rural palliative care networking group meeting · 1/28/2014 · kazanowski m. symptom management...
TRANSCRIPT
![Page 1: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/1.jpg)
Rural Palliative Care Networking Group MeetingJanuary 28, 2014
Staples, Minnesota
![Page 2: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/2.jpg)
Agenda
• Welcome and Introductions
• Educational Session
– Symptom Management at End-of-Life Part II
– Presented by Laura Scherer, RN, Director,
Unity Family Home Care and Hospice
• Round-robin discussion
• Wrap-up and next steps
![Page 3: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/3.jpg)
Clinical Review for the
Hospice and Palliative Nurse
Symptom Management
3
Anxiety, Delirium/Agitation. and Depression
![Page 4: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/4.jpg)
Objectives
1. Define anxiety, delirium/agitation, and depression that is
present at the end of life.
2. Identify possible etiologies of anxiety, delirium/agitation, 2. Identify possible etiologies of anxiety, delirium/agitation,
and depression at the end of life.
3. Assess for the physical and psychosocial aspects of
anxiety, delirium/agitation, and depression that are
common at the end of life.
4
![Page 5: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/5.jpg)
Objectives
4. Describe pharmacological and nonpharmacological
interventions for anxiety, delirium/agitation, and
depression that can be included in the plan of care at the
end of life.end of life.
5. Describe the patient and family instructions needed for
patients and families at the end of life.
5
![Page 6: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/6.jpg)
Domains of
Quality Palliative Care
Clinical Practice Guidelines of Quality Palliative Care
� Domain 2: Physical Aspects of Care
� Guideline 2.1 Pain, other symptoms, and side
effects are managed based upon the best available effects are managed based upon the best available
evidence, with attention to disease-specific pain
and symptom, which is skillfully and systematically
applied.
6
![Page 7: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/7.jpg)
Anxiety
� Feeling of deep sense of unease without an
identifiable cause
� Prevalence - varies
7
![Page 8: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/8.jpg)
Causes of Anxiety
� Poorly controlled pain
� Altered physiologic states
� Medications
� Withdrawal from alcohol/medications� Withdrawal from alcohol/medications
� Medical conditions
� Physiological/Emotional/Spiritual distress
8
![Page 9: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/9.jpg)
Assessment of
Anxiety
Physical symptoms
� Cognitive symptoms
� Pain
� Bowel/bladder � Bowel/bladder
� Familiarity with environment
� Interview questions
� Explore psychological and emotional dimensions
9
![Page 10: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/10.jpg)
Pharmacological
Treatment of Anxiety
Antidepressants
� Blocks serotonin reuptake
Benzodiazepines
� acts on limbic-thalmic-hypothalmic area of the CNS � acts on limbic-thalmic-hypothalmic area of the CNS
producing anxiolytic, sedative, hypnotic, skeletal muscle
relaxation
� Neuroleptics
� blocks dopamine reuptake
10
![Page 11: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/11.jpg)
Non-pharmacological
Treatment of Anxiety
� Coping skills
� Reassurance and support
� Manage stress and decrease stimulation
� Symptom management� Symptom management
� Complementary therapies
� Counseling
11
![Page 12: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/12.jpg)
Anxiety
Patient & Family Education
� Review causes
� Monitor for signs and symptoms
� Avoid stimulation
� Patient safety� Patient safety
� Discuss unresolved issues
12
![Page 13: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/13.jpg)
Anxiety
References
1. Kazanowski M. Symptom management in palliative care. In: Matzo ML,
Sherman D W, eds. Palliative care nursing: Quality Care to the End of
Life. New York, NY: Springer, 2006: 319-344.
2. Pasacreta JV, Minarik PA, Nield-Anderson L. Anxiety and depression.
In: Ferrell B R, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed.
New York, NY: Oxford, 2006: 375-399. New York, NY: Oxford, 2006: 375-399.
