Palliative care

from Wikipedia, the free encyclopedia

Palliative care comprises the nursing expertise as well as special measures and services that are part of the holistic concept of palliative care (palliative care) or in the palliative medicine of nurses (this includes nurses , nurses in elderly care , nurses in outpatient care and specialist nurses for Intensive care and anesthesia and bridge nurses) and serve to improve the quality of life of those in need of care with incurable, life-threatening or terminal diseases and their relatives. The focus of this concept is the "prevention and alleviation of suffering through early recognition, faultless assessment and treatment of pain and other stressful ailments of a physical, psychosocial and spiritual nature". The nursing processes of general and special curative-oriented care overlap with palliative care or, in many areas, flow smoothly into one another and complement one another.

Analogous to the origin of the term palliative , which comes from the Latin (from pallium , 'coat', or palliare , ' mänteln ', 'conceal', 'envelop'), palliative care is understood as needs-oriented support that goes beyond death that should increase individual well-being and convey security and security in all stages of suffering and dying and include the personal environment. In this context, the nurses are an integral part of the interdisciplinary palliative care team, which not only includes doctors, pastors and various therapists (e.g. psychotherapists, psychologists, art therapists, music therapists and physiotherapists) but also volunteers.

Definitions of terms

The individual discipline of palliative care is internationally known as palliative care nursing .

Starting from the die accompanying supplies, first by Cicely Saunders , the term Care of the Dying and later Hospice Care was called, has end-of-life -Care ( end of life ) in the Nursing Science established. The internationally used term palliative care was incorrectly translated as palliative care in early publications. The English term care , which means both care, nursing and treatment, cannot be adequately translated into German due to this complexity. German terms for this holistic approach are palliative care or palliative care.

development

Palliative care has developed from the care and support of terminally ill people, as it was first practiced in hospices . After the family members, it is the caregivers who have the closest contact with the patient.

Principles and Concepts

Palliative care is a structured and needs-oriented care process, the course of which is actively determined by the wishes, needs, possibilities and the subjective perception of the person in need of care and not by the needs and necessities of care. The underlying ethical principles of care have a special place within palliative care. This includes, above all, the preservation of the dignity and autonomy of the person being cared for after death, the acceptance of dying as part of life, the integration of personal and family resources and their integration into the care process as well as the application of the principle "as much as necessary, as little as possible ”( High Touch-Low Tech ), which is intended in particular to prevent oversupply and impairment of quality of life through nursing and medical measures. In principle, the palliative care approach tries not to artificially lengthen or shorten life.

The care of palliative patients does not have to be carried out by specialized staff. First and foremost, it requires a rethink with regard to achievable care goals as well as greater consideration of the environment and the personal wishes of the patient. With this general palliative care (AAPV), there are usually no separately billable costs; it can be implemented in the home as well as on normal wards in hospitals and nursing homes. In some cases, a transfer to a facility such as an inpatient hospice or a palliative care ward may be desired or necessary.
The design of palliative care within the ethical and legal framework depends, among other things, on the respective outpatient or inpatient care facility and its entrepreneurial objectives and / or the respective care mission statement of the facility. Another factor is the target group of care incorporating the standard standards of care , such as children's hospices have a child-friendly environment and then appropriate care organization, while gerontopsychiatric facilities to palliative nursing in particular dealing with the sometimes very long course of dementia and of impending Multimorbidity Set . An important component of the conceptualized palliative care is the multi-professional cooperation in a palliative care team, here all those involved in the team are regarded as equal, with clear roles and tasks being allocated. Regular team discussions, communication and supervision are essential elements of a concept. The professional training of the nursing staff and all other members of the team is mandatory.

Needs orientation

Physical dimension

  • Symptom recording: In order to be able to alleviate pain or other stressful symptoms , symptom or pain recording management plays an important role in the context of nursing diagnostics . Corresponding nursing assessment instruments are used to record the quantitative and qualitative extent of individual pain perception or complaints. The most common impairments that occur in nursing diagnostics in addition to pain include shortness of breath , tiredness , nausea , constipation , changes in the oral mucosa (such as dry mouth , stomatitis , thrush ), loss of appetite and changes in body image .
  • Symptom relief: Nursing staff carry out supportive measures to alleviate the symptoms, for example relieving positioning or oral care adapted to the situation . In addition, they implement medically prescribed pain and symptom relief and monitor their effects and possible side effects . In addition, they advise or guide palliative care patients and their relatives with regard to nutrition, mobilization and other symptom-relieving measures and coordinate appropriate therapies.
  • Evaluation: The course of the symptoms and the success of various measures and therapies are recorded, checked and evaluated in the care documentation . The respective results of the evaluation are included in the care planning and thus close the cybernetic control loop of the care process.

