Palliative care - Wikipedia
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It is best to begin with open-ended questions and use close-ended questions to follow up on details. Sensitive questions Care must be used when asking patients about potentially sensitive subjects such as adherence, alcohol use, recreational drug use, sexually transmitted diseases or side effects that impact sexual functioning.
Some of the following techniques can help reduce patient reticence and open communication. Ask a question about alcohol use in the same tone you would ask about aspirin use. Preface question with a statement that conveys acceptance of past failures or mistakes. For example, pharmacists can ask if something has ever happened or been done, then ask if it happened or was done recently, and finally move to specific questions about frequency.
It is also helpful to state that behaviors or problems related to the sensitive subject are common. This is especially useful when asking about adherence.
Questions about alcohol use might be less threatening if they follow questions about caffeine use. Do not underestimate the value of silence when eliciting information from a patient.
Allow the patient enough time to think and respond to your question especially if it is possibly threatening. Pharmacists should suppress the desire to fill awkward silence with chatter or filler. Activity 3 The questions below are poorly worded for a consultation.
Explain why they are poor and rephrase them. Does it hurt a lot? How often did you give your child the antipyretic? Why do you miss doses? Do you use recreational drugs frequently? Some of my low-income patients skip doses to save money. Do you do this? Activity 4 A patient enters your community pharmacy and asks about medications to treat a vaginal yeast infection. The patient says she bought a product but it was not effective. You need to assess whether the previous product was not appropriate, not used correctly, or if the patient has misdiagnosed the symptoms.
The symptoms of a vaginal yeast infection can be similar to those of some sexually transmitted diseases. Give examples of questions you would use to elicit information. Be cautious about interpreting nonverbal communication. The message can be ambiguous because people can have very different nonverbal reactions due to cultural and normative differences. You should interpret the message within its context and confirm your interpretation with a verbal feedback strategy.
With more time and knowledge of the other person, the more accurate you will be. The soundtrack will be muted. What does the body language communicate? Watch again with the sound.
Did you get a different message? Developing trust Since trust develops gradually over time, many assume that there is little they can do to foster it in a short encounter other then communicating friendliness and openness verbally and nonverbally. However, research into group communication4 has shown that consistently cultivating a supportive environment promotes trust.
Eliminate as many distractions as possible and focus fully on the other person 2. Observe nonverbal cues to understand how the other person is feeling 3. It may be necessary to ask questions to fully understand, such as a.
Finding out additional information, e. Finding out how someone feels, e. Paraphrase the content and feelings: The patient can then agree or further clarify. It is important to paraphrase rather than repeat. It is possible for two people to use the same words and have different meanings.
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An example of paraphrasing is below. I need a different one. Do you experience more pain than before? Not so much but I feel stiff when I move. Para-communication Para-communication refers to how something is communicated, rather than the actual content. A large barrier to developing trust is in the way things are said, not the message itself.
It is important to communicate content so that the overall tone promotes a supportive, collaborative climate rather than a defensive one. Judging Judging or evaluative language describes the worth of the other person and his ideas or feelings. You must be less careless.
Do you need any help to keep track of the dosage schedule? Pharmacists are medication experts but they are not experts in emotional or personal problems. The most appropriate person to solve these problems is the patient.
Even in medication matters, patients must participate in making choices for their own healthcare because they are ones who administer the medicine in most cases. There are times when patients want advice or are unable to cope with their emotional problems, such as when they are severely depressed. Rather than offering solutions as an expert, it is best if pharmacists assist patients in clarifying what they need or suggesting alternatives that the patient may not have considered.
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In this case the pharmacist is 9 SP 11Aug11 dr SP Foundation in Effective Communication Session 3 supporting the patient rather than imposing a solution that the pharmacist thinks is best. Imagine that a consumer has asked you about weight loss products. It would be better to help the patient clarify what he or she thinks are the main obstacles to weight loss and suggest several solutions to deal with them.
It is quite likely that the patient will have to make significant lifestyle changes or have trouble managing the chronic disease at first.
A placating response attempts to minimize the impact of the diagnosis. A placating response is often more self-centered than people want to admit. It tries to protect the speaker from the emotional involvement of listening and engaging with another person in distress.
