Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

CHCPAL001 Deliver Care Services Using A Palliative Approach

Download as pptx, pdf, or txt
Download as pptx, pdf, or txt
You are on page 1of 122
At a glance
Powered by AI
The key takeaways are applying a palliative approach to care by recognizing holistic needs over time, supporting expression of needs and preferences, communicating about quality of life and pain, and respecting family as part of the care team.

The objectives of the course are to apply palliative care principles, respect quality of life choices, follow advanced care directives, respond to symptoms, follow end-of-life strategies, manage emotional responses and ethical issues, and gain required skills and knowledge.

Strategies to promote comfort for patients include regular observation and documentation of comfort, pain relieving measures, and other measures like massage, relaxation, distraction and aromatherapy.

CHCPAL001

Deliver care services using a


palliative approach
Housekeeping
�Emergency procedures
�Mobiles and security issues
�Break times and smoking policy
�This course is interactive – ask questions
�Practise respect and confidentiality
�Ground rules
Objectives
�Discover how to apply principals and aims of a palliative
approach when supporting individuals
�Know how to respect the person’s preferences for quality of
life choices
�Learn how to follow the person’s advanced care directives
in the care plan
�Understand how to respond to signs of pain and other
symptoms
�Show how to follow end-of-life care strategies
�Ascertain how to manage own emotional responses and
ethical issues
�Gain the skills and knowledge required for this unit
Apply principals and aims of a
palliative approach when supporting
individuals

1.1 Recognise the


holistic needs of the
person extending over
time, not just end-of-life
Holistic care
�Emotional support
�Education
�Work
�Recreation
�Health and mental health
�Finances
�Accommodation/housing
�Networks/community/family
�Culture/religion
�Legal issues
Activity 1A
Apply principals and aims of a
palliative approach when supporting
individuals

1.2 Support the person,


carers and family to
express needs and
preferences and report
information to
supervisor
Learn about the following types of
needs and preferences:
�Social
�Emotional
�Physical
�Spiritual
Communicative barriers may be
overcome by:
�Using open body language
�Making eye contact
�Asking open questions and encouraging detailed
answers
�Repeating and approving individual statements.
Activity 1B
Apply principals and aims of a
palliative approach when supporting
individuals

1.3 Communicate with


the person, carers and
family in relation to the
person’s quality of life,
pain and comfort and
report information to
supervisor
Consider these personal requirements:
�Physical health
�Psychological wellbeing
�Level of independence
�Social relationships.
Strategies to promote comfort may
include:
�Regular observation, reporting and documentation of
client's comfort
�Provision of pain relieving measures by appropriate
member of staff (see state/territory legislation
regarding pain-relieving medications and organisation
protocols)
�Other measures to promote comfort and relieve pain -
massage, relaxation, distraction, aromatherapy.
Activity 1C
Apply principals and aims of a
palliative approach when supporting
individuals

1.4 Respect the family


and carers as an integral
part of the care team and
ensure that they have the
information and support
needed
Appropriate treatment of family
members
�You shouldn’t make any presumptions about the level
of input desired by family members
�Some may have already dedicated substantial amounts
of time to the provision of care for the individual
�They may welcome the break and be willing to trust
your expert services.
Family members may assume the
following responsibilities:
�Arranging trips that will be of interest to the elderly
person
�Washing and bathing
�Arranging spiritual services
�Attending counselling and therapy sessions
�Arranging entertainments
�Helping the elderly individual with mobility issues
�Preparing food and drink
Activity 1D
Respect the person’s preferences for
quality of life choices
2.1 Create a supportive
environment that
encourages the person,
carers, family members
and/or significant others
to share information
regarding changing
needs and preferences
Changing needs can be down to:
�Changes in condition
�Change in financial position
�Loss of support (e.g. family/friends/significant others)
�New conditions arising
�Age.
The types of information you need to
find out are:
�Previous jobs
�Domestic interests
�Recreational pastimes
�Religious views
�Family members
�Family history
�Homes and neighbourhoods
�Nationality and countries of residence.
Consider the following:
�Purpose
�Voluntary participation
�Enjoyment
�Success
Activity 2A
Respect the person’s preferences for
quality of life choices

