Palliative care unit
A palliative care unit is a spatially contiguous supply unit specializing in palliative medicine at a hospital or a palliative center . It differs from most other wards in that it is more homely and has a higher staffing ratio. The staff also has special qualifications in palliative care . A palliative care unit treats acute symptoms and complications in terminally ill people, not the underlying disease.
From the 19th to the beginning of the 20th century, hospitals for cancer patients and tuberculosis patients were also established more frequently, combining curative and palliative functions. After outpatient support and inpatient hospices had become established as part of the hospice movement , the establishment of palliative wards, which began in Montreal at the Royal Victoria Hospital in 1973, closed another gap in the care of seriously ill and dying people. The palliative care unit integrates the idea of hospice in the hospital, where most people still die. As a hospital ward, the patients in a palliative ward have all the options of a hospital at their disposal, such as medical care at any time. On the other hand, the spatial design is usually more homely and the overall atmosphere is quieter than in other wards.
People with an advanced incurable disease (such as cancer , AIDS or ALS ) who suffer from acute symptoms or are in a disease-related psychosocial crisis are admitted to palliative care units. They must be informed about their condition and prognosis and be aware that no disease-specific therapy takes place here.
A mere increased care intensity is not an admission criterion, but the patient's quality of life can only be improved or maintained with palliative medical measures by the palliative care department. After the symptoms have improved, a discharge to the familiar environment can be sought.
The principles of palliative care apply to treatment ; according to this, diagnostic, therapeutic and nursing measures are only used if they correspond to the will of the person concerned on the one hand and have a high probability of having a positive effect on his quality of life on the other. The examinations as well as the treatment are therefore limited to the least stressful procedures possible. By medical , nursing and other measures, such as physical therapy or psychological support, is trying to make a substantial alleviation of distressing symptoms reach. The social contacts made possible by the coexistence of the patients on the ward can contribute to the well-being of those receiving palliative care. The aim is to then release the patient back into the home environment, as the length of stay - as in other hospital wards - is limited in time. Before the discharge, the social service organizes the further care in cooperation with the relatives and assists in making applications.
If it must be assumed that after discharge into the home environment, similar medical and nursing care is required around the clock as in the palliative ward, this will be taken over by a team of Specialized Outpatient Palliative Care (SAPV) after prescription and consultation with all parties involved . If sufficient care at home or in the home is not possible or not desired, the transfer to a hospice will be arranged. If there is a waiting time for a free hospice place, the further stay on the palliative care unit is usually made possible, but this can lead to difficulties with reimbursement if the requirements of the cost bearer for longer hospital treatment are not (no longer) met.
If discharge or transfer is no longer possible, the palliative care unit will provide the dying person with adequate space and support.
In Germany, palliative wards (first set up in 1983 at the Surgical Clinic of the University Clinic in Cologne) are implemented as acute wards at hospitals and are subject to the local financing system . Patients with statutory health insurance must pay the usual contribution for inpatient care. The hospital operator cannot use the budget to finance the homely equipment of a palliative care unit and other amenities; donations are collected for this.
Palliative consulting service
In order to improve the situation of seriously ill and dying people in their general wards, some hospitals and clinics offer a palliative consultancy service (in Germany: palliative medical consultancy service ). This service consists of a multi-professional team of employees. The core group of the team is made up of doctors and nurses who have advanced training in palliative medicine or palliative care. The team is expanded by employees from the social service as well as pastors, psychologists, physiotherapists, pharmacists, pain therapists and nutritionists.
The consultation service can be requested for seriously ill hospital patients who cannot or do not need to be cared for in a palliative care unit. He determines the need for palliative care and then primarily advises the medical and nursing staff on how to proceed. Only in the second place does the service address the patient and his relatives.
The palliative consulting service disseminates specific knowledge by passing on palliative principles through concrete work, but also with the design of internal training offers. This can bring about a long-term change in attitude within the clinic.
- A. Bremer, B. Roesner, G. Pott: Tasks and functions of a palliative ward. In: G. Pott, D. Domagk (Ed.): Integrated Palliative Medicine. Schattauer, Stuttgart 2013.
- Stein Husebø , E. Klaschik (Ed.): Palliative Medicine. Springer Science & Business Media, 2009, pp. 33-35
- Michael Stolberg : The History of Palliative Medicine. Medical care for the dying from 1500 until today. Frankfurt am Main 2011, pp. 241–245 ( The first palliative wards ).
- Johann-Christoph Student, Elisabeth Bürger: Inpatient hospice - alternative or complementary facility to the palliative ward. In: Eberhard Aulbert, Eberhard Klaschik , Dieter Kettler (eds.): Contributions to Palliative Medicine , Volume 5: Palliative Medicine - Expression of Social Responsibility. Schattauer, Stuttgart 2002, pp. 52-58.
- National hospice and palliative registry of the German Society for Palliative Medicine
- Interview Rheinruhrmed with Christoph Gerhard about the advantages of palliative consulting services over palliative wards
- List of all German hospice and palliative facilities, with an online search engine
- Palliative Care Units, Social Affairs & Law , accessed on May 26, 2011
- Michael Stolberg: The history of palliative medicine. Medical care for the dying from 1500 until today. Frankfurt am Main 2011, pp. 210–226 and 241–243.
- Balfour Mount, J. Andrew Billings: What is palliative care? In: Journal of palliative medicine , Volume 1, 1998, pp. 73-81, here: p. 73.
- Günter Kirsch, Maria Blatt-Bodewig: Social and emotional stress and support from fellow patients. In: Eberhard Aulbert, Friedemann Nauck, Lukas Radbruch (eds.): Textbook of palliative medicine. Schattauer, Stuttgart (1997) 3rd, updated edition 2012, ISBN 978-3-7945-2666-6 , pp. 1139Ý – 1147.
- A. Bremer, B. Roesner, G. Pott: Tasks and functions of a palliative ward. In: G. Pott, D. Domagk (Ed.): Integrated Palliative Medicine. Schattauer, Stuttgart 2013, p. 59f.
- Friedemann Nauck: Palliative medical consulting service in the hospital. In: E. Aulbert, F. Nauck, L. Radbruch (eds.): Textbook of Palliative Medicine. Schattauer, Stuttgart 2007, pp. 125–126.
- Umbrella Association Hospice Austria: Data collection 2014. Definitions of the individual organizational forms according to ÖBIG. P. 4 ( Memento of the original from April 29, 2016 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. ; Retrieved April 29, 2016