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Palliative care, person-centered care
Geriatric Nursing 38 (2017) 262e263
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
AALNA Section
Palliative care, person-centered care Loretta Kaes, BSN, RN, BC, C-Al, Marjorie Risola, RN-BC
Many of the residents living in Assisted Living across the nation have four or more co-morbidities which indicate that chronic medical diseases significantly influence acuity and care planning for residents at end of life. Palliative medicine assists in managing the symptoms of chronic disease and symptoms associated with dying, Palliative Care is now a board certified sub-specialty of internal medicine with specialized fellowships for physicians who are interested in the field. Assisted living is well suited for the implementation of palliative care for those residents who have chronic medical conditions. Introducing palliative care to a resident and a loved one begins with a simple question, what do you know about your medical condition? Most likely the resident knows very little including the fact that chronic medical conditions are not curable but are manageable. The World Health organizations’ definition of palliative care is an approach that improves the quality of life of patients and their families facing the problem 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. You may be asking what is the difference between palliative care and hospice care? Palliative care and hospice care both focus on helping a person be comfortable by addressing issues causing physical or emotional pain, or suffering. Palliative care and other hospice care providers have teams of people working together to provide care. The goals of palliative care are to improve the quality of a seriously ill person’s life and to support that person and their family during and after treatment for which the person may recover. Hospice focuses on relieving symptoms and supporting patients with a life expectancy of months not years, and their families. However, palliative care may be given at any time during a patient’s illness, from diagnosis on including to recovery from the lifethreatening illness. Assisted living nurses perform a great service when they have the courage to open the conversion about how a person wishes to
Section editor information for proofing: Calvin Groeneweg, RN C-AL. E-mail address: [email protected] E-mail addresses: [email protected] (L. Kaes), [email protected] (M. Risola). 0197-4572/$ e see front matter http://dx.doi.org/10.1016/j.gerinurse.2017.05.010
be treated as the chronic disease progresses. This is personcentered care in its purest form. AL nurses care for geriatric residents, many who are nearing or at the end of life with no stated direction regarding how they wish to be cared for. Leaving end of life care without voicing their preferences, does not ensure that the resident will have quality of care or the quality of life as he or she wishes. The needs of residents and families living with chronic illnesses are straightforward. Most want high-quality care that promotes everyday functioning. Many also desire clear communication, dignity and a sense of control when making health decisions that impact their lives. Palliative care means resident and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate resident autonomy, access to information, dignity, respect and choice. It focuses on providing the person or persons with relief from the symptoms, pain, physical and mental stress of a serious, life threatening or chronic illnessdwhatever the diagnosis. The goal of such a holistic person-centered approach is to improve and maximize quality of life for both the person and the caregiver(s). Palliative care is provided by a team as an extra layer of support by healthcare, ancillary and spiritual resources. It is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care or along with curative treatment. There is no stipulation or limitation to the length of time palliative care can be provided. Palliative care can be provided across many settings including hospitals, skilled nursing facility, assisted living or in the person’s home. Palliative care focuses on progressive chronic conditions i.e., peripheral vascular disease, malignancies, renal failure (with or without dialysis) or liver failure, stroke with significant functional impairment, advanced heart or lung disease, frailty, neurogenerative disorders, and various forms of dementia. Seriously and terminally ill residents are those who may be living with end-stage dementia, terminal cancer, or severe disabling strokes who are unlikely to recover or stabilize; and for whom intensive palliative care is the predominant focus and goal of care for the reminder of their lives.
AALNA Section / Geriatric Nursing 38 (2017) 262e263
Components of Palliative Care encompass the following; physical, psychosocial, social interaction, spiritual and cultural beliefs/traditions allowing for a self-directed path to a more peaceful death. A plan of care/support plan is developed providing direction about the disease process itself, prognosis, and resident’s expected and actual functional limitations. The resident, and family may be assessed for their understanding of the illness in relationship to the resident-centered goals of care. One of the most important components of palliative care is the care of the resident at end of life. The focus of care is the management, alleviation and minimization of the symptoms of the dying process through the provision of outstanding team communication and documentation. Assessment and management of pain along with other symptoms is paramount in end of life care. It is essential to provide guidance to the family in what to expect in the dying process and once their loved one has passed. Support of the family begins with anticipatory grief in the period before their loved one passes, guided by their social, spiritual and cultural traditions. It most likely will be the responsibility of the nurse in partnership with the physician to initiate the conversation regarding residents’ wishes at end of life and to educate the family members as well as the residents concerning chronic disease progression and management. The following resources are strongly recommended for all staff including the nurse to share with the residents and their families. INTERACT (Interventions to Reduce Acute Care Transfers) is a quality improvement program initially developed by Joseph G. Ouslander, MD and Mary Perloe, MS, GNP at the Georgia Medical Care Foundation with the support of a contract from the Centers for Medicare & Medicaid Services (CMS) is designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities and assisted living communities. The Assisted Living version of INTERACT 4.0 was a product of Dr. Ouslander’s team and a team from Brookdale Senior Living led by Dr. Kevin O’Neil. The goal of the INTERACT system is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. Such transfers can result in numerous complications of hospitalization, and billions of dollars in unnecessary health care expenditures. INTERACT involves the entire staff, residents and family members to identify and report on all changes to the resident to allow for early interventions, support and treatments and prevent escalation to the hospital whenever safely possible. INTERACT version 4.0 for Assisted Living-Advance Care Plan guide consists of wonderful aids to enhance care and resident and family involvement in care decisions.
