Settings for Hospice and Palliative Care Palliative and hospice services are provided in settings with various types and domains of care. The most common settings include the following (National Coalition for Hospice and Palliative Care (NCHPC), 2017): ● Hospitals ● Long-term or chronic care facilities ● Inpatient hospice facilities ● The patient’s home However, as palliative care is supportive care within a medical plan of care, it is also offered across settings such as office practices, cancer centers, dialysis units, assisted-living facilities, home health and hospice agencies, social service agencies, prisons, and homeless shelters (NCHPC, 2017). Regardless of the setting, it is paramount that communication flows among the various settings for optimal healthcare. This flow of communication among clinicians is important for efficient and successful coordination of care. There are significant incentives for improved integration and collaboration among hospice, hospitals, and community-based programs (Center to Advance Palliative Care [CAPC], n.d.). Hospitals receive penalties for Benefits of Effective Palliative Care–Hospital Partnership ● Expedites and expands access to a continuum of high-quality palliative care services ● Extends and strengthens the hospice–hospital partnership through an improved understanding about the resources and constraints of each partner
rehospitalizations, unnecessary hospitalizations, and emergency department utilization. Therefore, they are incentivized to find methods to improve community-based palliative care providers (CAPC, n.d.). Healthcare Professional Consideration: Inpatient palliative care teams assist throughout a health system but play a significant role in intensive care units (ICU). Because 60% of deaths in critical care occur following withdrawal of treatment, hospital-based palliative care teams are essential in providing expertise and support for patients and staff in ICUs (Braganza et al., 2017). Life-sustaining procedures that can potentially postpone death include intravenous (IV) fluids for the purpose of hydration, enteral tube feedings, mechanical ventilation, chemotherapy, dialysis, and cardiopulmonary resuscitation (CPR; Coté et al., 2018). Compassionate care in an ICU that is directed to the patient’s family during treatment withdrawal is established through delivery of care and emotional support while maintaining the patient’s dignity by controlling symptoms, ensuring patient cleanliness, and removing technical apparatus (Efstathiou & Ives, 2017). ● Identifies strategies for improving patient and family satisfaction ratings ● Provides greater access to professional, community-based bereavement services for families of deceased patients ● Enhances access to appropriate reimbursement structures for palliative care and hospice services (CAPC, n.d.)
DELIVERY OF HOSPICE AND PALLIATIVE CARE
Hospice and palliative care include the family, which is defined by the patient (NHPCO, 2020). Spatuzzi and colleagues (2017) studied quality of life in family caregivers of patients with advanced cancer in active treatment centers and hospice care. Caregivers reported that they need more support and information from clinicians when their loved ones are moving from curative oncology treatment settings to other levels of care (Spatuzzi et al., 2017). Therefore, the availability of family/ caregiver support must be in place from the moment of the diagnosis (Spatuzzi et al., 2017). To gain the trust of their patients and caregivers, clinicians need to coordinate palliative care to improve the patient’s quality of life, understand the Interdisciplinary Care Services As previously mentioned, hospice and palliative care are both provided by IDT working in coordination to provide patient- and family-centered care (NHPCO, 2020). Patient- and family- centered care takes place when the health system’s mission and quality-improvement drivers are aligned with a patient’s goals, preferences, and cultural traditions, and when the patient, while receiving the right care at the right time, shares information as part of the care team to make informed decisions that result in Symptom Management Alleviation of physical and psychosocial symptoms to achieve the best quality of life is the major emphasis of both palliative and hospice care (CCH, 2021). Physical symptoms that may evolve as the disease takes its natural course are pain, constipation, ascites, anorexia, alterations in bowel and bladder functioning, itching, dry mouth, nausea and vomiting, skin breakdown, fever, cough, and altered breathing patterns such as dyspnea (CCH, 2021). As death approaches, it is important for both clinicians and family/caregivers to understand symptom progression at the EOL to provide better symptom management for the patient (NHPCO, 2021). Patients and family members are given information by clinicians about what to expect as the disease takes its natural course (CCH, 2021). During the last three months of life, patients may get their affairs in order, sometimes consciously and sometimes subconsciously (CCH, 2021). During this time, patients may acknowledge their
significance of providing palliative care across the life span, and understand hospice philosophy and central principles (Spatuzzi et al., 2017). The patient and their caregivers and/or family are involved in the plan of care as appropriate. Usually, the patient is central to decision making, but in some cultures, other members of the family may be designated to make decisions about the patient’s care (NHPCO, 2020). Family members are taught how to provide care to the patient, and they are educated about the disease process and how it progresses, as well as signs and symptoms of the dying process (Capital Caring Health [CCH], 2021). improved individual health outcomes (Picker Institute, 2021). The core concepts of patient- and family-centered care are dignity and respect for the patient and family; sharing of information and taking part in care and decision making; involvement in care at a level they choose; and collaboration among the patient, family members, and clinicians in developing and evaluating policies and programs (St. Jude Children’s Research Hospital, 2021). dying and begin to withdraw and communicate less with those around them, may lose interest in watching television or reading the paper, sleep more than usual, and take naps throughout the day (CCH, 2021). Patients may create a list of items that they want to bequeath to family and friends after they die (Caring Info, 2021). They may begin to seek advice on how to list financial assets and insurance policies. At this time, patients are encouraged to complete a living will, advance directive, healthcare proxy, or power of attorney for medical decisions once it has not been completed. Despite 90% of American adults agreeing on the importance of outlining and notifying family and/or friends about end-of-life decisions, only 30% of the same people have documented their preferences (CCH, 2021). An advance directive is oral or written instruction on how to care for an individual if they are unable to make decisions for themselves.
EliteLearning.com/Psychology
Book Code: PYFL4024
Page 246
Powered by FlippingBook