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Palliative and Hospice CareAn IntroductionModule 1Module 1 ObjectivesDescribe the historical trends that led to the Hospice and Palliative Care movements. Define a good death.Compare and contrast hospice care and palliative care. IntroductionBetween the 1960 and 1970 advances in diagnosis and procedures made treatment of disease achievable. The physician became the expert and decision maker in disease management and what was best for the patient. At the same time the trend to die at home surrounded by family shifted to patients dying in the hospital. Often medical treatments were given to patients whose outcome would not change with the treatment. This type of approach is expensive, involves the patient and family in painful medical procedures at the end of life and diverts attention from helping the patient achieve the most they can from their dying days. Introduction Days when patients might be able to focus on what they would still like to achieve. Such as healing relationships with family and friends and God. Recently a major legal focus has been on DNR orders, advanced directives and other forms of documents about life sustaining treatments. These documents focus on what will not be done instead of what a patient and family can expect from the palliative care team. Changing Death TrajectoryImproved nutrition, antibiotics, sanitation, preventive medicine, and vaccinations plus a healthier population worldwide has resulted in fewer deaths in infancy or childhood or from acute illness.Improved medical care globally has improved the ability to prolong life. In the United States the majority of deaths are over 65 years of age and from persons suffering from chronic debilitating illness such as cancer, cardiac disease, renal disease, lung disease and AIDS.Changing death trajectoryBecause most palliative care programs began in oncology settings people often forget that patients with chronic debilitating diseases like heart disease and emphysema can benefit from a palliative care team (Kuebler, Heidrich, & Esper, 2007, Chapter 1). Palliative care arose from the hospice movement as a result of the change in death trajectory.

Good versus Bad DeathThe IOM report on improving care at the end of life defines a good death as one that is free from avoidable distress and suffering for patients, families, and caregivers and that is in accord with a patient and their familys wishes and consistent with clinical, cultural, and ethical standards (p. 24). Interprofessional ApproachThe IOM report focused on the interdisciplinary nature of palliative care of which nursing is the core discipline. In palliative care the emphasis is on the patient and the control of symptoms and psychological distress.The relationship with the nurse or caregiver is at the forefront whereas in the tradition disease focused model the individual and their relationship to their care provider is of little importance.In palliative care the nurse counts and the nurses relationship with the patient and the family counts. Of course it is not just about the relationship the nurses knowledge and skills are also important.

Interprofessional team Physician/ Nurse PractitionerNurseClergySocial workerChild life counselor Hospice CareHospice was developed as a concept by Cicely Saunders.In 1999 the National Hospice and Palliative Care Organization (NHPCO) described hospice philosophy as follows: hospice provides support and care for persons in the last phases of incurable disease so that they may live as fully and as comfortably as possible. Hospice CareHospice is based on the understanding that dying is part of the normal life cycle.Hospice provides comprehensive palliative medical and supportive services compassion and care with the goals of comfort and quality of life. Hospice supports the person and the family so the remainder of a persons life is lived with dignity and in a manner that is meaningful to them.

Hospice Care Hospice recognizes dying as part of the normal process of living and focuses on enhancing the quality of remaining life.Hospice affirms life and neither hastens nor postpones death. Hospice exists in the hope and belief that through appropriate care, and the promotion of a caring community sensitive to their needs that individuals and families may be free to attain a degree of satisfaction in preparation for death. Hospice recognizes that human growth and development can be a lifelong process. Hospice seeks to preserve and promote the inherent potential for growth within individuals and families during the last phase of life. Hospice CareHospice provides state of the art palliative care and supportive services to individuals, families, and significant others 24 hours a day, 7 days a week inpatient and in the home settings. Physical, spiritual, and emotional care is provided by an interdisciplinary team. Hospice CareAs physical abilities decline spiritual and emotional dimensions take on greater meaning.Life goals may change and what one feel is quality of life may change. The hospice Medicare program was designed to support patients and families who were caring for patients in the last six months of life at home. Hospice CareHowever it does not take into account the elderly dying of chronic illnesses who are on a continual downward spiral as the result of several chronic illnesses for which there is no cure and that will eventually result in death. For hospice the focus is quality of life closure.

Palliative Care (ELNEC)Palliative care is both a philosophy of care and an organized, highly structured system for delivering care. Palliative care expands traditional disease model medical treatments to include the goals of enhancing quality of life for patients and families, optimizing function, helping with decision-making and providing opportunities for personal growth. As such, it can be delivered concurrently with life-prolonging care or as the main focus of care. Hospice Versus Palliative CareHospice CareIntense form of palliative care.Less than six months to live.Agrees to enroll in. Chooses not to received aggressive or curative care. Palliative CareCan begin at the time of diagnosis.No life expectancy requirement. Can compliment curative treatments. http://www.capc.org/building-a-hospital-based-palliative-care-program/case/definingpc

Specialty Areas for Palliative carePediatrics Elderly Stroke patientsNursing home patientsICU patientsOncology patients