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263
Part (1) tips for starting and conducting the conversation Part (2) communication tips, Part (3) helpful language for discussing end of life care. Part (4) the resident and/or family who want everything done.
INTERACT version 4.0 has information for the nurse, resident and family regarding deciding whether to go to the hospital, and identifying the resident who may be appropriate for palliative care or comfort care and their associated interventions. INTERACT also, has available information sheets written for the resident and the family concerning several chronic diseases as well as the benefits and risks of CPR for the elderly. G. Tube feeding and other related topics which may help in the decision-making process of the resident and/or family regarding a plan of care. To access INTERACT 4.0 go to www.interact4.net then click on tools for assisted living. Much of the material is free or at a very modest cost. In addition, it is highly recommended for residents, families and all staff to view the film and read the book, titled “Being Mortal” by Atul Gawande, MD. Also, visit Dr. Gawande’s website at atulgawande.com for additional information. At a resident educational event held in your AL community, read the book and watch the film. It is a great way to introduce the importance of having the conversation to all staff, as well as residents and families at family night. Another resource for advance care planning, “Five Wishes”; what I want my loved ones to know can be obtained at the Five Wishes website is www.agingwithdignity.org or by calling 888594-7437. Palliative care is coordinated and consistently focused on the resident, their choices and the illness trajectory, and offers the right care at the right time, during an individual’s disease or condition. It is imperative with the changes in acuity levels, increased numbers of co-morbidities, delayed entry into assisted living communities and ever growing needs during the progression of chronic, life threatening illness that assisted living nurses be educated to provide or obtain pertinent information and external palliative care teams. Take a look at what your care team is doing for your residents at the end of life and see if there is more they could offer to assure the path is that chosen by the resident. We, as assisted living nurses, have a responsibility to provide resident-directed care at the end of life for all of our residents; to do this well, we must know what matters most to the person so we indeed can ensure a death with dignity.
Contents lists available at ScienceDirect
Geriatric Nursing journal homepage: www.gnjournal.com
AALNA Section
Palliative care, person-centered care Loretta Kaes, BSN, RN, BC, C-Al, Marjorie Risola, RN-BC
Many of the residents living in Assisted Living across the nation have four or more co-morbidities which indicate that chronic medical diseases significantly influence acuity and care planning for residents at end of life. Palliative medicine assists in managing the symptoms of chronic disease and symptoms associated with dying, Palliative Care is now a board certified sub-specialty of internal medicine with specialized fellowships for physicians who are interested in the field. Assisted living is well suited for the implementation of palliative care for those residents who have chronic medical conditions. Introducing palliative care to a resident and a loved one begins with a simple question, what do you know about your medical condition? Most likely the resident knows very little including the fact that chronic medical conditions are not curable but are manageable. The World Health organizations’ definition of palliative care is an approach that improves the quality of life of patients and their families facing the problem 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. You may be asking what is the difference between palliative care and hospice care? Palliative care and hospice care both focus on helping a person be comfortable by addressing issues causing physical or emotional pain, or suffering. Palliative care and other hospice care providers have teams of people working together to provide care. The goals of palliative care are to improve the quality of a seriously ill person’s life and to support that person and their family during and after treatment for which the person may recover. Hospice focuses on relieving symptoms and supporting patients with a life expectancy of months not years, and their families. However, palliative care may be given at any time during a patient’s illness, from diagnosis on including to recovery from the lifethreatening illness. Assisted living nurses perform a great service when they have the courage to open the conversion about how a person wishes to
Section editor information for proofing: Calvin Groeneweg, RN C-AL. E-mail address: [email protected] E-mail addresses: [email protected] (L. Kaes), [email protected] (M. Risola). 0197-4572/$ e see front matter http://dx.doi.org/10.1016/j.gerinurse.2017.05.010
be treated as the chronic disease progresses. This is personcentered care in its purest form. AL nurses care for geriatric residents, many who are nearing or at the end of life with no stated direction regarding how they wish to be cared for. Leaving end of life care without voicing their preferences, does not ensure that the resident will have quality of care or the quality of life as he or she wishes. The needs of residents and families living with chronic illnesses are straightforward. Most want high-quality care that promotes everyday functioning. Many also desire clear communication, dignity and a sense of control when making health decisions that impact their lives. Palliative care means resident and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate resident autonomy, access to information, dignity, respect and choice. It focuses on providing the person or persons with relief from the symptoms, pain, physical and mental stress of a serious, life threatening or chronic illnessdwhatever the diagnosis. The goal of such a holistic person-centered approach is to improve and maximize quality of life for both the person and the caregiver(s). Palliative care is provided by a team as an extra layer of support by healthcare, ancillary and spiritual resources. It is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care or along with curative treatment. There is no stipulation or limitation to the length of time palliative care can be provided. Palliative care can be provided across many settings including hospitals, skilled nursing facility, assisted living or in the person’s home. Palliative care focuses on progressive chronic conditions i.e., peripheral vascular disease, malignancies, renal failure (with or without dialysis) or liver failure, stroke with significant functional impairment, advanced heart or lung disease, frailty, neurogenerative disorders, and various forms of dementia. Seriously and terminally ill residents are those who may be living with end-stage dementia, terminal cancer, or severe disabling strokes who are unlikely to recover or stabilize; and for whom intensive palliative care is the predominant focus and goal of care for the reminder of their lives.