Generalizing Sometimes people try to reassure by telling a person in distress that others had faced a similar problem and had a positive outcome.
It can also encourage jumping to conclusions based on what other people have experienced rather than listening to the patient. Probing Although probing questions are useful in answering a question about appropriate medication or dosage, they are less useful when helping patients deal with emotional difficulty.
It can also lead to an expectation that gathering sufficient information will lead to a solution. Many human or emotional problems are not so easily solved. Activity 6 A woman is looking at products promising quick and lasting weight loss. She confides that she has been diagnosed as pre-diabetic and she wants to lose weight to improve her health.
How would you respond as a pharmacist? Write a dialogue between you and the woman. Passive behavior Passive behavior tries to avoid conflict. Passive people are likely to avoid expressing themselves out of fear that others may not agree. They tend to avoid initiating conversation and will put the needs or desires of others before their own.
They frequently worry about how others view them and have a high need for approval.
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Because of this, they tend to have a lot of anxiety in their relationships. Problems arise when passive people feel angry, resentful, victimized or manipulated. It damages their self-esteem and if not dealt with, it can lead to a seemingly unexplained expression of negative emotion. They tend to promote their own interests, but are indifferent or even hostile to the needs or desires of others. Aggressive people often believe that their goals are under attack or they are being thwarted by others.
Because of this, they tend to be easily frustrated and quick to anger. For instance, they may respond with anger when feeling disappointed. There are often benefits in the short term so aggressive people may be unwilling to modify their behavior. But because people are unwilling to have a relationship with them, their behavior has long-term consequences.
Assertive behavior Assertiveness is the direct expression of ideas, opinions and desires while respecting others. The objective is to stand up for oneself while not damaging relationships. Assertive people tend to view conflict as a problem to be resolved. They can even have a positive view of conflict as an event that can lead to discussion of differences and eventual growth and maturity in relationships.
A key factor in assertiveness is taking responsibility for what happens. Assertive people define goals in terms of what they will do, not what they want others to do. An unassertive goal would be wanting doctors to appreciate the role of the pharmacist in patient care. Assertive pharmacists would focus instead on specific things they could do to improve their relationship with doctors, such as telling them about pharmaceutical care services or showing nonverbally that a collaborative relationship is valued.
The doctors may not be convinced, but the assertive pharmacist would not have failed in his or her goal. When goals focus on what we can do, we have control over our ability to meet them.
Several skills are part of assertive behavior, such as initiating conversations, encouraging assertiveness in others, expressing appreciation, expressing opinions and conveying 11 SP 11Aug11 dr SP Foundation in Effective Communication Session 3 confidence.
There are also several assertive techniques to manage conflict1. They are described below. Providing feedback Letting others know how you respond to their behavior can help avoid misunderstandings and resolve conflicts that are inevitable in a relationship. But some of the techniques below can make negative feedback less threatening. Focus on problem solving rather than letting off steam. Assume that the relationship can be repaired and perhaps become stronger.
Inviting feedback from others In addition to providing feedback, assertive people also explicitly invite feedback from others. An assertive pharmacist would routinely ask patients whether they are satisfied with his or her services. Hospice services and palliative care programs share similar goals of providing symptom relief and pain management. Hospice care focuses on five topics: The end of life treatment in hospice differs from that in hospitals because the medical and support staff are specialized in treating only the terminally ill.
This specialization allows for the staff to handle the legal and ethical matters surrounding death more thoroughly and efficiently with survivors of the patient.
Hospice comfort care also differentiates because patients are admitted to continue managing discomfort relief treatments while the terminally ill receiving comfort care in a hospital are admitted because end-of-life symptoms are poorly controlled or because current outpatient symptom relief efforts are ineffective.
Hospice is a type of care involving palliation without curative intent. Usually, it is used for people with no further options for curing their disease or in people who have decided not to pursue further options that are arduouslikely to cause more symptoms, and not likely to succeed.
Hospice care under the Medicare Hospice Benefit requires that two physicians certify that a person has less than six months to live if the disease follows its usual course.
