Kim Klamut, MSN, RN, CCRN

Kim Klamut, MSN, RN, CCRN

What does Palliative Care mean to you? What do you think of when you hear the words Palliative Care? What kind of patients do you think would benefit from Palliative Care? When do you think Palliative Care should be initiated on a patient?

Palliative Care Is. Care focused on preventing, treating, and relieving the debilitating effects of serious and chronic illness Not dependent on prognosis and can be delivered at the same time as curative treatment About improving the quality of life for both patients and families during serious illness About meeting the physical, psychosocial and spiritual needs of patients and families

Palliative Care is NOT the same as end of life care or hospice!

Palliative Care and Patients Can you think of a patient that could benefit or would have benefited from palliative care? What benefits do you think the patient can receive from palliative care?

Patient Benefits The patient s personal goals are able to be met The patient s suffering is decreased The patient has a feeling of physical, emotional and spiritual support Appropriate resources are obtained for the patients if needed

Palliative Care and Families Can you think of a family situation that could benefit from palliative care? In what ways do you think that palliative care can be a benefit for families?

The Benefit for Families Review of family goals and values How do they differ from the patient s? Increased communication Interdisciplinary family meetings Assistance with making tough decisions Withdrawal of life support Support for the family unit

Ethics ANA Code of Ethics #2: The nurse s primary commitment is to the patient, whether an individual, family, group, or community #8: The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs

Why can t we just get along! Many patients don t share their wishes with their family members or their physicians There may be points, issues or secrets that have been within the family for years What happened before the patient became ill? What are our previous experiences? Lack of information Lack of support for families when they are stressed Do you need an ethics consult? Call the operator and ask for the ethics committee. Give your name, number that you can be reached at, and a brief synopsis of the issue

Role of Palliative Care Build trust with the patient and family Improve communication The goal is to understand and support the family, not the code status or disposition

Therapeutic Relationship Building Trust Involves Consistent and Unconditional Respect Active Listening Ability to Remain Objective Empathy Honesty Humor

Good Communicators Know How To Listen Effective Communication Involves Active Listening Awareness of Body Language Calm Presence Inhibition Patience

Caring for the Caregivers Caring is at the heart of what we do Sometimes though, we are so focused on caring for others, we forget to care for ourselves, or let others care for us Unfortunately, we often have experiences that are emotionally trying

Questions to ponder Do you ever feel our patient s suffering? Do you ever feel that you didn t do enough for our patients?

Work Related Loss Lack of support Helplessness and Frustration Attachment Lack of respite time Outside perceptions of nurses work

How do we cope? Hobbies Relaxation Techniques Team Dialogues and Debriefing- Talk it out Lasting Connection with the family Take breaks and take time off Cry- it is OK. Remember we are human! Rely on our support systems. It s OK to refuse an assignment because it hits too close to home

How can palliative care help? Let s look at an example

Mrs. F and the Wedding Mrs. F was a 60 year old who had complications from a gastric bypass procedure. She had developed enterocuteric fistulas, and had multiple surgeries. Due to the fistulas, Mrs. F had several abdominal surgeries and an open abdominal wound. The abdominal wound and the fistula drainage caused Mrs. F. significant pain, that was very hard to manage.

Pain management Mrs. F had a PCA to manage her pain, and received boluses prior to the very painful dressing changes. The pain led to decreases in Mrs. F s mobility, and the high doses of medications plus the dressing changes required Mrs. F to be in the hospital. Mrs. F was married, and had two grown children. Mrs. F was very active prior to her surgery and had interests such as cooking.

The Role of Palliative Care Mrs. F became very depressed over the lack of control over her pain and having to be hospitalized. She felt that the pain got worse with each subsequent surgery that she had, and did not want to have any more operations. Palliative Care was consulted for Mrs. F. She was seen by the palliative care service on a regular basis.

Benefits of Palliative Care Mrs. F. did not have any more surgeries Her pain regime was changed and was more tolerable for her Her personal goals were discussed Mrs. F changed her code status to limited Family meetings occurred, and Mrs. F s family was OK with her decisions Mrs. F was transferred to a transitional care unit

Goal achievement Mrs. F. wanted to live long enough to see her daughter get married. With the help of the palliative care team and the TCU staff, Mrs. F was able to attend her daughter s wedding. Mrs. F passed away shortly thereafter in accordance with her wishes.

Nursing Benefits We made a difference! Happy that she met her personal goal and happy that her family had that special moment. Felt pride to be a nurse. Even though it was sad to hear of Mrs. F s passing, you were happy to hear that Mrs. F was comfortable in her last hours

New Perceptions Has your vision of Palliative Care changed? Do you think any of your patients today can benefit from Palliative Care?

UPMC Palliative and Supportive Institute At UPMC St. Margaret For palliative care consults, please call 412.784.5111

References American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretative statements. Silver Spring, MD: Author Lachman, V. D. (2009). Practical Use of the Nursing Code of Ethics: Part I. MEDSURG Nursing, 18(1), p. 55-57. Wenzel, J., Shaha, M., Klimmek, R., & Krumm, S. (2011). Working through grief and loss: Oncology nurses perspectives on professional bereavement. Oncology Nursing Forum, 38(4), p. e272-e282.