1 Latifah Jehloh - งานนำเสนอ

Palliative care in Thai aging Muslim
 Latifah Jehloh
 In response to an increasing aging population in the
near future, a well-developed palliative care provisio
n is needed. Thais live an average of 74.4 years.
 Cancer and coronary heart disease have been the to
p leading causes of death in Thailand and more than
50% of the deaths are in hospitals.
Key challenges are described below:
 Not well-supported
 Need more funding: heavily donor-dependent
 Limited availability of morphine: most opioids are available in
regional and tertiary/university hospitals while it is limited in c
ommunity hospitals
 A small number of hospice-palliative care services : yet the m
ajority of persons with advanced stage spend their last year o
f life at home in their own community
Key challenges are described below:
 Inadequate training and skills in medical and nursing results i

n delaying patient access to palliative care services
 Difficult to initiate end-of-life care discussion with patients an
d families. patients are referred when they were in an active
dying stage.
 Most research studies were descriptive. There is very little int
ervention research to promote quality of life among palliative
care patients and their families
 As nearly 50% of Thais died at home, strengthening social rel
ations and building compassionate community-based care is i
mportant for enhancing end-of-life care in community and for
supporting persons to die peacefully at home.
What is palliative care?
 An approach that improves the quality of life of patients and their families facing t
he problems associated with life-threatening illness, through the prevention and re
lief of suffering by means of early identification and impeccable assessment and tr
eatment of pain and other problems, physical, psychosocial and spiritual.
 any care that alleviates symptoms, whether or not there is hope of a cure. Palliativ
e treatments may be used to alleviate the side effects of curative treatments, such
as relieving the nausea associated with chemotherapy
 Palliative care is for people living with a terminal illness where the disease is incura
ble.
 It focuses on providing relief from the symptoms, pain, physical stress, and mental
stress of a terminal diagnosis.
 The goal is to improve quality of life for both the patients and their family
 This includes addressing practical needs and providing bereavement counselling. It
offers a support system to help patients live as actively as possible until death.
 Do you think palliative care is only waitin
g to die?
 No, palliative care can be used along with curative or
aggressive therapies.
 What are the common symptoms occurring in palliati
ve care?
Pain
 Educate patients and family

 Do not delay treatment
 Use the pain diary and objective measures of pain
 Have a good understanding about pharmacology of drugs
 Give medication regularly, match with the severity of pain
 Observe drug overdose
Pain
 Non- opioid : NSAID, paracetamol--- side effect GI, renal toxicity, platelet function
interference
 Opioid: codein, tramadol, morphine, fentanyl---- s/e constipation, N/V, sleepiness,
tiredness, itching --- signs of overdose drowsiness, delirium (reduce the dose/ stop
the drug)
 Treat emotional, spiritual, and social pain
Nausea and vomiting
 Gastric stasis
 Intestinal obstruction
 Biochemical disturbances
 Drugs
 Raised ICP
 Treat with causes
breathlessness
 Manage the cause

 Non drug therapy : positioning, breathing exercise, relaxation technique
 Pharmacological: oxygen, bronchodilator, corticosteroid, analgesics, anxiolytic, anti
depressant, opioid
restlessness
 Treat the cause

 If no delirium : midazolam
 If delirium: haloperidol
Core competencies of healthcare professio
nals
 Should know how to diagnose and treat symptom effectively
 Should know how to talk to an emotionally disturbed patients and offer support
 Should know where to get social help for the patients
 Should know where to get spiritual help for the patients
Primary palliative care
 Any doctor or nurse should be able to

 Diagnose, monitor, support the management of major symptoms like pain, nausea
, vomiting, breathlessness
 Communicate well to the patients in a professional and supportive way
 Essential medicine and equipment to be able at the primary level
Care in the final days and hours of life
 Decision making
 Families are often unable to make timely decisions that respect the patient's wishe
s and values
 This can result in over-treatment, under-treatment, and other problems
 Living wills
Nursing care plan
 Anticipatory Grieving
 Situational Low Self-Esteem
 Acute Pain
 Altered Nutrition: Less Than Body Requirements
 Risk for Fluid Volume Deficit
 Fatigue
 Risk for Infection
 Risk for Altered Oral Mucous Membranes
 Risk for Impaired Skin Integrity
 Risk for Constipation/Diarrhea
 Risk for Altered Sexuality Patterns
 Risk for Altered Family Process
 Fear/Anxiety
Nursing Diagnoses Related to the Dying Pe
rson
 Death Anxiety  Chronic Pain
 Risk for Aspiration  Powerlessness
 Risk for Imbalanced Body Temperature  Readiness for Enhanced Religiosity
 Bowel Incontinence  Self-Care Deficit (specify)
 Decreased Cardiac Output  Impaired Skin Integrity
 Risk for Caregiver Role Strain  Impaired Social Interaction
 Impaired Verbal Communication  Readiness for Enhanced Spiritual Well-Being
 Ineffective Denial  Impaired Swallowing
 Functional Urinary Incontinence  Ineffective Thermoregulation
 Impaired Bed Mobility
 Impaired Oral Mucous Membrane
 In the model, perceptions of dignity at the end of life are organized into three maj
or categories: illness-related concerns, arising directly from the illness (e.g., the ne
ed for symptomatic relief); a dignity-conserving repertoire, those psychological and
spiritual resources that enable individuals to maintain a sense of dignity during the
illness experience (e.g., hopefulness, a sense of meaning); and a social dignity inv
entory, which includes various environmental resources that foster a sense of digni
ty (e.g., privacy, family support).
 Coenen et al. 2007)
Research examples
 Self-care and Compassion Fatigue in Nurses Caring for Dying Patients in

