Monday, November 9, 2009

Comfort measures

End-of-life care means that we look after the needs of our client, and him him/her comfortable.

This means controlling the environment, having a Pain Management Kit on hand, feeding the patient as s/he indicates, providing physical comfort measure for skin, mouth, preventing bed sores by moving the patient every two hours or so.

Dr. Mike Harlos warns that common end-of-life complications include pneumonia, exacerbated by other physical issue: dementia, malignancy, and neurodegenterative, respiratory, and rheumatic conditions.

Quality of life Bill of Rights

Quality of life and end-of-life care policies in Canada are clear. The Canadian Bill of Rights guarantees the dignity and worth of every human being. The Government of Canada (2000) in its policy statement said the key mechanisms for improving the care of the dying include:
• Service delivery by interdisciplinary teams
• Access to services in the most appropriate location
• Availability of services when needed, whether for a few hours or around the clock
• Availability of services before death is imminent
• Services for a broad-based clientele, both with respect to cultural background and type of illness
• Awareness and skill in pain and symptom management
• Support for caregivers and family members

Symptom Management In Comfort End-Of-Life Care Of Pneumonia
I have learned that it is important to give regular doses of pain medication, to achieve, or quickly 'reclaim comfort', as Dr. Harlos says.

Often, patients are given oxygen to relieve breathing issues. It keeps them calmer, as they fight a little less to get a breath.
Typical symptoms may include, but are not limited to:
  • Dyspnea (shortness of breath)
  • Tachypnea (rapid breathing)
  • Agitated delirium (80% or more in the final days)
  • Pain
  • An agitated state of paranoia
  • dry lips since the patient breathes by mouth  (use a sterile mouth creme)

The mistake many caregivers make is in feeding the patient when s/he isn't hungry. The body begins to shut down, organ by organ, and food with compromise the client's comfort as i tries to digest food.
Patients, one nurse told me, can go two weeks without food, two days without water and two minutes without air.

My mother was eating about a tablespoon of food, three times a day in her last two weeks. This is entirely normal. My father, similarly, reduced his food intake slowly. It was only sweets he loved!

If you are choosing to remain at home, caregivers should be given a Pain Management Kit, to be used in the event of severe pain in the wee hours. Ensure that you advocate for this. It is well within the patient's End-of-life Bill of Rights (Gov't, 2000) , no matter where you live, and how many health care support workers are available to you.

  • In 2006, 228,079 Canadians died (*)
  • 75% of all deaths occur in people over 65 years of age.
  • 75% of the deaths take place in hospitals and long-term care facilities.
  • Each death potentially affects the well being of an average of five other people.
  • An estimated 5% of dying Canadians receive integrated and interdisciplinary palliative care.
  • About one quarter of the total deaths in Canada are related to cancer, but cancer patients account for more than 90% of those receiving palliative care.
  • The number of institutional palliative care beds has been cut as result of health care restructuring.
  • Few provinces have designated palliative care as a core service with a specific budget.

Palliative Care
  • People are receiving significantly different treatment in various institutions across the country.
  • People over 65 years of age are less likely than younger people to want to die at home.
  • Rural residents have considerably less access to palliative care than the residents of large urban areas.
  • Most of the costs and other burdens of homecare are assumed by the family.
  • Palliative care relies disproportionately on charitable donations for survival.
(from: Government of Canada. 2000. Quality end-of-life-care: The right of every Canadian. )

Palliative Care(PPT)

Bereavement Care. End of Life Care. Terminal phase. Current Model .

The Dying Person's Bill of Rights (PDF)

Canadian Hospice Palliative Care Association
National association provides leadership in hospice palliative care in Canada.

See also:

1 comment:

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