PALLIATIVE CARE FOR HEALTHCARE ASSISTANTS YOUR ROLE Dr. Catherine Buckley PhD, MSc, BSc, RGN

What is Palliative Care? “Palliative care is an approach that improves the quality of life of people and their families facing the problems associated with life-limiting illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”. (WHO, 2002) Version 1

Who Should Receive Palliative Care? All persons with a life-limiting illness irrespective of age, diagnosis or setting A life-limiting illness is a condition, illness or disease which is progressive and fatal and cannot be reversed by treatment Version 1

Who Provides Palliative Care? Everyone working in a service that provides health and social care is obliged to understand and provide a level of palliative care that uses palliative care principles and a palliative care approach

What is a Palliative Care Approach? Recognises that death is inevitable Provides opportunities for the person to make plans and set goals about their care Includes the family, should the person wish, to be involved in planning for their care Maximises the persons full potential and quality of life as defined by them

A core skill in health and social care and focuses on: Promoting quality of life Providing effective symptom control Holistic approach that includes the person’s life experience and current situation Care for the dying person and those who matter to the person Open sensitive communication with the person, family/carers and colleagues

What are the Levels of Palliative Care Provision? Level 1 – Palliative Care Approach: provided by all staff as part of their general role Level 2 – General Palliative Care: provided by some with extra knowledge/education/skill as part of their general role Level 3 – Specialist Palliative Care: provided by a few in a specialist palliative care role with specialist knowledge and skills

What is the Role of the Specialist Palliative Care Team? Provides support to families including bereavement support. Act as a resource for other health and social care professionals in the area, by providing support and advice when needed. Clinical management and care coordination including: triage, assessment and care planning for persons with complex care needs associated with life limiting illness and/or end of life Provide facilities for research and education in palliative care.

What is a Palliative Care Needs Assessment? A palliative care needs assessment is an individualised assessment of palliative care needs based on palliative care principles and the domains of palliative care Version 1

Domain 1: Physical Wellbeing Unique to the person and may require prompting to share Pain Fatigue Respiratory Gastrointestinal Neurological Other All forms of physical pain Fatigue not relieved by rest and not appropriate to level of activity Breathlessness, cough, secretions Anorexia, nausea, vomiting, constipation Insomnia, confusion, delirium, anxiety, depression Functional status, balance problems, oedema, wound problems

Physical Wellbeing: Health Care Assistant Role When interacting and providing care: Observe for signs of pain, discomfort, nausea, breathlessness or any evidence of distress and report to your team Report promptly any complaints of pain, discomfort, nausea, breathlessness, constipation or any other distress Following intervention observe for signs of symptom relief and report if symptoms persist ....and report back to the team

P = pick up on mood changes A = Asses verbal ques Assessing pain P = pick up on mood changes A = Asses verbal ques I = Inspect facial expression's N= Notice body language

What can you do as a healthcare assistant to identify pain Report any behaviours to nurse, family, and GP. Assessment   begins   by   asking   an   individual   about   their   pain   because   only   the   individual   can   determine  how  much  pain they  are  experiencing, despite their cognitive impairment. Consider, interventions that can be done by you, at the time of pain, ie Pressure care, hunger, hydration, distraction, oral care and reassurance. Monitor for interventions that relieve or worsen pain.

Domain 2: Social and Occupational Wellbeing Background Family support Emotional and social support Practical concerns Version 1

Social and Occupational Wellbeing: Health Care Assistant Role When interacting and providing care: Background Tell me about yourself: occupation, hobbies. Any concerns? Family Support Who lives with you: adults, children, dependants. Any worries, concerns? Emotional and Social Support Other supports: friends, neighbours, community nurse, home help. How often do you see people? Mood Observe mood. Practical Concerns Practical issues, coping at home, stairs, cooking, money worries. Any worries or concerns ? ...and report back to the team

Domain 3: Psychological Wellbeing Persons mood and interest How the person adjusts to their illness What gives the person strength Total pain Pre-existing mental illness Version 1

Psychological Wellbeing: Health Care Assistant Role When interacting and providing care observe, take note and consider gently exploring: Mood and Interest Feeling down or bothered? Are you tense, frightened? Adjustment to Illness Do you understand your illness? Resources What/who is your support? Total pain Pain that is more than physical e.g. emotional, spiritual Co-morbid diagnosis Current or past history of mental illness ...and report back to team

Domain 4: Spiritual Wellbeing People have many different understandings of the word spiritual and how it impacts on their lives. When completing a spiritual assessment, assessors need to be aware of alternative terms i.e. faith, belief, philosophy, religion, inner strength. Version 1

Spiritual Wellbeing: Health Care Assistant Role When interacting and providing care: Look around and see if the person has any pictures, ornaments, or religious symbols that you could use to open a conversation If you see any religious symbols gently ask the person if their faith gives them strength If no religious symbols gently enquire about source of inner strength Don’t probe too much if the person seems distressed and report back to the team ....and report back to team

Finally On completion of your assessment or observation report any issues you have identified back to the team.