Psychological dimension

For the palliative patient and his relatives, the diagnosis and progression of an incurable disease creates a borderline situation in which fear of loss, anger, sadness, hopelessness and similar feelings arise. The task of the caregiver is to give those affected the opportunity to express these emotions and to feel serious and accepted in this situation, to support the coping strategies of the individual and to offer conversations. If those affected signal that there is an additional need for discussion or if they need psychological help, the nurse will organize support from other members of the palliative care team or appropriately trained staff.

Spiritual dimension

In the personal confrontation with death, questions arise for the sick person about the meaningfulness of life, the balance of life and their own spirituality . Nurses support the person concerned by being willing to talk, encourage them to live their spirituality and leave room for farewell and loss situations, for example the loss of a body part or a body function. If necessary, they organize pastoral assistance , e.g. B. in the context of hospital pastoral care, whereby emphasis is placed on observing individual cultural and religious values ​​in the context of culturally congruent care. The term “spiritual care” is increasingly used in the literature for this spiritual dimension. The dignity therapy is a psychotherapeutic brief intervention for patients in the terminal stage with the aim of spiritual to reduce existential or psychosocial stress and strengthen their sense of dignity.

Social dimension

Integration into the social network, the regulation of unfinished business and conflict resolution are important social aspects in palliative care. The people close to the palliative patient are often referred to as relatives. This makes it clear that not only family members, but also friends, colleagues and neighbors can belong to the affected environment. If relatives are not integrated into the care process, this has a negative effect on the effectiveness and efficiency of care. Palliative care supports the person in need of care in the organization of their everyday life, structures the daily routine, creates opportunities for rest and retreat on request or establishes contact with caregivers. Other tasks may include mediating and finding compromises between the different needs of the person in need of care, the caregiver and the caregiver, as well as moderating conflicts with relatives.

implementation

The Best Care for the Dying guide emerged from the Liverpool Care Pathway (LCP). It is intended to facilitate a systematic approach to the care and support of critically and terminally ill patients in the last days and hours of their lives. In particular, it can help institutions whose main field of work is not palliative care (e.g. hospital wards, old people's homes, nursing services) to do justice to the complex and demanding tasks involved in care in the dying phase.

further education

Germany

Various providers run palliative care courses for nurses, some based on the palliative care curriculum by Martina Kern, Monika Müller and Klaus Aurnhammer, the first curriculum on this subject in Germany (1996).

According to the framework agreement according to Section 39a, Paragraph 1, Clause 4 of Book V of the Social Code to ensure the quality of inpatient hospice care, a minimum number of nurses must be employed in this area who have completed such further training to the extent of at least 160 teaching hours. This further training must also be proven in other palliative care facilities for some of the nursing staff, for example in specialized outpatient palliative care .

The prerequisite for this is usually a completed training in health and (child) nursing; at least two years of professional experience is recommended. Palliative care training courses are assessed and recognized by the German Society for Palliative Medicine (DGP) or, at state level, by Alpha NRW or TÜV Süd, if certain standards are met.

literature

Basics

  • Martina Kern: Palliative care: guidelines and care standards. Pallia Med Verlag, 2000, ISBN 3-933154-42-1
  • Susanne Kränzle, Ulrike Schmid, Christa Seeger: Palliative Care: Handbook for care and support. Springer, 5th updated & extended edition, Berlin 2014, ISBN 978-3-642-41607-1 (print); ISBN 978-3-642-41608-8 (eBook)
  • Jean Lugton, Margaret Kindlen: Palliative Care: The Nursing Role. Elsevier Health Sciences, 1999, ISBN 0-443-05513-0
  • Marianne Matzo, Deborah Witt Sherman: Palliative Care Nursing: Quality Care to the End of Life. Springer Publishing Company, 2006, ISBN 0-8261-5794-7
  • Susanne Nagele, Angelika Feichtner: Textbook of palliative care. Facultas, 2005, ISBN 3-85076-685-3
  • Thomas Sitte: Die Pflegetipps - Palliative Care. Deutscher Palliativ Verlag, 14th edition 2014, ISBN 978-3-944530-04-8
  • Johann-Christoph Student , Annedore Napiwotzky: Palliative Care: perceive - understand - protect. Nursing practice. Thieme, Stuttgart 2007, ISBN 978-3-13-142941-4

