Palliative and End Of Life Care

If you work as a member of the health care team in long term care, supportive living, C3 or Adult Day Programs, you must complete this Annually Required Learning and quiz. 
Palliative Care is:
  • A holistic approach that includes physical, social, psychological, and spiritual aspects of care.
  • An approach that improves the quality of life of persons/families facing life-limiting illness. It does  not  focus on quantity of life.
  • Provides relief from pain and other distressing symptoms.
  • Affirms life and regards death as a normal process.
  • Integrates the psychological and spiritual aspects of care.
  • Uses a team approach to address the needs of the client and their families by creating a support system. Consult Pastoral Care, Social Work, or a Pain and Palliative Care nurse if you feel extra support is needed, if a resident, client/family asks for it, or if a MD orders it.
  • Focuses on assisting clients to live out their remaining time as comfortably as they can and on lessening suffering, loneliness, and grief.
  • Palliative care, supportive care, comfort care, C1 or C2 Goals of Care Designation do not mean minimal or less care.
  • Do everything you can to make the client’s last weeks, days, or hours as comfortable as possible.
What is End-of-Life Care?
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End-of-Life care is the final stage of the palliative care approach and the journey of life.
·     The client is expected to die within the near future.
·     Focus is on supporting the client and family choices, and addressing anticipatory grief.

End of Life Care Assessment and Flowsheet:
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Complete when the client is at the end of life.
·     The form is available on Careweb under Clinical Forms.
·     File completed form in the Assessment section of the health record.

The Palliative Care Team can be involved for anyone with a life-limiting illness at any point during their disease process.
Pain is a Major Issue in Palliative Care

Uncontrolled pain leads to a death without grace and dignity. 
  • Pain is personal; it is what the client says it is. It must be treated.
  • Use the ordered PRN (as needed) medications. If the client is on a scheduled analgesic and continues to receive 3 or more PRN doses a day, inform the physician so the scheduled doses can be adjusted.
  • Try non-pharmacological strategies for pain and restlessness, e.g., repositioning, good oral hygiene, soft music, reading to them, providing a quiet calm presence, warm blankets.
  • As the client begins to have increasing difficulty swallowing, talk with the physician regarding “pill burden”. Are there oral medications that could be discontinued?
  • Repositioning every 2 hours is important, however, consider each client’s comfort and current condition.  
Goals of Care Designations
A Goals of Care Designation is the end result of Advance Care Planning and often forms part of palliative care. They are instructions that guide the health care team about the general focus of client care and where this care will be provided. After speaking with client, family and/or agent, a physician or nurse practitioner will write the Goals of Care Designation as a medical order. The most current form is held in the “Green Sleeve”.

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Sample of the Goals of Care document used in Alberta

Sample of the Goals of Care document used in Alberta
Additional Considerations for Palliative Care:

In case of delirium, provide a quiet environment and decrease stimulation; less activity or noise around is best. 
 
Oxygen therapy at the end of life for decreased O2 saturation is not always necessary nor helpful.
 
See the Pain and Palliative Resource Manual (Section 9) for an algorithm to help you.

Respiratory congestion is common and can be upsetting for families/others.
 
Assessing vital signs is not necessary. 

Keep families well informed of the client’s status:  

·     Explain to families what changes they may see as death gets nearer.
·     Find out from the family if it is important for them to be present at time of death.
·    
Ask the family if they have chosen a funeral home. Encourage them to consider  doing so before death occurs.
·     Provide psychosocial support.
·    
Try not to leave the resident alone if death is imminent and family is not around

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* 1. What is Your last name?

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* 2. What is your first name (in full)

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* 3. Primary Carewest site of employment

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* 4. Unit (for NH, C3 and C Belcher SL4 write N/A)

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* 5. Palliative care is concerned about the client’s quality of life.

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* 6. One of the main motivations of palliative care is

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* 7. End-of-Life care is the same as

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* 8. End-of-Life Care Assessment and Flowsheet must be

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* 9. When can you contact the Carewest Pain & Palliative Care team?

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* 10. Palliative care, supportive care, comfort care, and C1 or C2 Goals of Care Designation mean care will be minimal.

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* 11. Non-pharmacological strategies for pain management include

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* 12. Respiratory congestion is common towards the end of life. Therefore, oxygen therapy is

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* 13. Keeping families well informed of the client’s status is important because it

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* 14. A Goals of Care Designation is a medical order that provides instructions on the general focus of client care. They can be written by

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