1. Palliative Care: The Team Approach Palliative Care: The Team Approach Presented by Reverend Alice Gilbert M.Th BCC Nick Weitzel RN-BC, MSN, APN

2. Learning Objectives: Participants will: Identify definition of Palliative Care and Hospice Care. Verbalize understanding of team roles Verbalize understanding of basic pain / symptom management interventions. Verbalize understanding of culturally sensitive individualized spiritual care. Participate in Case Study Discussions for Palliative, Hospice and End of Life Care Scenarios.

3. “Palliative Care is interdisciplinary care that aims to relieve suffering and improve the quality of life, for patients with life-threatening illnesses, and their families. Expert control of pain and symptoms and practical support for patient and family is integrated into every stage of illness along with all other appropriate medical treatments” (CAPC: Center to Advance Palliative Care, 2004)

4. What is Palliative Care? “ Palliative medicine (care) is aimed at improving quality of life and supporting patients and the families of patients with serious and complex chronic illnesses in whom prognosis is uncertain or may be measured in years.” Adler, E.D., Goldfinger, J.Z. & Kalman, J. (2010) Palliative care in the treatment of advanced heart failure. Circulation: The Journal of the American Heart Association. Downloaded from circ.ahajournals.org http://circ.ahajournals.org

5. What is Hospice Care? Different from Palliative Care Palliative care is not limited to hospice care. Palliative care may be provided at any time during a person’s illness, even from the time of diagnosis. Palliative care can take place at the same time as curative treatment. Palliative care is not limited to hospice care. Palliative care may be provided at any time during a person’s illness, even from the time of diagnosis. Palliative care can take place at the same time as curative treatment. Hospice always provides palliative care. However, hospice is focused on terminally ill patients—people who no longer seek treatments to cure them. Hospice always provides palliative care. However, hospice is focused on terminally ill patients—people who no longer seek treatments to cure them. Downloaded from http://www.getpalliativecare.org/whatis

6. Vision and Philosophy Our goal at Scripps La Jolla is that every patient receives excellent, compassionate care. There are times when a medical problem can not be resolved but the need for comfort and support to the patient and family is extremely important. This is why we offer palliative care. Our goal at Scripps La Jolla is that every patient receives excellent, compassionate care. There are times when a medical problem can not be resolved but the need for comfort and support to the patient and family is extremely important. This is why we offer palliative care. Dr. Donald Ritt, Program Medical Director

7. Team Roles “It Takes a Village” Patient & Family Medical Director/Physicians Nursing Director Palliative Care Coordinator RN APN RN Chaplain/Spiritual Counselor Bio-ethicist Social Worker Case Manager Healing Touch Practitioner Pain Resource Nurse (

8. Potential Patients Appropriate AppropriatePalliative Care Referrals Principles of Principles ofImprovedSymptomControl

9. Spiritual Care. “Spirituality involves finding meaning and purpose in one’s life and experiences…” Spiritual Care. “Spirituality involves finding meaning and purpose in one’s life and experiences…”

10. “We are not human beings having a spiritual experience. We are spiritual beings, having a human experience.” Pierre Teilhard de Chardin

11. Case Study Discussions Individual Human Beings Individual Human Beings Not a cookie-cutter process Not a cookie-cutter process “Inquiry before Advocacy” “Inquiry before Advocacy”

12. Case Study 1 Sally 56 year old female Sally 56 year old female Ovarian CA w Mets to Lungs PainDyspneaNausea/VomitingAnxiety Spiritual Distress

13. Case Study 2 Robert 36 y.o. Male Robert 36 y.o. Male ETOH ETOH Hep B, Hep C Hep B, Hep C Social issues Social issues ARF ARF Family in England Family in England

14. Case Study 3 Martha 93 y.o. Female Martha 93 y.o. Female Pneumonia, Infiltrates Pneumonia, Infiltrates Mild COPD Mild COPD Cultural Issues Cultural Issues Family Conflict Family Conflict POLST POLST

15. Case Study 4 Paul 50 y.o. Male Paul 50 y.o. Male Father of two young children. Father of two young children. Appendectomy; peritonitis Appendectomy; peritonitis Open Abdominal Wound X 3 years Open Abdominal Wound X 3 years Complimentary modalities Complimentary modalities “I have had enough” “I have had enough” End of Life Care End of Life Care

16. Although the world is full of suffering, it is also full of the overcoming of it. Helen Keller, “Optimism”, 1903