3. Bednash G, Ferrell BR. End-of-Life Nursing Education Consortium
(ELNEC – Geriatric ). Washington, DC: Association of Colleges of
Nursing, 2007.
4. Breitbart W, Chochinov H, Passik S. Psychiatric aspects of palliative
care. In: Doyle D, Hanks G, MacDonald N, eds. Oxford Textbook of
Palliative Medicine. New York, NY: Oxford, 2003.
5. Berry PH, ed. Core Curriculum for the Hospice and Palliative Nurse
2nd ed. Dubuque, IA:Kendal/Hunt; 2005.
13
![Page 14: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/14.jpg)
Delirium/Agitation
� Delirium – a global, potentially reversible
change in cognition and consciousness that is
relatively acute in onset
� Common in patient near death (approx 88%)
� Agitation - excessive restlessness accompanied
by increased mental and physical activity
14
![Page 15: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/15.jpg)
Delirium/Agitation
Prevalence
� Almost half of patients experience
delirium/agitation in last 48 hours
� Experienced by 77-85% of terminally ill cancer � Experienced by 77-85% of terminally ill cancer
patients
15
![Page 16: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/16.jpg)
Causes of
Delirium/Agitation
� Infection
� Malignancies / Tumor burden and secretions
� Renal or hepatic failure
� Metabolic abnormalities (low/hi Na, low K, hi Ca,
low/hi glucose, hypothyroid, renal/liver failure) low/hi glucose, hypothyroid, renal/liver failure)
� Hypoxemia
� Sensory deprivation
� Medications
� Fecal impaction / Urinary retention
� Vitamin deficiencies
16
![Page 17: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/17.jpg)
Assessment of
Delirium/Agitation
� Distinguish from other related symptoms
� Physical assessment
� History
� Spiritual distress
� Consider medical etiologies
17
![Page 18: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/18.jpg)
Assessment of
Delirium/Agitation
Established tools
� Mini-Mental Status Examination (MMSE)
www.chcr.brown.edu/MMSE.pdf
� Memorial Delirium Assessment Scale (MDAS) � Memorial Delirium Assessment Scale (MDAS)
www.painconsortium.gov
� Delirium Rating Scale (DRS)
18
![Page 19: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/19.jpg)
Assessment of
Delirium/Agitation
Established tools
� Confusion Assessment Method (CAM)
www.hartfordign.org/publications/trythis/issue13.pdf
� Neecham Confusion Scale (NCS)
www.unc.edu/courses/2005fall/nurs/213/001/neuropsychiatricwww.unc.edu/courses/2005fall/nurs/213/001/neuropsychiatric
/neecham.html
19
![Page 20: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/20.jpg)
Treatment of
Delirium/Agitation
� Correct underlying cause
� Consider symptomatic and supportive therapies
� At end of life, causes may not be reversible and
medications are indicatedmedications are indicated
20
![Page 21: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/21.jpg)
Treatment of
Delirium/Agitation
Pharmacological interventions
� Neuroleptics
� blocks dopamine uptake; metabolized by the liver
� Haloperidol (Haldol)� Haloperidol (Haldol )
� Severe agiation
21
![Page 22: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/22.jpg)
Treatment of
Delirium/Agitation
� Benzodiapines
� Midazolam (Versed)
� Anxiolytics
� Lorazepam (Ativan) � Lorazepam (Ativan)
� Atypical Antidepressants – blocks dopamine
uptake selectively, but with less anticholingeric
effects
� Risperidone
22
![Page 23: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/23.jpg)
Non-pharmacological
Treatment of Delirium/Agitation
� Encourage presence of family
� Avoid excessive stimulation
� Reorient if indicated
� Familiar people and items� Familiar people and items
� Acknowledge visions
� Complementary therapies
23
![Page 24: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/24.jpg)
Delirium/Agitation
Patient & Family Education
� Reassure patient and family
� Review symbolic language
� Review medications
� Sensory stimulation if indicated� Sensory stimulation if indicated
� Instruct how to reorient
24
![Page 25: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/25.jpg)
Delirium/Agitation
References
1. Emanuel L, von Gunten C, Ferris F. The Education for Physicians on End of Life Care (EPEC) Curriculum. Washington, DC: American Medical Association, 2003.
