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A pleasant afternoon!


OVERVIEW ON HOSPICE and PALLIATIVE CARE What is Hospice? From the word “ Hospes” Originally, referred to shelter or way station for weary travelers. Today, means a concept of care that provides comfort and quality of life to clients, and their significant others, who are facing life’s final journey associated with terminal illness.


OVERVIEW ON HOSPICE and PALLIATIVE CARE What is Hospice? A type of care and a philosophy of care which focuses on palliation of terminally ill patient’s symptoms. Physical Emotional Spiritual Social


OVERVIEW ON HOSPICE and PALLIATIVE CARE What is Hospice? The primary goals of hospice care are to: Provide comfort. Relieve physical, emotional, and spiritual suffering, promote the dignity of terminally ill persons. Hospice care neither prolongs nor hastens the dying process.


OVERVIEW ON HOSPICE and PALLIATIVE CARE Is It a Place? Hospice care is a philosophy or approach to care rather than a place. Care may be provided in a person’s home, nursing home, hospital, or independent facility devoted to end-of-life care.

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Hospice is… (Not necessarily) a place A philosophy of care A structure for care


OVERVIEW ON HOSPICE and PALLIATIVE CARE What Kind of Treatment Is Provided Through Hospice Care? Hospice care is holistic: The health care team attends to practical needs, and assistance in addition to emotional and spiritual needs and fear of dying. Care is provided by an interdisciplinary team.




HISTORY OF HOSPICE CARE 11th century, around 1065= the 1st hospice care are believed to have originated when the first incurably ill were permitted into places dedicated to treatment by Crusaders. 14th century- Order of Knights Hospitaller of St.John of Jerusalem opened the 1st hospice in Rhodes 17th century- Hospices were revived in France by the Daughters of Charity of Saint Vincent de Paul. 19th Century- established also in UK where attention was drawn to the needs of the terminally ill. 1902-1905- hospice care spread to other nations.( Australia, North America, Japan, China, Russia) Cecily Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit with Yale University.  Her lecture, given to medical students, nurses, social workers, and chaplains about the concept of holistic hospice care, included photos of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care.  1965: Florence Wald, then Dean of the Yale School of Nursing, invites Saunders to become a visiting faculty member of the school for the spring term.

The Modern Hospice Movement : 

The Modern Hospice Movement In the 1950s, as medical technology developed, most people died in hospitals. The medical profession increasingly saw death as a failure. Physical pain associated with terminal illness was not a target of treatment. Dame Cicely Saunders, MD, founded St. Christopher’s Hospice in London in the 1960s, in an effort to discover practical solutions to alleviating human suffering. She introduced hospice in the U.S. in a lecture at Yale in 1963. This contact set off a chain of events which resulted in the development of hospice care as we know it today.


HISTORY OF HOSPICE CARE 1972:  Kubler-Ross testifies at the first national hearings on the subject of death with dignity, which are conducted by the U.S. Senate Special Committee on Aging.  In her testimony, Kubler-Ross states, “We live in a very particular death-denying society.  We isolate both the dying and the old, and it serves a purpose.  They are reminders of our own mortality.  We should not institutionalize people.  We can give families more help with home care and visiting nurses, giving the families and the patients the spiritual, emotional, and financial help in order to facilitate the final care at home.” 1996: Major grant-makers pour money into funding for research, program initiatives, public forums, and conferences to transform the culture of dying and improve care at the end of life.

Myths of Hospice : 

Myths of Hospice A place. Only for people with cancer. Only for old people. Only for dying people. Can help only when family members are able to provide care. For people who don’t need a high level of care. Only for people who can accept death. Expensive. Not covered by managed care. For when there is no hope.

Realities of Hospice : 

Realities of Hospice About 80% of hospice care takes place in the home. Hospices are increasingly serving people with the end-stages of chronic diseases. Hospices serve people of all ages. Hospice focuses as much on the grieving family as on the dying patients. Alternative locations or resources may be available.

Realities of Hospice : 

Realities of Hospice 6. Hospice is serious medicine, offering state-of-the-art palliative care. 7. Hospices gently help people find their way at their own speed. 8. Hospice can be far less expensive than other end-of-life care. Most people who use hospice are over 65 and entitled to the Medicare Hospice Benefit, which covers virtually all hospice services.

