Palliative Care. Needs in the. Gwen Regan

Transcription

1 Nursing the Patient with Palliative Care Needs in the Community Gwen Regan

2 I say to people who care for people who are dying, if you really love that person and want to help them m, be with them when their end comes close. Sit with them - you don't even have to talk. You don't have to do anything but really be there with them. Kubler-Ross

3 The Community Nursing Service Under the Nurses Act 1970 public health nursing became enshrined in legislation as a universally accessible service - A health board shall, in relation to persons with full eligibility ibilit and such other categories of persons and for such purposes as may be specified by the Minister, provide without charge a nursing service to give to those persons advice and assistance on matters relating to their health and to assist them if they are sick (Health Act, 1970) Contrary to the situation in acute, secondary, or tertiary care services, there are no waiting lists or trolleys on which clients with nursing needs in the community can be placed. Consequently, as the population continues to increase, needs become more complex, and the shift to primary care settings takes place, pressures on the PHN service are likely to increase (Pye, 2011; Irish Nurses and Midwives Organisation, 2013; Pye, 2015)

4 What is the PHN Service Public Health Nurses Community Registered General Nurses HSE Health Care Assistants Supported by: Primary Care Teams Private home care agencies Community Intervention Teams Liaising with: Acute providers Hospice Care Specialist groups MS Ireland, Irish Cancer Society, Jack & Gill etc.

5 The Palliative Ca are patient t Evidence consistently shows that the majority of people have a preference to be cared for at home. According to the current TILDA research progress report, approximately 10% of patients on PHN caseloads die every year. Increasing medical requirements mean dying at home is not always an option for patients. Where possible the Public Health Nursing service will fully support discharge home for palliative care patients. For this to be successful, and to promote a multiple agencies is required. dignified and peaceful death, collaboration across

6 Planning for discharge home Needs to take place as early as possible Wishes of patient and their family/carers must be considered Do not give unrealisti c expectations What supports are required can the community services meet these? Failed discharges are traumatic and must be avoided at all cost through plann ning, consultation and team working across acute, hospice, primary care team and public health nursing services.

7 Pi Prior to discharg ge PHN/CRGN should be part of discharge. PHN/CRGN should make themselves known to family / carers prior to patients discharge to discuss any issues / fears / concerns which may arise as a result of client coming home The requirements for discharge should be agreed as soon as possible to include: Travel arrangements home Proposed day / time of discharge (avoid Fridays) Equipment required in the home Hospice home care team referral Home care package application Who will be there when the patient gets home? any multi-disciplinary team when planning

8 On discharge home Palliative care patients are Priority 1 patients This means they, or their families, must be contacted and if possible have a home visit within 24hours Time must be given to initial assessment visit Assessment must be carried out with tact and compassion it is not a serious of tick boxes to be completed. Nurse should give their work mobile number to the main carer to ensure distress is not caused due to inability to make contact.

9 Initial assessment In community Orems model of care is commonly used. With regard to palliative patients t R oper. Logan, Tierney's Activities of Daily Living tool is used. Full assessment to include skin integrity, bowel and bladder care, nutrition, invasive devices etc. Devise care plan to encompass the full assessment and requirements of the client. Obtain consent Refer to Primary Care Team as necessary OT, Physio, GP, Social work etc.

10 Other assessment tools Multiple other tools are used during the assessment process Waterlow, MUST, Mini-mental, Barthel as appropriate A completed Waterlow is required when ordering beds / mattresses Decision regarding ordering hospital bed must be made with an awareness of the upheaval delivery may cause a patient close to death may not easily transfer and indeed undue distress could be caused. Aids such as commodes / urinals etc. can be ordered through PHN and collected by family prior to discharge Repose mattresses available through PHN

11 Entitlements t Emergency medical cards (hospital / PCT social worker) Home care package will be reviewed six weeks following discharge and hours will be taken back if no longer required. Aids & Appliances Voluntary agencies Will depend d on acuity of patien nt Please do not give false expectati ons if you are unsure of a patients actual entitlements

12 The Care Plan Discuss any plan for care with patient Documented in clients chart Review and amend in line with clinical need Discuss with carers If devolving care the PHN/C CRGN is responsible for ensuring that the person they devolve care to is trained, competent and receives ongoing support to undertake the care task.

13 Current Challen nges Not a 24 hour service as yet Weekend service is planned essential calls only Services to clients can appear disjointed i d multiple l health care staff coming and going into patients home at all hours of the day Communication between service providers can be poor. Mixed messages given to pati ients and their families Specialised palliative care education for primary care workers.

14 Finally -a word about compassion Roach (2002) considered compassion, along with confidence, competen nce, conscience, commitment and comportment, as one of the six core elements of caring g. If nurses claim to genuinely care for their patients, then without compassion their caring may be incomplete and lacking. Roach, MS M.S. (2002) Caring, The Human Mode of Being: A Blueprint for the Health Professions. Ottawa: Canadian Hospital Association Press