Target group-related palliative care

  • Janet Dunphy: Communicating with the Dying . Swantje Kubillus (Ed.), Bern 2014, Verlag Hans Huber, ISBN 978-3-456-85357-4
  • Eckhard Frick (Hrsg.): Traugott Roser (Hrsg.): Spirituality and Medicine. Joint care for the sick person. (= Munich series Palliative Care. Palliative Medicine - Palliative Care - Hospice Work, Volume 4), Stuttgart 2009, ISBN 978-3-17-020574-1
  • Erich Grond , Palliative Care in Gerontopsychiatry: Guide for Nurses in Elderly Care . Kohlhammer 2003, ISBN 3-17-017479-7
  • Stephan Kostrzewa: Palliative care for people with dementia . Bern 2007, ISBN 978-3-456-84459-6
  • Corinna Warnken: Palliative care in inpatient elderly care: organizational development, quality management and end-of-life care . Schlütersche, 2007, ISBN 978-3-89993-178-5

Web links

Individual evidence

  1. ^ Definition of WHO 2002.
  2. ↑ Definition of the German Society for Palliative Medicine from October 31, 2003 ( Memento from July 20, 2004 in the Internet Archive ) ( available as PDF )
  3. ↑ Andreas Heller, Sabine Pleschberger, Michaela Fink, Reimer Gronemeyer: history of the hospice movement in Germany. Der Hospiz Verlag, Ludwigsburg 2012, p. 301.
  4. ↑ G. Bollig, M. Unger, P. Pani: Is there a difference between palliative care and palliative medicine? In: Journal of Palliative Medicine. Volume 11, No. 6, 2010, pp. 304-313. doi: 10.1055 / s-0030-1248613 .
  5. ^ Claudia Bausewein, Susanne Roller: Interdisciplinary team. In: Claudia Bausewein, Susanne Roller, Raymond Voltz (eds.): Guideline Palliative Care. Palliative medicine and hospice care. 5th edition. Elsevier, Munich 2015, ISBN 978-3-437-23313-5 , pp. 418-420.
  6. ^ Mary K. Kazanowski: Symptom Management in Palliative Care. In: Marianne Matzo, Deborah Witt Sherman: Palliative Care Nursing: Quality Care to the End of Life. Springer Publishing Company, 2006, ISBN 0-8261-5794-7 , pp. 319-344.
  7. ^ Arthur G. Lipman, Kenneth C. Jackson, Linda S. Tyler: Evidence Based Symptom Control in Palliative Care. Haworth Press 2000, ISBN 0-7890-1013-5 .
  8. ↑ Deborah Witt Sherman: Spirituality and Culture as Domains of Quality Palliative Care. In: Marianne Matzo, Deborah Witt Sherman: Palliative Care Nursing: Quality Care to the End of Life. Springer Publishing Company 2006, ISBN 0-8261-5794-7 , pp. 3-50.
  9. ↑ Traugott Roser (author), Eberhard Schockenhoff (preface), Spiritual Care. Ethical, organizational and spiritual aspects of hospital pastoral care. A practical-theological approach (= Münchner Reihe Palliative Care Volume 3), 1st edition, Stuttgart 2007, 2nd, revised edition Stuttgart 2011, ISBN 978-3-17-021439-2 .
  10. ↑ Harvey M. Chochinov, Thomas Hack a. a. 2005. Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. J Clinical Oncology 23, 5520-5525.
  11. ↑ Andrea Gasper-Paetz: The special role of the relatives in palliative care. Journal of Palliative Medicine, November 2013; P. 252.
  12. ↑ Palliative Portal: Liverpool Care Pathway .
  13. ↑ Article Best Care for the Dying ( Memento of the original from May 29, 2014 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. of the University Hospital Cologne (link checked on August 22, 2014) @1@ 2Template: Webachiv / IABot / palliativzentrum.uk-koeln.de
  14. ↑ M. Müller, M. Kern, F. Nauck, E. Klaschik (eds.): Qualification of full-time employees. Curricula for doctors, nurses, social workers, pastors in palliative medicine. Pallia Med Verlag, Bonn 1999, 2nd edition SV ISBN 3-933154-36-7
  15. ↑ Further training for nurses. On www.dgpalliativmedizin.de ; accessed on January 18, 2019