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Who Are the Members of the Hospice Team? 1. Primary Physician Provides the hospice team with medical history. Oversees medical care through regular communication with the hospice team. Provides orders for medications and tests, signs death certificate, etc. Determines his or her level of involvement on a case-by-case basis with the hospice medical director.

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Who Are the Members of the Hospice Team? 2. Hospice Physician Provides expertise in pain and symptom control at the end of life. Works closely with the hospice team and primary physician to determine appropriate medical interventions. Makes home visits on as needed basis. May oversee the plan of care, write orders, and consult with patient and family regarding disease progression and appropriate medical interventions on a case-by-case basis.

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3. Nurse Visits patient and family in the home or nursing home on regular basis. May provide on-call services. Assesses pain, symptoms, nutritional status, bowel functions, safety, and psychosocial-spiritual concerns. Educates patient and family. Educates and supervises nursing assistants. Provides emotional and spiritual support to patient and family.

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4. Home Health Aide Assists patient with activities of daily living. Provides a variety of other services depending on assessment of need. 5. Social Worker Attends to both practical needs and counseling needs of patient and family. Arranges for durable medical equipment, discharge planning, funeral/burial arrangements Serves as liaison with community agencies. Assist family in finding services to address financial needs and legal matters. Provides counseling. Assesses patient and family anxiety, depression, role changes, caregiver stress. Provides general grief counseling.

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Chaplain Provides patient and family with spiritual counseling. Assists patient and family in sustaining their religious practice and in drawing upon religious/spiritual beliefs. Ensures that patient and family religious or spiritual beliefs and practices are respected by the hospice team. serves as a liaison with the patient/family faith, community and clergy. May conduct funeral and memorial services. Provides hospice staff with spiritual care and counseling.

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Volunteer Provides respite care to family members May assist with light housekeeping or grocery shopping. Helps patients stay connected with community groups and activities. Facilitates special projects. provide community education and outreach. May assist with office work.


LEVELS OF CARE ROUTINE HOME CARE- -most common level of care provided. -interdisciplinary team members supply a variety of services during routine home care, including offering necessary supplies. ( diapers, bed pads, gloves, & skin protectants)

Levels of Care: : 

Levels of Care: CONTINUOUS CARE Is a service provided in the patient’s home. Intended for pts. who are experiencing severe symptoms & need temporary extra support. Provides services in the home a minimum of 8 hours a day.


LEVELS OF CARE GENERAL INPATIENT CARE -Is an intensive level of care which may be provided in a nursing home. -intended for pts. who are experiencing severe symptoms which require daily interventions from the hospice team to manage. -Often, patients on this level of care have begun the “ active phase” of dying.


LEVELS OF CARE: RESPITE CARE-( referred as respite inpatient) Is a brief & periodic level of care a patient may receive. A unique benefit in that the care is provided for the needs of the family, not the patient. Is provided for a maximum of 5 days every benefit period.


OVERVIEW ON HOSPICE and PALLIATIVE CARE Is Hospice the Same as Home Health Nursing? Two primary differences between hospice care and home health nursing: 1. Any patient with a skilled medical care need is qualified to receive home health nursing care. Hospice care, on the other hand, is limited to persons with a terminal illness, with a life expectancy of six months or less, and with a focus on palliation not cure. 2. Patients in home health care receive visits primarily from a nurse while patients in hospice care receive the services of an entire interdisciplinary team whose area of expertise is end-of-life care.


OVERVIEW ON HOSPICE and PALLIATIVE CARE What Services Does Hospice Offer? For the Patient…. 1.Providing care to the patient. 2. Medical care to relieve pain and other symptoms arising from a life-limiting illness. 3. Basic needs of daily living. 4. Counseling. 5. Assisting the patient with unfinished legal or financial business and in making funeral arrangements. 6. Religious care.