2.2 Respect the person’s


preferences for quality of
life choices

2.3 Encourage the person,


carer, family and /or
significant others to freely
discuss spiritual and cultural
issues in an open and safe
environment within scope of
role
Things you need to consider and build
the plan around include:
�Personal supports and relationships
�Social activities
�Emotional supports
�Cultural and spiritual supports
�Sexuality and intimacy supports.
The types of beliefs that may concern
matters in the workplace include:
�Ageing
�Spirituality
�Relationships
�Sexuality
�Culture
�Intimacy.
To provide culturally appropriate
palliative care:
�Using interpretation services
�Establishing the openness with which the patient and
family wish to discuss death
�Discussing with families and patient whether they wish
for an open discussion of the diagnosis and prognosis
�Identifying and support the cultural, linguistic and
spiritual needs of care recipients and their families.
To provide culturally appropriate
palliative care:
� The appropriateness of certain treatments and medications
with regards to religion and cultural beliefs
� Differences in the definition of 'quality of life'
� The role of family members in decision-making
� Culturally appropriate strategies
� Providing information in the preferred language
� Providing access to culturally appropriate spiritual and
emotional support
� Training staff responsible for palliative care.
Activity 2B
Respect the person’s preferences for
quality of life choices

2.4 Identify needs and


issues outside the scope
of your role and refer to
supervising colleague
The referral process
�In some cases, the clients will have further needs and
issues that you are not qualified to deal with or
implement
�in these cases, you should refer the matter to your
supervisor, your manager or another more qualified
care worker
�Exactly who you should refer them to and the process
of referral should be detailed in your organisation's
protocols.
Activity 2D
Respect the person’s preferences for
quality of life choices

2.5 Communicate with


individuals, families,
carers and /or significant
others in a manner that
shows empathy and
provides emotional
support
Ways you can engage them are:
�Encouraging communication
�Body language/contact
�Empathic/active listening
�Non-verbal cues
�Provision of information.
Tips for encouraging communication
may include:
�Make eye contact whenever you are communicating
with them
�Short simple statements
�Speak slowly and clearly
�Be patient with them for responses
�Don't interrupt them or try to finish their sentences
�Encourage them to join in conversations with others
Tips for encouraging communication
may include:
� Don't speak on behalf of the person – especially during
conversations about decision-making. This is demeaning
� Don't patronise/ridicule them
� Don't dismiss what they say, even if it is irrelevant to the
current conversation
� Keep choices and decisions as simple as possible
� If they don't appear to understand you, rephrase what you
say or utilise different communication strategies e.g. visual
communication.
Factors of non-verbal communication
include:
�Facial expressions
�Para-language (speed of speech, intonation and pitch of
voice)
�Kinesics (body movements)
�Distance between communicators
�Posture
�Eye contact.
Activity 2E
Follow the person’s advanced care
directives in the care plan

3.1 Interpret and follow


advanced care directives
in the care plan in line
with own work role and
organisation, legal and
ethical requirements
Follow the person’s advanced care
directives in the care plan

3.2 Comply with end-of-


life decisions as
documented in the care
plan and in keeping with
legal requirements
Follow the person’s advanced care
directives in the care plan

3.3 Report the person’s


changing needs and
issues, in relation to
end-of-life, to the
appropriate team
member for
documentation in the
care plan
Situations and preferences that an
Advanced Care Directive may cover:
�Medical treatment preference
�Particular conditions or states that the person would
find unacceptable should these be the likely result of
applying life-sustaining treatment
�How far treatment should go when the patient's
condition is 'terminal', 'incurable' or 'irreversible'
�The wishes of someone without relatives to act as their
'person responsible‘.
Situations and preferences that an
Advanced Care Directive may cover:
�A nominated substitute decision-maker that the treating
clinician may seek out to discuss treatment decisions
�Other non-medical aspects of care that are important to
the person during their dying phase
�Relevant state and territory legislation or guidelines on
advanced care directives.
Legal and ethical standards:
�Dignity of risk
�Duty of care
�Human rights
�Privacy, confidentiality and disclosure
�Work role boundaries – responsibilities and limitations.
Reporting changing needs and issues
� If the individual is suffering from a terminal illness or other
condition then you may identify serious signs of
deterioration
� Additional support may be arranged to ensure the dignity
and comfort of the aged person
� You may have to make specific arrangements, depending on
the spiritual, legal and medical circumstances
� Details of any decisions should be documented in the care
plan.
Activity 3A
Follow the person’s advanced care
directives in the care plan
3.4 Monitor the impact of
the person’s end-of-life
needs, issues and decisions
on families, carers and /or
significant others and refer
to appropriate member of
the care team in line with
organisation protocols to
ensure they are supported
Follow the person’s advanced care
directives in the care plan

