Palliative Care: Palliative Care: The Team ApproachThe Team Approach

Presented byPresented by

Reverend Alice Gilbert M.Th BCCReverend Alice Gilbert M.Th BCC

Nick Weitzel RN-BC, MSN, APN Nick Weitzel RN-BC, MSN, APN

Learning Objectives:Learning Objectives:Participants will: Participants will:

Identify definition of Palliative Care and Hospice Care. Identify definition of Palliative Care and Hospice Care.

Verbalize understanding of team rolesVerbalize understanding of team roles

Verbalize understanding of basic pain / symptom Verbalize understanding of basic pain / symptom management interventions.management interventions.

Verbalize understanding of culturally sensitive Verbalize understanding of culturally sensitive individualized spiritual care. individualized spiritual care.

Participate in Case Study Discussions for Palliative, Participate in Case Study Discussions for Palliative, Hospice and End of Life Care Scenarios.Hospice and End of Life Care Scenarios.

““Palliative Care is interdisciplinary care Palliative Care is interdisciplinary care that aims to relieve suffering and improve that aims to relieve suffering and improve

the quality of life, for patients with life-the quality of life, for patients with life-threatening illnesses, threatening illnesses,

and their families. and their families. Expert control of pain and symptoms and Expert control of pain and symptoms and practical support for patient and family is practical support for patient and family is

integrated into every stage of illness along integrated into every stage of illness along with all other appropriate medical with all other appropriate medical

treatments”treatments”(CAPC: Center to Advance Palliative Care, 2004)(CAPC: Center to Advance Palliative Care, 2004)

What is Palliative Care?What is Palliative Care?

““Palliative medicine (care) is aimed at Palliative medicine (care) is aimed at improving quality of life and supporting improving quality of life and supporting patients and the families of patients patients and the families of patients with serious and complex chronic with serious and complex chronic illnesses in whom prognosis is illnesses in whom prognosis is uncertain or may be measured in uncertain or may be measured in years.” years.”

Adler, E.D., Goldfinger, J.Z. & Kalman, J. (2010) Palliative care in the treatmentAdler, E.D., Goldfinger, J.Z. & Kalman, J. (2010) Palliative care in the treatmentof advanced heart failure. of advanced heart failure. Circulation: The Journal of the American HeartCirculation: The Journal of the American HeartAssociation. Association.

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What is Hospice Care?What is Hospice Care?

Different from Palliative CareDifferent from Palliative Care• Palliative care is not limited to hospice care.Palliative care is not limited to hospice care.

Palliative care may be provided at any time during Palliative care may be provided at any time during a person’s illness, even from the time of diagnosis. a person’s illness, even from the time of diagnosis. Palliative care can take place at the same time as Palliative care can take place at the same time as curative treatment. curative treatment.

• Hospice always provides palliative care.Hospice always provides palliative care. However, hospice is focused on terminally ill However, hospice is focused on terminally ill patients—people who no longer seek treatments to patients—people who no longer seek treatments to cure them. cure them.

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Vision and PhilosophyVision and Philosophy

• Our goal at Scripps La Jolla is that Our goal at Scripps La Jolla is that every patient receives excellent, every patient receives excellent, compassionate care. There are compassionate care. There are times when a medical problem times when a medical problem can not be resolved but the need can not be resolved but the need for comfort and support to the for comfort and support to the patient and family is extremely patient and family is extremely important. This is why we offer important. This is why we offer palliative care.palliative care.

Dr. Donald Ritt, Program Medical DirectorDr. Donald Ritt, Program Medical Director

Team Roles Team Roles “It Takes a Village”“It Takes a Village”

Patient & FamilyPatient & FamilyMedical Director/PhysiciansMedical Director/Physicians

Nursing DirectorNursing DirectorPalliative Care Coordinator RNPalliative Care Coordinator RNAPN RNAPN RNChaplain/Spiritual CounselorChaplain/Spiritual CounselorBio-ethicistBio-ethicistSocial Worker Social Worker Case ManagerCase ManagerHealing Touch PractitionerHealing Touch PractitionerPain Resource NursePain Resource Nurse

((

Potential PatientsPotential Patients

• Appropriate Appropriate

Palliative Palliative

Care ReferralsCare Referrals

• Principles of Principles of

Improved Improved

Symptom Symptom

ControlControl

Spiritual Care.Spiritual Care.“Spirituality involves finding meaning “Spirituality involves finding meaning and purpose in one’s life and and purpose in one’s life and experiences…” experiences…” 

““We are not human beings We are not human beings having a spiritual having a spiritual experience. We are spiritual experience. We are spiritual beings, having a human beings, having a human experience.” experience.”

Pierre Teilhard de ChardinPierre Teilhard de Chardin

Case Study DiscussionsCase Study Discussions

• Individual Human BeingsIndividual Human Beings

• Not a cookie-cutter processNot a cookie-cutter process

• ““Inquiry before Advocacy”Inquiry before Advocacy”

Case Study 1Case Study 1

• Sally 56 year old femaleSally 56 year old female

Ovarian CA w Mets to LungsOvarian CA w Mets to Lungs

PainPain

DyspneaDyspnea

Nausea/VomitingNausea/Vomiting

AnxietyAnxiety

Spiritual DistressSpiritual Distress

Case Study 2Case Study 2

• Robert 36 y.o. MaleRobert 36 y.o. Male

• ETOH ETOH

• Hep B, Hep CHep B, Hep C

• Social issuesSocial issues

• ARFARF

• Family in England Family in England

Case Study 3Case Study 3

• Martha 93 y.o. FemaleMartha 93 y.o. Female

• Pneumonia, InfiltratesPneumonia, Infiltrates

• Mild COPDMild COPD

• Cultural IssuesCultural Issues

• Family ConflictFamily Conflict

• POLSTPOLST

Case Study 4Case Study 4

• Paul 50 y.o. MalePaul 50 y.o. Male

• Father of two young children.Father of two young children.

• Appendectomy; peritonitisAppendectomy; peritonitis

• Open Abdominal Wound X 3 years Open Abdominal Wound X 3 years

• Complimentary modalitiesComplimentary modalities

• ““I have had enough”I have had enough”

• End of Life Care End of Life Care

Although the world is full of suffering, Although the world is full of suffering, it is also full of the overcoming of it.it is also full of the overcoming of it.

Helen Keller, “Optimism” , 1903