OVERVIEW ON HOSPICE and PALLIATIVE CARE What Services Does Hospice Offer? For Caregivers/Family Members… 1.Counseling services.. 2.Respite care. 3. Health Education. 4.Practical assistance. 5.Assistance with cremation/burial arrangements and with funeral/memorial services. 6.Bereavement care. ^top

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Principles Underlying Hospice (SAUNDERS-founder St. Christopher’s Hospice in London,1996) 1.Death must be accepted. 2. The patient’s total care is best managed by an interdisciplinary team whose members communicate regularly with each other. 3. Pain and other symptoms of terminal illness must be managed. 4. The patient and the family should be viewed as a single unit of care. 5. Home care of the dying is necessary. 6. Bereavement care must be provided to family members. 7. Research and education should be ongoing.

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What is Palliative Care? An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. WHO

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Palliative care: provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care;

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Palliative care: offers a support system to help the family cope; uses a team approach to address the needs of patients and their families; will enhance quality of life; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life.

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The focus of palliative care: controlling symptoms, managing complications and maintaining quality of life.

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Goals of Palliative Care: 1. relief from suffering, 2. treatment of pain and other distressing symptoms, 3.psychological and spiritual care, 4. a support system to help the individual live as actively as possible, 5. and a support system to sustain and rehabilitate the individual's family.

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PALLIATIVE CARE GOAL : Its goal is much more than comfort in dying; palliative care is about living, through meticulous attention to control of pain and other symptoms, supporting emotional, spiritual, and cultural needs, and maximizing functional status.

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How Does Palliative Care Work? Palliative care focuses on the whole person during the course of the illness. Composing a diverse team of professionals, including: Physicians. Nurses. Pharmacists. Social workers. Pastoral counselors. Physical therapists. Occupational therapists. Music therapists. Art therapists. Specially trained volunteers.

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Palliative Care Nursing The essence of palliative care nursing is the art and science of caring for and comforting the dying and their families

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FLORENCE THE FIRST PALLIATIVE CARE NURSE : Florence Nightingale herself stated: “I use the word nursing for want of a better.” She went on to say: “The very elements of nursing are all but unknown.” (Nightingale, 1860).

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VIRGINIAS DEFINITION OF NURSING : The most concise and relevant to palliative care is Virginia's definition of nursing; “Nursing is primarily assisting the individual in the performance of those activities contributing to health and its recovery, or to a peaceful death.”

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PALLIATIVE CARE COMPETENCIES: Communication skills Physical care skills Psychosocial skills Teamwork skills Intrapersonal skills Life closure skills (BECKER 2009)

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COMMUNICATION SKILLS : The ability to field and respond to sometimes profound or rhetorical questions about life and death, to know when to say nothing, because that is the most appropriate response; to use therapeutic comforting touch with confidence; to challenge colleagues who may wish to deny patients information; and, perhaps to discuss the imminent death of a relative with families.

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Therapeutic Communication Active listening Open-ended questions Reflective statements Clarification Summarization Validation Reassurance Transitions Being present Silence

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PHYSICAL CARE SKILLS : - The knowledge and skills necessary to deliver active, hands-on care in whatever setting throughout a long period of illness. - Observational skills and the intuitive ability to recognize signs, advising doctors of the appropriate prescription and dosage to manage pain. - The advocacy role nurses have towards patients at a time of extreme vulnerability.

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Role of the Nurse in Palliative Care Dimensions of Care

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Hospice Care vs Palliative Care




EXAMINATION NO.1 The word HOSPICE comes from a Latin Word _________. 2-3. Goals of Hospice 4.It is called as a comprehensive care for patients whose disease is not responsive to cure. 5. -6. Goals of your answer to NO.4. 7.She introduced the idea of specialized care for the dying in the US. 8. -10 Roles of NURESE in Hospice Care.

Pain management : 

Pain management Pain management (also called pain medicine; algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain.[ The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners

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Treatment approaches to long term pain: 1. pharmacologic measures, such as analgesics, tricyclic antidepressants and anticonvulsants, 2.interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and 3. psychological measures, such as biofeedback and cognitive behavioral therapy

WHO Pain Ladder : 

WHO Pain Ladder The three-step WHO Analgesic Ladder provides guidelines for selecting the kind and stepping up the amount of analgesia. 1. Mild pain Paracetamol (acetaminophen), or a non steroidal anti-inflammatory drug such as ibuprofen 2. Mild to moderate pain -Paracetamol, an NSAID and/or paracetamol in a combination product with a weak opioid such as Hydrocodone used in combination, may provide greater relief than their separate use. 3. Moderate to severe pain

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