

Who are valuable resources to improve palliative care accross settings and specialties?

Advanced Practice Nurses are a valuable resources to improve and address the needs of patients and families facing life-threatening illness in a variety of clinical settings.

What are the Societal factors that influenced the development of advanced practice Nursing?

-Aging of the population
-Technological advances
-Economic changes

What are the Roles of the advanced Practice Nurse in Palliative Care?

-Expert Clinician
-Educator
-Researcher
-Manager/Administrator

What are the assessment tools for palliative care?

-Physical symptoms
-Emotional symptoms
-Spirituality
-Quality of life
-Caregivers Outcomes

What are some of the tools of Prognostication?

-Performance Status (Karnofsky-ECOG poor predictor)
-Multiple symptoms
-Biological markers (e.g. Albumin)
-"Would I be surprised if this patient died in the next 6 month?

What is CONFHER Model?

*Brief Cultural Assessment.
C: communication
O: orientation
N: nutrition
F: family relationships
H: health and health beliefs
E: education
R: religion

How can advanced Practice Nurse impact end-of-life care?

By use of Research, evaluation of practice, and participation in collaborative research.

What are the models of Quality of Life?

-Physical Well-Being
-Psychological Well-Being
-Social Well-Being
-Spiritual Well-Being

What are the physical Competencies?

-Functional ability
-Stregth/fatigue
-Sleep & rest
-Nausea
-Appetite
-constipation & Pain

What are the Psychological competencies?

-Anxiety
-Depression
-Enjoyment/leisure
-Pain Distress
-Fear, Cognition/Attention

What are the Social Competencies?

-Finantial Burden
-Caregiver Burden
-Roles & relationships
-Affection/Sexual Function
-Appearance

What are the Spiritual competencies?

-Hope
-Suffering
-Meaning of pain
-Religiosity
-Transcendence

What is the concept of Suffering?

-State of severe distress that threatens intactness of the person
-Failure to respond to patient needs intensifies suffering.

What are the opportunities to Growth?

The last phase of life provides continued opportunities for positive growth in the face of suffering

In conclusion hospice and palliative care helps:

-Expanding the concept of healing
-Quality palliative care addresses quality-of-life concerns.

What is the greatest gift to the patients and their families?

Presence!

Who individually or collectively as a profession play a vital role in improving care at the end of life?

Advanced Practice Nurses!