3.5 Deliver services in a


manner that supports the
right of individuals to
choose the location of
their end of life care
Signs of stress in caregivers:
�Denial
�Anger
�Anxiety
�Social withdrawal
Signs of stress in caregivers:
�Sleeplessness
�Exhaustion
�Irritability
�Health problems
�Trouble concentrating
Elderly people may decide to live their
last days in:
�Their own domestic residences
�Hospitals
�Care homes
�Hospices
Activity 3B
Respond to signs of pain and other
symptoms

4.1 Observe and


document the person’s
pain and other
symptoms in line with
care plan directives and
promptly report to
appropriate member of
the care team
Some of the symptoms of deterioration
include:
�Loss of appetite
�Restlessness, agitation
�Excessive fatigue/sleep
�Extreme physical weakness
�Mental confusion/disorientation
�Difficulty breathing (short period of apnoea)
Some of the symptoms of deterioration
include:
�Clients report seeing people who are already dead
�Social withdrawal, followed by brief, unexplained
spurts of alertness and attention
�Swelling in ankles and feet (also sometimes in hands,
feet and face)
�Inability to heal from wounds and infections.
Some of the symptoms of immediate
death include:
�Difficulty breathing (long periods of apnoea)
�Severe agitation of the client/hallucinations
�Severe incontinence/concentrated urine (that was not
present before)
�Inability to swallow
�Patient states they are going to die.
Some of the symptoms of immediate
death include:
�Fluid build-up in lungs
�Coolness in toes and fingers (due to lack of circulation)
�Mottled veins (due to lack of circulation)
�Lack of consciousness
�Inability to speak.
Other types of general pain that might
need treating are:
�Nausea/vomiting
�Constipation
�Aches/pains
�Stiffness of joints.
Activity 4A
Respond to signs of pain and other
symptoms

4.2 Implement strategies


to manage pain and
promote comfort in line
with care plan and role
Managing pain
�Elderly people are often affected by different types of
pain
�It may be centralised in a particular area of the body, or
more widespread
�If the pain isn’t alleviated then elderly people may have
mobility issues
�Carers and support workers should be able to identify
the signs of pain and administer different types of
relief.
The types of comfort you need to
account for are:
� Physical comfort – pain, breathing problems, skin
irritation, digestive problems, temperature sensitivity,
fatigue etc.
� Mental and emotional needs – fear of death, physical
contact, depression, anxiety, loneliness
� Spiritual issues – finding meaning in life, ending conflicts
and unresolved issues, sharing memories
� Practical tasks – reassurance that essential tasks will be
done in their absence.
Activity 4B
Respond to signs of pain and other
symptoms

4.3 Regularly evaluate


and document
effectiveness of
implemented strategies
Goals of pain relief and comfort
promotion:
� Physical comfort – pain, breathing problems, skin
irritation, digestive problems, temperature sensitivity,
fatigue etc.
� Mental and emotional needs – fear of death, physical
contact, depression, anxiety, loneliness
� Spiritual issues – finding meaning in life, ending conflicts
and unresolved issues, sharing memories
� Practical tasks – reassurance that essential tasks will be
done in their absence.
The aims of continuous improvement
should be to:
�Increase the value of care regarding their needs and
preferences
�Enhance compliance with accreditation standards
�Identify opportunities for improvement in a systematic
and planned manner.
The steps of continuous improvement
are as follows:
�Identify the area or activity for improvement
�Plan the process of creating the improvement
�Make the improvement
�Evaluate the improvement
�Decide on future actions. 
Activity 4C
Respond to signs of pain and other
symptoms

4.4 Refer to appropriate


member of staff any
misconceptions in the
workplace surrounding
the use of pain relieving
medication
Common beliefs:
�Pain can be determined by observation
�All patients with the same symptoms experience the
same amount of pain
�Medication is the best solution to pain
�Patients will become addicted to opioids
�Medication should always be started at the lowest level
�Morphine will alleviate all pain symptoms.
Common beliefs:
� Opioids are the only medication required to control pain
� Opioids are associated with addiction, respiratory
depression, tolerance, nausea, sedation and cognitive
impairment, constipation, and regulatory concerns
� Patients should not be trusted with control of their
medication
� If patients are intolerant to one type of pain medication,
they will be intolerant to all painkillers.
Other misconceptions that may be
stated are:
�'Pain relief should only be given for pain that is
currently present'
�'Doctors and nurses are the best judge of a client's pain'
�'Clients should not receive pain relief until cause is
determined'
�'Clients may become addicted‘.
Other misconceptions that may be
stated are:
�'Strong analgesics may shorten life'
�'Pain management alone is not palliative care'
�'The client may become too drowsy to communicate
with family‘.
Activity 4D
Follow end-of-life care strategies