This does not mean, though, that if a person is still living after six months in hospice he or she will be discharged from the service. The philosophy and multi-disciplinary team approach are similar with hospice and palliative care, and indeed the training programs and many organizations provide both. Outside the United States there is generally no such division of terminology or funding, and all such care with a primarily palliative focus, whether or not for people with a terminal illness, is usually referred to as palliative care.
Outside the United States the term hospice usually refers to a building or institution which specializes in palliative care, rather than to a particular stage of care progression. Such institutions may predominantly specialize in providing care in an end-of-life setting; but they may also be available for people with other specific palliative care needs.
Hospitals are able to accommodate the demand for acute medical attention as well as education and supportive therapies for the families of their loved ones. Within hospital settings, there is an increasing shortage of board-certified palliative care specialists. This shortage results in the responsibility of comfort care falling on the shoulders of other individuals.
The average time between death and the admission of a terminally ill patient is 7. The average length of stay at a hospice house from admission to death is about 48 hours. End-of-life care Medications used in palliative care are used differently from standard medications, based on established practices with varying degrees of evidence. Routes of administration may differ from acute or chronic care, as many people in palliative care lose the ability to swallow.
A common alternative route of administration is subcutaneous, as it is less traumatic and less difficult to maintain than intravenous medications. Other routes of administration include sublingual, intramuscular and transdermal. Medications are often managed at home by family or nursing support. Distress in cancer caregiving For many, knowing that the end of life is approaching induces various forms of emotional and psychological distress.
The key to effective palliative care is to provide a safe way for the individual to address their distresses, that is to say their total suffering, a concept first thought up by Cicely Saundersand now widely used, for instance by authors like Twycross or Woodruff.
Usually, the sick person's concerns are pain, fears about the future, loss of independence, worries about their family and feeling like a burden. The interdisciplinary team also often includes a licensed mental health professional, a licensed social workeror a counseloras well as spiritual support such as a chaplainwho can play roles in helping people and their families cope.
There are five principal methods for addressing patient anxiety in palliative care settings. They are counseling, visualisation, cognitive methods, drug therapy and relaxation therapy.
Palliative pets can play a role in this last category. This Total Body Pain is the sum of all of the physical, psychosocial, and spiritual pain they can be enduring at this stressful time. This pain can be a physical manifestation to where their body is beginning to fight back on itself causing a multitude of physical symptoms.
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The pain can be in a psychosocial manifestation and can be dealt with by the medical team having open communication about how to cope with and prepare for death. The last aspect of pain that is included in Total Body Pain is the spiritual pain manifestation; if patients spiritual needs are met, then studies show that they will be more likely to get hospice care.
Addressing the needs of the Total Body Pain can lead to a better quality of life overall for the patients. Being able to identify the distressing factors in their life other than the pain can help them be more comfortable. Having a Psychosocial assessment allows the medical team to help facilitate a healthy patient-family understanding of adjustment, coping and support.
This communication between the medical team and the patients and family can also help facilitate discussions on the process of maintaining and enhancing relationships, finding meaning in the dying process, and achieving a sense of control while confronting and preparing for death. Chaplain services are one of the best services available for meeting this spiritual need.
That being said, there are not enough Chaplains available at any one time and the majority of them are not qualified to be giving services to Comfort Care patients whom often have the most serious illnesses. It embraces physical, emotional, social and spiritual elements and focuses on the enhancement of quality of life for the child or young person, and support for the whole family.
It includes the management of distressing symptoms, provision of short breaks, end of life care and bereavement support. Some children may require palliative care from birth, others only as their condition deteriorates. Families may also vary as to whether they wish to pursue treatments aimed to cure or significantly prolong life.
In practice, palliative care should be offered from diagnosis of a life-limiting condition or recognition that curative treatment for a life-threatening condition is not an option; however, each situation is different and care should be tailored to the child.
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Some of these conditions cause progressive deterioration rendering the child increasingly dependent on parents and carers. Children in long-term remission or following successful curative treatment are not included. Children's palliative care by country [ edit ] UK[ edit ] There are an estimated 49, children and young people in the UK living with a life-threatening or life-limiting condition that may require palliative care services.