AALNA Section / Geriatric Nursing 38 (2017) 262e263
Components of Palliative Care encompass the following; physical, psychosocial, social interaction, spiritual and cultural beliefs/traditions allowing for a self-directed path to a more peaceful death. A plan of care/support plan is developed providing direction about the disease process itself, prognosis, and resident’s expected and actual functional limitations. The resident, and family may be assessed for their understanding of the illness in relationship to the resident-centered goals of care. One of the most important components of palliative care is the care of the resident at end of life. The focus of care is the management, alleviation and minimization of the symptoms of the dying process through the provision of outstanding team communication and documentation. Assessment and management of pain along with other symptoms is paramount in end of life care. It is essential to provide guidance to the family in what to expect in the dying process and once their loved one has passed. Support of the family begins with anticipatory grief in the period before their loved one passes, guided by their social, spiritual and cultural traditions. It most likely will be the responsibility of the nurse in partnership with the physician to initiate the conversation regarding residents’ wishes at end of life and to educate the family members as well as the residents concerning chronic disease progression and management. The following resources are strongly recommended for all staff including the nurse to share with the residents and their families. INTERACT (Interventions to Reduce Acute Care Transfers) is a quality improvement program initially developed by Joseph G. Ouslander, MD and Mary Perloe, MS, GNP at the Georgia Medical Care Foundation with the support of a contract from the Centers for Medicare & Medicaid Services (CMS) is designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities and assisted living communities. The Assisted Living version of INTERACT 4.0 was a product of Dr. Ouslander’s team and a team from Brookdale Senior Living led by Dr. Kevin O’Neil. The goal of the INTERACT system is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. Such transfers can result in numerous complications of hospitalization, and billions of dollars in unnecessary health care expenditures. INTERACT involves the entire staff, residents and family members to identify and report on all changes to the resident to allow for early interventions, support and treatments and prevent escalation to the hospital whenever safely possible. INTERACT version 4.0 for Assisted Living-Advance Care Plan guide consists of wonderful aids to enhance care and resident and family involvement in care decisions.
➢ ➢ ➢ ➢
263
Part (1) tips for starting and conducting the conversation Part (2) communication tips, Part (3) helpful language for discussing end of life care. Part (4) the resident and/or family who want everything done.
INTERACT version 4.0 has information for the nurse, resident and family regarding deciding whether to go to the hospital, and identifying the resident who may be appropriate for palliative care or comfort care and their associated interventions. INTERACT also, has available information sheets written for the resident and the family concerning several chronic diseases as well as the benefits and risks of CPR for the elderly. G. Tube feeding and other related topics which may help in the decision-making process of the resident and/or family regarding a plan of care. To access INTERACT 4.0 go to www.interact4.net then click on tools for assisted living. Much of the material is free or at a very modest cost. In addition, it is highly recommended for residents, families and all staff to view the film and read the book, titled “Being Mortal” by Atul Gawande, MD. Also, visit Dr. Gawande’s website at atulgawande.com for additional information. At a resident educational event held in your AL community, read the book and watch the film. It is a great way to introduce the importance of having the conversation to all staff, as well as residents and families at family night. Another resource for advance care planning, “Five Wishes”; what I want my loved ones to know can be obtained at the Five Wishes website is www.agingwithdignity.org or by calling 888594-7437. Palliative care is coordinated and consistently focused on the resident, their choices and the illness trajectory, and offers the right care at the right time, during an individual’s disease or condition. It is imperative with the changes in acuity levels, increased numbers of co-morbidities, delayed entry into assisted living communities and ever growing needs during the progression of chronic, life threatening illness that assisted living nurses be educated to provide or obtain pertinent information and external palliative care teams. Take a look at what your care team is doing for your residents at the end of life and see if there is more they could offer to assure the path is that chosen by the resident. We, as assisted living nurses, have a responsibility to provide resident-directed care at the end of life for all of our residents; to do this well, we must know what matters most to the person so we indeed can ensure a death with dignity.