5.1 Regularly check for


any changes on care
plan that indicate
decisions made by the
person have been
reviewed
Reviewing the care plan
�It is important to regularly check the care plan
throughout the duration that a patient is under your care
�If you are still following their old plan, you may not be
providing care according to their agreed wishes
�They have the right to make changes to their care plan
and Advanced Care Directive (ACD) – make sure these
are authorised changes before carrying them out.
Activity 5A
Follow end-of-life care strategies

5.2 Provide a supportive


environment to the
individual, families,
carers and /or significant
others involved in their
care at end-of-life
Implement the following concepts into
your life:
�Develop a consistent schedule
�Remember not to blame the person with dementia for
their behaviour
�Educate yourself on the effects of dementia and
strategies for managing it
�Talk to family, friends, or other people in a similar
situation.
Implement the following concepts into
your life:
�Take care of yourself – manage your diet, take regular
exercise and maintain a social life
�Be realistic about your ability to carry out required
tasks – if you take care of yourself, the quality of your
care increases.
Self-care strategies
�Allowing expression of feelings (rather than bottling
them up)
�Crying
�Talking (sharing feelings can be cathartic)
�Keeping a journal – writing feelings down can help you
understand them and process them more easily
�Not becoming consumed by the feelings.
Self-care strategies
�Performing comforting rituals/behaviours.
�Thinking carefully before you make any decisions on
your feelings
�Finding a balance between the negative feelings and
positive ones in life
�Rediscovering your sense of humour.
Activity 5B
Follow end-of-life care strategies

5.3 Respect and support


the person’s preferences
and culture when
providing end-of-life
care according to care
plan and role
Hydration and nutrition requirements
� A divisive subject for end-of-life care is that of nutrition and
hydration – some medical professionals see it as crucial to
continue providing it to the patient, whereas others see it as
unnecessary and allowing natural dehydration will not cause any
distress to the patient and quicken their death.
� Remember that the patient has the right to refuse hydration or
nutrition, even if it would be beneficial to their condition. This
request can be made verbally, if they are conscious and
competent or, if they are incompetent or unconscious, through
and Advance Care Directive.
Activity 5C
Follow end-of-life care strategies

5.4 Maintain dignity of


the person when
providing planned end-
of-life care and care
immediately following
death
Ways to maintain dignity include:
�Give support to client's and allow them to have as
much say in decisions as possible
�Allow people to die when and where they want
�Minimise pain and suffering
�Allowing client's to talk to qualified staff about death
and the related issues
�Assist people to plan for after-death arrangements and
say farewell to loved ones
Ways to maintain dignity include:
�Provide professional counselling and support
�Encourage continuation of normal activities, as far as
possible
�Be aware of cultural, religious and individual
preferences
�Provide support for family and carers
�Provide grief and bereavement support.
The types of comfort you need to
account for are:
�Physical comfort
�Mental and emotional needs
�Spiritual issues
�Practical tasks
Follow appropriate protocols after
death
The things that will need to be covered immediately
include:
�Obtaining the medical certificate from the doctor
�Registering the death (within five days)
�Arranging the funeral
�Arranging burial/cremation/disposition of the body.
Follow appropriate protocols after
death
The things that will need to be covered in the near
future include:
�Wills, money and estate
�Grief counselling
�Religious protocols and traditions (see
amemorytree.co.nz for a full list of religious traditions
surrounding death).
Activity 5D
Follow end-of-life care strategies