Thailand
 The result showed that overall of self-care was at a moderate level
Five Items with Highest Percentage of Very Often Perform Behaviors
Items Questions Dimension n %
1 Be aware of nonmaterial aspect of spiritual self-care 41 20
life
2 Wear cloth you like physical self-care 39 19
3 Cherish your optimism and hope spiritual self-care 36 17.6
4 Eat healthily physical self-care 34 16.6
5 Play with children emotional self-care 31 15.1

 The Level of Compassion Fatigue of Nurses Caring for Dying Patients
 The mean score of the secondary traumatic stress was at a low level (M = 20.17,
SD = 0.47). The mean score of burnout for this group was at a moderate level (M
= 23.09, SD = 0.29)
Mean, Standard Deviation, and the Level of Nurses’ Compassion Fatigue (N= 205)
Note: STS means secondary traumatic stress
Compassion M SD Level
Fatigue
STS 20.17 0.47 Low
Burnout 23.09 0.29 Moderate

 The Relationship Between Self-Care and Compassion Fatigue of Nurses C
aring for Dying Patients
 The result showed that there is a negative correlation between self-care and
burnout (r = -.36, p < .01). Burnout was negatively correlated with all aspects
of self-care, i.e., emotional self-care (r = -.34, p < .01), balance self-care (r = -.34
, p < .01), physical self-care (r = -.32, p < .01), spiritual self-care (r = -.29, p < .0
1), workplace or professional self-care (r = -.28, p < .01), and psychological self-c
are (r = -.14, p < .05).
 On the other hand, the result showed that there was no relationship between
self-care and secondary traumatic stress (r = -.05, p > .05). Data analysis
also revealed only one negative correlation between secondary traumatic stres
s and physical self-care (r = -.20, p < .05).
 Surrogates’ Decision Making Process Regarding Treatments for Critically
Ill Elderly Muslim Patients at the End Stage of Life
 Results revealed the steps of the decision making process regarding treatments for
critically classified as list: 1) practical steps to acknowledge the data found th
at : the decision makers chose to know in the most about patients symptoms (
M = 3.28, S.D. = 1.06) and possibility of the disease healing (M = 3.14, S.D.
= 1.05) 2) compliance in process analysis: the decision makers analyzed the
most about religion (M = 3.98, S.D. = 0.03), and patients preference (M = 3.9
4, S.D. = 0.06) and 3) practice in the process of the formulation and analys
is of alternatives: the decision makers analyzed the most about discussion alt
ernative treatments with family (M = 3.75, S.D. = 0.48), and the family rela
tionship after making decision (M = 3.46, S.D. = 0.71)
 Surrogate’s Decision Making Regarding Treatments of Critically Aging M
uslim Patients in End of Life.
 Results revealed decision makers chose the most to withhold treatment 84.17 i
ncluding full treatment and limit treatment, withdraw treatment 15.83 and bot
h of choice choosing comfortable treatment 76.67. Decision makers who chos
e full withhold treatment because they want to take care patients as bes
t as they can (4.95), and patients hope to live longer (3.96). Choosing of
limited withhold treatment because patients suffering (91.09), patients
wish (81.19), and patients age (51.49). Withdraw treatment because pat
ient wish to die at home (63.16), and worsened signs and symptoms (21
.05). Comfortable treatment because suffering from treatment (95.65),
and usual care (84.78)
 http://www.thaps.or.th/download-symptom-management/
 http://www.thaps.or.th/category/news/conference/
 Thai palliative care society (THAPS)

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Palliative care in Thai aging Muslim

 Inadequate training and skills in medical and nursing results i

 Educate patients and family

 Manage the cause

 Treat the cause

 Any doctor or nurse should be able to

 Self-care and Compassion Fatigue in Nurses Caring for Dying Patients in

3 Cherish your optimism and hope spiritual self-care 36 17.6

4 Eat healthily physical self-care 34 16.6

5 Play with children emotional self-care 31 15.1

Burnout 23.09 0.29 Moderate

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