2. Breitbart W, Chochinov H, Passik S. Psychiatric aspects of palliative care. In: Doyle D, Hanks G, MacDonald N, eds. Oxford textbook of palliative medicine. New York, NY: Oxford, 2005.palliative medicine. New York, NY: Oxford, 2005.
3. Lichter I, Hunt E. The last 48 hours of life. Journal of Palliative Care 1990;6:7-15.
4. Pereira J, Bruera E. The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer 1997;79:835-842.
5. Caraceni A. Delirium in palliative medicine. European Journal of Palliative Care 1995;2:62-67.
6. Kuebler KK, Heidrich D, Vena C, English N. Delirium, confusion, and agitation. In: Ferrell BR, Coyle N, eds. Textbook of Palliative Nursing. 2nd ed. New York, NY: Oxford, 2006:401-420.
25
![Page 26: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/26.jpg)
Delirium/Agitation
Additional References
Bednash G, Ferrell BR. End-of-Life Nursing Education Consortium
(ELNEC). Washington, DC: Association of Colleges of Nursing, 2009.
26
![Page 27: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/27.jpg)
Depression
� Intense and often prolonged feelings of sadness,
hopelessness and despair
27
![Page 28: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/28.jpg)
Depression
Prevalence
� 25–77% terminally ill population
� 22% of nursing home residents
� Often not recognized at end-of-life� Often not recognized at end-of-life
28
![Page 29: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/29.jpg)
Causes of Depression
� Medical conditions
� Pain
� Treatment-related factors
� Medications� Medications
� Psychological factors
� Financial issues
29
![Page 30: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/30.jpg)
Assessment of Depression
� Symptoms associated with medically ill
� Enduring sad mood
� Hopelessness
Fatigue� Fatigue
� Diminished ability to make decisions
30
![Page 31: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/31.jpg)
Assessment of Depression
� Risk factors
� Medical co morbidity
� Male > age 45
� Stressful life events
� Uncontrolled pain
31
![Page 32: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/32.jpg)
Assessment of Depression
� Screening tools
� Mini-Mental Status Examination (MMSE)
� Beck Depression Inventory
� Geriatric Depression Scale
� Cultural influences
� Cultures may judge severity of depressive symptoms
differently
� Symptoms should not be dismissed because it is seen as a
characteristic of a particular culture
� Chinese may use the term ‘imbalance’
� Latino/Mediterrean may say ‘nerves’, ‘headaches’
32
![Page 33: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/33.jpg)
Assessment of Depression
� Ask questions regarding
� Mood
� Behavior
� Cognition� Cognition
� Suicide assessment risk factors
� Psychiatric disorder
� Depression
� Alcohol abuse
33
![Page 34: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/34.jpg)
Treatment of Depression
� Optimal
� Pharmacological
� Non-pharmacological
� Interpersonal interventions� Interpersonal interventions
� Complementary
34
![Page 35: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/35.jpg)
PharmacologicalTreatment of Depression
� Antidepressants
� Blocks serotonin, (5HT) reuptake
� SSRIs
� Considered as first line treatment� Considered as first line treatment
� For debilitated patients start at 1/3 dose
35
![Page 36: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/36.jpg)
PharmacologicalTreatment of Depression
� Tricyclics
� Blocks reuptake of various neurotransmitters at the
neuronal membrane
� Improves sleep
� Effective on 70% of patients treated
36
![Page 37: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/37.jpg)
PharmacologicalTreatment of Depression
� Stimulants
� Stimulates CNS and respiratory centers
� Increases appetite and energy levels
� Improves mood� Improves mood
� Reduces sedation
37