5.5 Recognise any signs


of the person’s imminent
death or deterioration
and report to appropriate
member of care team in
line with organisation
requirements
Some of the symptoms of deterioration
include:
�Loss of appetite
�Restlessness, agitation
�Excessive fatigue/sleep
�Extreme physical weakness
�Mental confusion/disorientation
�Difficulty breathing (short period of apnoea)
Some of the symptoms of deterioration
include:
�Clients report seeing people who are already dead
�Social withdrawal, followed by brief, unexplained
spurts of alertness and attention
�Swelling in ankles and feet (also sometimes in hands,
feet and face)
�Inability to heal from wounds and infections.
Some of the symptoms of imminent
death include:
�Difficulty breathing (long periods of apnoea)
�Severe agitation of the client/hallucinations
�Severe incontinence/concentrated urine (that was not
present before)
�Inability to swallow
�Patient states they are going to die
�Fluid build-up in lungs
�Coolness in toes and fingers (due to lack of circulation)
Some of the symptoms of imminent
death include:
�Mottled veins (due to lack of circulation)
�Lack of consciousness
�Inability to speak
�Sudden drop in blood pressure
�Systolic blood pressure
�Numbness of patient's legs/feet
�Rigidity of the body
�Cyanosis (bluish/purple hue to limbs)
�Jaw drop (unable to be held together).
Activity 5E
Follow end-of-life care strategies

5.6 Provide emotional


support to other
individuals, carers,
families and /or
significant others when
a death has occurred in
line with role
Debriefing
� Staff, clients, and families should be debriefed on the
death. This is a session where the information is shared
and processed by those affected – it can be therapeutic
and help people more easily understand and accept the
events surrounding the death. The session should be run
by someone who has experience and qualifications in
the debriefing process – they can help those affected
recover from the distress caused. From this, they can
also identify and recommend those in need of further
support and counselling.
Activity 5F
Manage own emotional responses and
ethical issues

6.1 Follow organisation


policies and procedures
in relation to managing
own emotional
responses and ethical
issues
Emotional Responses
� When managing emotional responses and ethical
issues, you must always follow your organisation's
policies and procedures. These will be specific to
where you work and should guide you on the
appropriate protocols to follow in these cases.
� These policies and procedures should be available to
all workers and they should be tested on their
knowledge of them, as well as having a reference
copy for use in each individual situation where they
need to check what to do.
Activity 6A
Manage own emotional responses and
ethical issues
6.2 Identify and reflect
upon own emotional
responses to death and
dying and raise and
discuss any issues or
reactions with
supervisor or other
appropriate person
Impact on the carers
� Seeing someone deteriorate and then pass away can create
emotional turmoil; the stress and demands on things like
time, money and sleep can compound on these emotions to
make the ordeal a huge burden. It can produce feelings of
anger and guilt and also be difficult to cope with physically,
as well as mentally.
� There can also be the impact of grief from multiple losses to
consider – when you lose someone you have cared for to
death, it can mean you lose a sense of purpose from the
caring role and also miss the personality and presence of the
person you have lost.
Symptoms of grief
�Shock and disbelief
�Sadness
�Guilt
�Anger
�Fear
�Physical symptoms
Activity 6B
Manage own emotional responses and
ethical issues

6.3 Raise any ethical


issues or concerns with
supervisor or other
appropriate person
Ethical issues
� The time, place and method of discussion about
imminent death with family members
� Deciding when to stop giving treatment and to let
the patient die naturally
� Advance care planning (whether to follow the
wishes of the patient)
� Decisions on what type of medical treatment to
give
� Making decisions that conflict with personal
values
Activity 6C
Manage own emotional responses and
ethical issues
6.4 Identify and action
self care strategies to
address the potential
impact of personal
responses on self
6.5 Access bereavement
care and support of other
team members as needed
Looking after yourself
�You’ll be in a better position to make a positive
contribution to the elderly person’s life if you are in a
fit physical and mental state
�You shouldn’t be too hard on yourself or give in to
feelings of despair
�You are encouraged to find means of taking your mind
away from the deterioration of the elderly person.
Coping with bereavement
�The family members of deceased care home residents
often experience extreme forms of bereavement
�It is also important to recognise the bereavement that is
experienced by residential care staff
�They often establish personal bonds with the elderly
individuals and have difficulty overcoming loss.
Bereavement support may be provided
by:
�Hospitals and community health centres
�Palliative care agencies
�Volunteer groups
�Church and religious organisations.
Activity 6D
Activity 6E
Skills and Knowledge Activity
Major Activity
�This activity should take anywhere between 1-2 hours
to complete and can be found at the end of your
workbook.

�Your instructor will let you know whether they wish for
you to complete it in session time or your own time.
Summary and Feedback
�Did we meet our objectives?
�How did you find this session?
�Any questions?
Congratulations!

You have now finished the unit…

‘Deliver care services using a palliative approach’

You might also like