Palliative/End of Life Support

Palliative Care

Improving quality of life for patients and families when faced with life threatening illness

Palliative Care for Adults

Palliative care is an holistic approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness. Through a variety of measures its primary focus is the prevention and relief of suffering by means of early identification, assessment and treatment of pain and other problems, physical, psychological and spiritual.

Palliative care:

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;
uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Palliative Care for Children

Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO’s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):

Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
It can be provided in tertiary care facilities, in community health centres and even in children’s homes.

Palliative Care in Ireland

Palliative care is provided in a number of ways by specialist palliative care in-patient units (hospices). These units form the hub around which other services are developed. Currently there are nine hospice units; three in the Dublin area and one each in counties Limerick, Cork, Galway, Kildare, Sligo and Donegal.

Hospice or palliative care is provided:

In people’s own homes, by home-care nurses working in cooperation with the family doctor and/or specialist palliative care team
In hospices (dedicated specialist palliative care in-patient units)
In general hospitals, by the hospital’s specialist palliative care team
In community hospitals and nursing homes, by home-care nurses working in cooperation with the family doctor and/or specialist palliative care teams

Palliative care is provided by the HSE in partnership with voluntary service providers. The Irish Cancer Society for example provides a night nursing support to people with cancer who are in the last days of their life, and this can be accessed via the public health nurse or specialist home care team.

Both public and private patients can use the palliative care in-patient units and other services. You can be referred for palliative care services in a number of ways; through your family doctor or through your hospital doctor in consultation with your family doctor or through the hospital’s specialist palliative care team in consultation with your family doctor.

You can talk to any of the above on your own initiative about getting a referral.

**Extract taken from Citizen Information website**

Support for The Patient

If you are in receipt of Palliative Care as either a Hospice Inpatient or as an outpatient with the Specialist Palliative Home Care Team a range of services are available

Physiotherapy

The objective of the Physiotherapy service is to improve symptoms associated with the various conditions which may affect palliative care patients and to help patients live their lives as fully as possible.

Physiotherapists will also provide patients with advice and education on home exercises, back care, postural control and best breathing techniques.

Occupational Therapy

The focus of Occupational Therapy in Palliative Care is to support independence and quality of life by assisting patients to set and accomplish goals in the areas of their lives which are important to them.

The range of therapeutic interventions provided by the Occupational Therapist includes:

Education and practical advice on how to manage symptoms associated with fatigue, breathlessness, anxiety and pain. This includes breaking down tasks into achievable steps, prioritising activities, introducing alternative techniques to promote or maintain independence, and advice on conserving energy.
Home Assessment as appropriate to identify what is practically possible to support a patient’s choice to visit, return or remain within their home environment, this includes:
- Reviewing how clients manage in their own homes to maximise their independence, comfort and safety.
- Provision of assistive equipment from our loan bank.
- Advice on home modifications together with advice for carers.
Advice and provision of specialised seating, powered wheelchairs and appropriate pressure care.
Adaptation of call alarms, computers and other equipment where necessary, to increase independence, safety and enhance social communication.
Relaxation, Anxiety Management and Pain Management Techniques.
Prescribed Therapeutic Group Work/Individual Activity – This is designed to raise self esteem, increase self awareness and provide opportunities for creative expression and reflection.

Psychology/Social Work

The Palliative Care Social Worker provides support and counselling to patients and their families, as they attempt to adjust to significant changes in their lifestyle as a result of illness.

They also provide information and advice about welfare benefits and community resources.

Support for Friends, Family, Carers

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