T When People Are Dying:

L Palliative Care
C
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

L Neville Strumpf, PhD, RN, C, FAAN

T Edith Clemmer Steinbright Professor in Gerontology
C 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

Geriatric Education Center of Greater Philadelphia

T
L
C
Introduction

• The U.S. population is rapidly aging

• Many people who live in a long-term
care setting will die there
L • The long-term care setting is an
T
C excellent one for palliative care

Geriatric Education Center of Greater Philadelphia

T
L Objectives
C • 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
L them using a palliative care approach
•T Describe ways to recognize the final hours and
C
how best to support resident, family and staff,
including spiritual and cultural considerations

Geriatric Education Center of Greater Philadelphia

T
L
C What is Palliative Care?
• WHO definition
• Different from traditional care
• Different from hospice
L • A philosophy of care….
T
C

Geriatric Education Center of Greater Philadelphia

T
L Who Benefits from
C
Palliative Care?
• Residents
• Family
• Staff
L
T
C

Geriatric Education Center of Greater Philadelphia

T
L
C
Who Provides Palliative Care?

• A team approach is best

• Anyone involved in the resident’s

L care can provide some aspect of
T
C palliative care

Geriatric Education Center of Greater Philadelphia

T
L
C Who Provides Palliative Care?
• Nurse
• Nursing Assistant
• Physician
• Social Worker
L
T • Dietitian
C
• Chaplain
• Physical/Occupational Therapist
• Recreation Therapist

Geriatric Education Center of Greater Philadelphia

T
L Developing a Palliative
C Plan of Care
• Agreed to by all members of
interdisciplinary team
• Propelled by nursing
• Addresses the following:
L – Goals of Care
T – Physical Symptoms
C
– Psychological Symptoms
– Spiritual Needs
– Family Needs and Concerns
– Liberalized Restrictions
Geriatric Education Center of Greater Philadelphia
T
L Goals of Care
C
• 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
L • Complete advance directives
T – Know various types
C – Understand that family may be overwhelmed
• Frame plan to meet goals of care
• Revisit plan frequently with team,
including family
Geriatric Education Center of Greater Philadelphia
T
L Symptoms at End-of-Life
C
• Pain
– Common, complex
• Respiratory Symptoms
– Shortness of breath, coughing,
wheezing
L
T • Gastrointestinal Symptoms
C
– Nausea, constipation
• Psychological Symptoms
– Depression, delirium, anxiety
Geriatric Education Center of Greater Philadelphia
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L
C Interventions
• Around the clock vs. PRN medications,
especially for pain
• Oxygen, nebulizers, diuretics,
antitussive w. codeine, prednisone
L
•T Anti-nausea medications, gentle bowel
Cstimulants

• Anti-depressants, anxiolytics
• Non-pharmacological therapies
Geriatric Education Center of Greater Philadelphia
T
L
C Addressing Spiritual Needs

• Don’t wait until the last minute!

• Offer religious music and/or icons
• Arrange visit from religious leader
L
T • Facilitate rituals
C
• Assist with funeral arrangements

Geriatric Education Center of Greater Philadelphia

T
L
C Cultural Considerations
• Everyone has one or more cultures
• Race, ethnicity, religion, lifestyle
contribute to culture
• Culture
L
T – Is manifested through values,
C customs, behaviors & beliefs
– Affects decision-making and views re:
death and dying and palliative care

Geriatric Education Center of Greater Philadelphia

T
L Preserving Personhood and
C
Dignity
• Cleanliness and odor control
• Bathing and grooming
– Face, hands, and feet
L • Mouth care, nail care
T
•C Clothing and bedding
• Promote home-like environment
– Pictures, bedding, personal items

Geriatric Education Center of Greater Philadelphia

T
L
C Final Hours
• Common symptoms are distressing
– Pain, noisy breathing
• Attend to symptoms and hygiene
• Limit/withhold food and fluid intake
L
•T Maintain personhood
C
– Talk to resident

Geriatric Education Center of Greater Philadelphia

T
L
C Supporting the Family
• Address questions
• Provide information
• Give suggestions on how to support
resident
L
T• Offer comforting items
C –
Chairs, tissues, drinks
• Offer interdisciplinary support
– Social work, chaplain

Geriatric Education Center of Greater Philadelphia

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L Can You Now…
C
• 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
L them using a palliative care approach
T
• CDescribe ways to recognize the final hours
and how best to support resident, family and
staff, including spiritual and cultural
considerations

Geriatric Education Center of Greater Philadelphia