1. PALLIATION
Concept 49

2. Goals for This Concept Presentation
Define and describe the concept.
Identify how palliation is integrated in the management of chronic diseases.
Discuss the application of palliation in nursing practice.

3. DEFINE AND DESCRIBE THE CONCEPT OF PALLIATION

4. Concept Definition
Palliation is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychologic, social, and spiritual problems is paramount.
World Health Organization: In National cancer control programmes. Policies and managerial guidelines. ed 2, 2002, Author, Geneva, Switzerland.

5. Understanding the Definition
Collaborative Learning #1 In your learning groups, discuss the definition of palliation. Underline two key words that describe what this definition really means. Rewrite a definition in your own words. Be prepared to share with the class.
Your Own Definition

6. Goals of Palliative Care
To achieve the best quality of life for patients and their families:
Prevent or treat the symptoms of the disease, or treat the disease as early as possible.
Prevent or treat the psychologic, social, and spiritual problems related to the disease or treatment.
Help patients with chronic conditions live more comfortably.

7. Concept Categories Symptom Management Supportive Care Comfort Care
End-of-Life Care
Hospice
Care

8. Related Terms and Categories
Collaborative Learning #2
In your learning groups, discuss the meaning of the following terms and concept categories. How are they similar and different than palliation?
Symptom management
Supportive care
Comfort care
End-of-life care
Hospice care

9. Concept Attributes
Focus on the care of the patient, not on the cure of the disease
Supportive care, including symptom management
Interprofessional approach
Patient- and family-centered care
Collaborative communication
Quality of life versus length of life

10. Identify how palliation is integrated in the management of chronic diseases

11. Impact of Chronic Diseases
Seven out of 10 Americans can expect to live with their diseases several years before dying.
Major growth has occurred in the number of individuals with diabetes, cardiovascular disease, and obesity.
Majority of health care dollars is spent during the last 6 months of life.
Increased nursing workforce is needed to keep up with these demands.

12. Disease Trajectory
Trajectory of disease can be viewed from three different perspectives:
Short period of evident decline
Sudden death from complications or acute exacerbation
Long-term limitations

13. Paradigm Shift
Aims of the U.S. Department of Health and Human Services produce a paradigm shift and implement new strategies.
Goals:
To maintain optimal health and a quality of life for those with multiple chronic conditions
To introduce palliative care earlier into the management of chronic diseases

14. Discuss the application of palliation in nursing practice

15. Interprofessional Team
Patient
Nursing
Social services
Physician
Spiritual care
Ancillary services
Plan of care is based first on the patient and family’s realistic expectations and goals and second on the team’s assessment, recommendations, and support.
The family serves as a member of the team.

16. Palliative Interventions
Trajectories
Collaborative Learning #3
In your learning groups, discuss palliative interventions and interrelated concepts to each disease trajectory.
Trajectory
Palliative Interventions
Short period of evident decline
Prolonged dwindling
Long-term limitations with intermittent episodes

17. Exemplars Palliative care (not actively dying)
Comfort care (actively dying)
Supportive care
End-of-life care

18. Assessment
Box 36-8

19. Legal Requirements
P&P 723 & 724

20. Care of the Body
Box page 726 P & P

21. Documentation Requirements
Box 36-9