HISTORY of PALLIATIVE CARE

Materi Keperawatan Palliative S1 Keperawatan 2016

 ‘Hospice’ comes from a Latin word hospitium, meaning hospitality, and was
used in the Middle Ages in Europe and Mediterranean regions to describe a
place of rest for travellers and pilgrims

HISTORY OF HOSPICE
Existed in Roman Times – Charitable institutions for travellers 19th century
religious influence and opened for care of the dying

1967 with the opening of St Christopher’s Hospice, London, established by

Cicely Saunders (1918 – 2005). 20th century medical advances, while offering
a cure for many illnesses, also resulted in the neglect of the suffering of the
terminally ill.

1975 by Canadian surgeon Balfour Mount, an early Saunders pupil ---

Palliative Care
 Mount developed a comprehensive hospital-based
service: an in-patient ward, consultation service, home
care programme, and bereavement support service
under the name Palliative Care service by which he
meant non-curative therapy aimed at improving the
quality of life.
Hospice
A program of care that supports the patient and family
through the dying process and the surviving family
members through bereavement
 END OF LIFE CARE

• End of Life Care: allowing patients to ‘live as well until they

die throughout the last phase of life and into bereavement’.

• The last phase considered to be last 12 months of life.

The Cure - Care Model:
The Old System
D
Life Palliative/ E
Prolonging
Hospice A
Care
Care
T

Disease Progression H
 Palliative Care’s Place in the Course of Illness

Life Prolonging Therapy

Death

Diagnosis of
serious
illness ‘life
limiting Palliative Care Hospice
disease’
Perawatan Paliatif

Perawatan paliatif: pelayanan kesehatan yang bersifat holistik dan

terintegrasi dengan melibatkan berbagai profesi --- setiap pasien
berhak mendapatkan perawatan terbaik sampai akhir hayatnya

Pendekatan u/ meningkatkan kualitas hidup pasien & keluarga

menghadapi masalah terkait penyakit yang mengancam kehidupan,
dengan upaya prevensi dan mengurangi penderitaan; melalui
identifikasi dini, management nyeri, masalah fisik, psikosoial dan
spiritual (WHO, 2009)
Aims
 Provides relief from pain and other distressing symptoms;
 Affirms life and regards dying as a normal process;
 Intends neither to hasten or postpone death;
 Integrates the psychological and spiritual aspects of patient care;
 Offers a support system to help patients live as actively as possible
until death
 Offers a support system to help the family cope during the patients
illness and in their own bereavement;
Aims
 Uses a team approach to address the needs of patients and
their families, including bereavement counselling, if indicated;
 Will enhance quality of life, and may also positively influence
the course of illness;
 Applicable early in the course of illness, in conjunction with
other therapies that are intended to prolong life, such as
chemotherapy or radiation therapy.
PRINCIPLES
 Focus on quality rather than quantity of life
 Life affirming but death accepting
 Effective communication at all levels
 Respect for autonomy and choice
 Effective symptom management
 Holistic, multi-professional approach
 Caring about the person and those who matter to that
person
KEY ISSUES
 Information needs
 Being treated as a human being
 Empowerment
 Physical needs
 Continuity of care
 Psychological needs
 Social needs
 Spiritual needs
 Pelaksanaan Palliative care di tatanan pelayanan kesehatan
 Pihak-pihak yang berperan dalam pelayanan kesehatan bagi
klien dalam konteks Palliative care.
 Peran perawat dalam Palliative care.
 ADVANCED CARE PLANNING
Person Centred Care
 Seriously Ill Patients Want

 Treatment of pain and other symptoms

 Achieve a sense of control
 Communication regarding their care
 Coordinated care throughout the course of illness
 Relieve burdens on family
 Strengthen relationships with loved ones
 Sense of safety in the healthy care system --- financial
impact
 Cancer Trajectory, Diagnosis to Death

High Cancer
Function

Low death

Time
 Organ System Failure Trajectory
High
Function

Low death

Time
 High
Function Dementia/Frailty Trajectory

Low death

Time
Palliative Care

Person – Centered Care

Optimizes quality-of-life by anticipating, preventing,

and treating suffering.

Facilitating patient autonomy, access to information,

and choice
Person Centered Care

Tujuan: merasa bahwa setiap individu memiliki

tujuan dalam hidup

Rasa Diterima: merasa bahwa setiap individu

diterima di tempatnya berada

Kepentingan: untuk merasakan apa yang penting

bagi setiap individu untuk dipertimbangkan
“dilibatkan’)
Prinsip-Prinsip Person-Centred Care

V I P S

Value Individual Perspectives Supportive

Menciptakan
lingk. Yg
Menghargai & Memahami apa
Memperlakuka mendukung
menghormati yg dianggap kebebasan,
n tiap orang
(individu yg penting bg inklusi, &
sbg individu
dirawat) individu tsb kegiatan yg
bertujuan
Person Centered Care: Personhood
 Personhood: suatu kondisi atau status yang diberikan pada
seorang manusia oleh manusia lain, dalam konteks
hubungan manusia dn makhul sosial. Ini menyiratkan
pengakuan, penghormatan dan keperacayaan.

Tom Kitwood (1997)

Aspek – Aspek Kesejahteraan (well-being)

Occupation
Kesibukan

Attachement
Inclusion
kedekatan

Love

Comfort Identity
Person Centred Care
 Memaksimalkan Kekuatan dan Kemampuan
 Meminimalkan keterbatasan
 Memastikan Kualitas Hidup
CORE ELEMENTS OF PALLIATIVE CARE PROGRAM

 Patient and family centered care

 Timing of care
 Comprehensive care
 Interdisciplinary team
 Proactive
 Focus on relief of suffering
 Effective communication skills
 Continuity of care
 Smooth transitions
 Access to care
 Quality and patient safety

27
Maslow’s Hierarchy
 comfort and to reduce
Pain patients’ distress
management

treating symptoms : nausea, dealing with the

weakness, bowel and bladder PC emotional demands of
problems, mental confusion, fatigue,
and difficulty breathing support critical illness

service
Emotional
Symptom
dan spiritual
management
support
 Comprehensive and Compassionate care

Comprehensive: Compassionate care

 physical: based on the patient’s ‘a care that centred on the
symptoms and needs relationship of the palliative team
 psychological: verbal and physical, and those in their care’
simple to complex
strategies
 spiritual: perform prayers
together, work with the local
chaplaincy
 Strategies to provide compassionate care

A willingness to have a fully engaged relationship based on a

good communication
 Making sure the family had sufficient information about the
patient’s conditions
 Providing the family with practical instructions and information
for caring the patient
 Responding well to any questions by doing more assessment
and providing sufficient answer