1. Lecture: Introduction to palliative care March 2011 v?

2. Lecture: Introduction to palliative care HLTEN511B: Provide nursing care for clients requiring palliative care

3. What is palliative care?  Palliative care is an approach that “ addresses the quality of life of people who have life-limiting illnesses and their families by identifying, assessing and addressing physical, psychosocial and spiritual concerns” (World Health Organisation 2008) “ Although palliative care includes addressing the needs of people as they die and providing bereavement support for families, the emphasis is on improving living” (Guidelines for a palliative approach for aged care in the community setting: 2011)

4. Life limiting illnesses An illness where it is expected that death will be a direct consequence of the specified progression of the disease Includes malignant and non malignant illness Life limiting illnesses might be expected to shorten an individuals life expectancy What are some disease states or events that can be effectively managed by Palliative Care?

6. The interdisciplinary team

7. Where does death occur? Home Hospice Acute Setting ( Hospital) Residential Care

8. Issues in palliative care Quality of life Assessment and Management of pain and symptoms Resident and family anxiety Resident and family insight Spiritual and cultural issues Communication Grief and Bereavement issues Legal and ethical

9. Palliative Care in the Australian Context  Three forms of palliative care service delivery within Australia include:  The Palliative Approach: Can be utilized for any person living with a life limiting illness that has a need for relief from pain or other related symptoms.  Specialist Palliative Provision: Care provided through the guidance of a specialized palliative care team. People requiring this care have more complex symptoms than ordinarily experienced  End of life Care (formally ‘terminal care’): Care provided in the last weeks/days of life; it is a part of both a palliative approach and specialized palliative care provision

10. Illness trajectories

11. Illness trajectories and palliative care

12. Three forms of palliative care service delivery within the Australian Context

13. A Palliative Approach to Care Is a term used to describe care which seeks to improve the quality of life of individuals living with a life limiting illness. Key aspects of this care focus on:- Improve the quality of life for the individual and their family Achieved by early assessment and treatment of pain, physical, psychological, social and spiritual problems It is implemented earlier rather than delayed to the ‘end stage’ Focuses on active comfort care Actively supports the family through the process

14. Specialist Palliative Care Provision Based on the original framework by the Australian National Standards in Palliative Care (2003-5) Australian states and territories have specific planning documents relating to the delivery of specialist services across the population. In SA the Statewide Palliative Care Services Plan 2009-2016, now endorsed until 2021. Diagram: explains the efficient and practical use of specialist services and supports the principle that palliative care is “everyone’s business”

15. End of Life Care Is care focused on the comfort of people at the ‘end of life’ (usually defined in terms of days – week) Can be difficult to determine in some circumstances due to Dependant upon: Advancing disease status Co-morbidities and other underlying pathology are increasing the impact on functional, physical and cognitive status Client and/or family views and pre-existing advanced care plans Ability to eat and drink becomes compromised Inability to accept medications via oral route

16. References  “Illness trajectories and palliative care”BMJ. 2005 April 30; 330(7498): 1007–1011.BMJ. 2005 April 30; 330(7498): 1007–1011.  SA Statewide Palliative Care Services Plan (2009-2016) http://www.health.sa.gov.au/Portals/0/palliative-care-plan-2009-2016.pdf http://www.health.sa.gov.au/Portals/0/palliative-care-plan-2009-2016.pdf  Palliative Care Australia http://www.palliativecare.org.au/Policy/Referencedocuments.aspx http://www.palliativecare.org.au/Policy/Referencedocuments.aspx  www.caresearch.com www.caresearch.com  Guidelines for a Palliative Approach for Aged Care in the Community Setting  Murray SA et al http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2335219/ Care for all at End of Life (2008)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2335219/