![Page 38: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/38.jpg)
PharmacologicalTreatment of Depression
� Other
� Steroids
� Improves appetite
� Elevates moodElevates mood
� Non-benzodiazepines
� Useful in patients wit mixed anxiety/depressive
symptoms
38
![Page 39: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/39.jpg)
Non-pharmacological
Treatment of Depression
� Counseling
� reinforce goals and interventions of care plan established by
interdisciplinary team
� Behavioral interventions
� Provide directed / structured activities
� Focus on goal attainment / prepare for future adaptive coping
39
![Page 40: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/40.jpg)
Non-pharmacological
Treatment of Depression
� Cognitive interventions
� Assist patient to reframe negative thoughts into positive
thoughts
� Interpersonal interventions
Build rapport with frequent, short visits� Build rapport with frequent, short visits
� Mobilize family and social support systems
� Complementary therapies
� Guided imagery
� Art and music therapy
40
![Page 41: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/41.jpg)
Non-pharmacological
Treatment of Depression
Specific Behavioral Strategies
� Negotiate structured schedule
� Realistic goals
� Positively reinforce� Positively reinforce
41
![Page 42: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/42.jpg)
Depression
Patient & Family Education
� Review signs and symptoms
� Instruct on prevalence
� Review medications
� Review non-pharmacological interventions� Review non-pharmacological interventions
� Provide private opportunity to talk
42
![Page 43: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/43.jpg)
Depression
References
1. Bednash G, Ferrell BR. End-of-Life Nursing Education
Consortium (ELNEC ). Washington, DC: Association of Colleges
of Nursing, 2009.
2. Pasacreta JV, Minarik PA, Nield-Anderson L. Anxiety and
depression. In: Ferrell BR, Coyle N, eds. Textbook of Palliative
Nursing. 2nd ed. New York, NY: Oxford, 2006:375-399.Nursing. 2nd ed. New York, NY: Oxford, 2006:375-399.
3. Breitbart W, Chochinov H, Passik S. Psychiatric aspects of
palliative care. In: Doyle D, Hanks G, MacDonald N, eds.
Oxford Textbook of Palliative Medicine. New York, NY: Oxford,
2005.
4. Wrede-Seaman L. Symptom management algorithms: A
handbook for palliative care. Yakima, WA: Intellicard, 1999.
43
![Page 44: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/44.jpg)
Questions?
Please join us on May 6 for Part 3 or 3
Symptom Management – Respiratory ,
Fatigue, & pressure ulcers
Laura Scherer RN, CHPN
Director at Unity Family Home Care and Hospice
320-631-5595 44
![Page 45: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/45.jpg)
Round-Robin Discussion
![Page 46: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/46.jpg)
Wrap-Up and Next Steps
• Next meeting
– Tuesday, May 6, 2014, 10 am – noon
– Knute Nelson Grand Arbor hosting
• 4403 Pioneer Road SE
Alexandria, MN 56308
– Educational Session: Symptom
Management Part III– Respiratory,
Fatigue, & pressure ulcers
• Presented by Laura Scherer
![Page 47: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/47.jpg)
Questions?
Janelle Shearer, MA, RN, BSN
� 952-853-8553 or 877-787-2847
www.stratishealth.org
![Page 48: Rural Palliative Care Networking Group Meeting · 1/28/2014 · Kazanowski M. Symptom management in palliative care. In: Matzo ML, Sherman D W, eds. Palliative care nursing: Quality](https://reader033.vdocument.in/reader033/viewer/2022043020/5f3c718787060b62424cc439/html5/thumbnails/48.jpg)
Stratis Health is a nonprofit organization based in Minnesota that leads collaboration
and innovation in health care quality and safety, and serves as a trusted expert in
facilitating improvement for people and communities.
This effort is sponsored by UCare and supported by Stratis Health.