WHEN PEOPLE ARE DYING:
PALLIATIVE CARE
Originally by:
Pamela Parrish, RN, CHPN
Clinical Consultant
School of Nursing, University of Pennsylvania
Diane Stillman, MSN, RN, CS
School of Nursing, University of Pennsylvania
Neville Strumpf, PhD, RN, C, FAAN
Edith Clemmer Steinbright Professor in Gerontology
Director, Center for Gerontologic Nursing Science and
Hartford Center of Geriatric Nursing Excellence
Rewritten in 2012 by:
Rebecca Trotta, PhD, RN
Hospital of the University of Pennsylvania
Introduction
The U.S. population is rapidly aging
Many people who live in a long-
term care setting will die there
The long-term care setting is an
excellent one for palliative care
Objectives
Understand the principles of palliative care
Understand importance of establishing goals
of care
Describe common physical and psychological
symptoms at end-of-life and ways to address
them using a palliative care approach
Describe ways to recognize the final hours
and how best to support resident, family and
staff, including spiritual and cultural
considerations
What is Palliative Care?
WHO definition
Different from traditional care
Different from hospice
A philosophy of care.
Who Benefits from
Palliative Care?
Residents
Family
Staff
Who Provides Palliative
Care?
A team approach is best
Anyone involved in the residents
care can provide some aspect of
palliative care
Who Provides Palliative
Care?
Nurse
Nursing Assistant
Physician
Social Worker
Dietitian
Chaplain
Physical/Occupational Therapist
Recreation Therapist
Developing a Palliative
Plan of Care
Agreed to by all members of
interdisciplinary team
Propelled by nursing
Addresses the following:
Goals of Care
Physical Symptoms
Psychological Symptoms
Spiritual Needs
Family Needs and Concerns
Liberalized Restrictions
Goals of Care
Hold family meeting with interdisciplinary
care team
Clarify that palliative care does not mean
withdrawing care
Focus on what will be done, not what will be
removed
Complete advance directives
Know various types
Understand that family may be overwhelmed
Frame plan to meet goals of care
Revisit plan frequently with team, including
family
Symptoms at End-of-Life
Pain
Common, complex
Respiratory Symptoms
Shortness of breath, coughing,
wheezing
Gastrointestinal Symptoms
Nausea, constipation
Psychological Symptoms
Depression, delirium, anxiety
Interventions
Around the clock vs. PRN medications,
especially for pain
Oxygen, nebulizers, diuretics,
antitussive w. codeine, prednisone
Anti-nausea medications, gentle bowel
stimulants
Anti-depressants, anxiolytics
Non-pharmacological therapies
Addressing Spiritual Needs
Dont wait until the last minute!
Offer religious music and/or icons
Arrange visit from religious leader
Facilitate rituals
Assist with funeral arrangements
Cultural Considerations
Everyone has one or more cultures
Race, ethnicity, religion, lifestyle
contribute to culture
Culture
Is manifested through values,
customs, behaviors & beliefs
Affects decision-making and views re:
death and dying and palliative care
Preserving Personhood and
Dignity
Cleanliness and odor control
Bathing and grooming
Face, hands, and feet
Mouth care, nail care
Clothing and bedding
Promote home-like environment
Pictures, bedding, personal items
Final Hours
Common symptoms are distressing
Pain, noisy breathing
Attend to symptoms and hygiene
Limit/withhold food and fluid intake
Maintain personhood
Talk to resident
Supporting the Family
Address questions
Provide information
Give suggestions on how to support
resident
Offer comforting items
Chairs, tissues, drinks
Offer interdisciplinary support
Social work, chaplain
Can You Now
Understand the principles of palliative care
Understand importance of establishing
goals of care
Describe common physical and
psychological symptoms at end-of-life and
ways to address them using a palliative
care approach
Describe ways to recognize the final hours
and how best to support resident, family
and staff, including spiritual and cultural
considerations
