week 4 Flashcards
(28 cards)
define end of life
‘approaching the EOL’ when they are likely to die within the next 6‐12 months.
whats the levels of tumors
Grade I. These tumors are slow growing and unlikely to spread. They can often be cured with surgery.
Grade II. These tumors are less likely to grow and spread but are more likely to come back after treatment.
Grade III. These tumors are more likely to have rapidly dividing cells but no dead cells. They can grow quickly.
Grade IV. In a grade IV tumor, cells in the tumor are actively dividing. In addition, the tumor has blood vessel growth and areas of dead tissue. These tumors can grow and spread quickly.
physical affects brain tumour
Jenny
: Jenny is already experiencing upper limb weakness. Paired with persistent headaches and a low appetite, Jenny is likely to be fatigued more consistently throughout the day and may not have the energy to participate in domestic household activities.
cognitive affects brani tumor Jenny
Jenny Difficulty in finding the right word
Alert, willing to participate in Ax
definition palliative care
- An approach that improves the quality of life of patients and families facing the problems associated with life‐threatening illness.
- Prevention and relief of suffering by means of early identification and comprehensive assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
role of OT in palliative care
“Occupational therapists help to optimise the individual’s function, promote dignity and support participation in essential and valued activities. Consistent with palliative philosophy, interventions are developed in consultation with patients, family and carers and support people to live and die in the place of their choosing.”
home assessments
- Majority of people wish to receive end of life care at home
- Temporary nature of return home due to person’s poor prognosis
- Time intensive
- Settle for less, keep it simple – rarely do home modifications
- OT seen as the practical help to enabling care at home
- Uncertain time for patients and families
OT role involving family and friends
- Families are not neutral bystanders
- Provide care, witness care, receive care & evaluate care
- Routinely work with families as patients are too tired & unwell
- May be at different stages of acceptance
- Relationships can be strengthened or complicated
- Provides support, education and training to informal caregivers to reduce risk of injury, negative experiences and complex bereavement. The informal caregiver role can be challenging, generating anxiety and stress in an already uncertain situation
occupations focused on in palliative care
- Independence in self care is highly valued
- Patient fear of being a burden
- Continual redefining of roles
- Heightened meaning to occupational roles
- Doing things that matter, being present in daily activities, taking charge, exerting influencing
What is voluntary assisted dying and clinical practice
- VAD can only be provided at the request of the individual
- VAD cannot be raised in discussion or offered as a choice by any health professional
- VAD is a medical procedure
- Some (but not all) health services/health organisations provide VAD in Victoria
- Doctors can choose to provide VAD or not
- Some palliative medicine specialists provide VAD, most don’t
- Most palliative care services don’t provide or facilitate VAD in the service
- All palliative care services continue to support patients, irrespective of a choice for VAD
- Individual health professionals can conscientiously object to being involved, if their health service is a provider
- All patients requesting VAD must be offered palliative care
- Demonstrate knowledge of the carer issues / impacts associated with caring for someone who has a terminal illness.
Understanding how caregivers feel: • Becoming caregivers • Loss of control • Decreased personal space • Lack of social support
Taking on caregiver duties
• The patient being more trusting of the family member
• Domestic & personal matters
Fulfilling their own needs
• No time for recreation
• Sleep deprived
• Always having to be at home
Handling emotions
• Feeling lonely
• Giving up activities, friends and work, while also losing a companion
• Being under constant stress
• Expectations of others 🡪 felt like others didn’t understand stress
• Stress of looking after children and their reactions
whats carer payment
The Carer Payment provides financial support to people who cannot work in substantial paid employment because they provide full-time daily care to someone with a severe disability, mental illness or medical condition, or terminal life-limiting illness, or to an older person with care needs.
You may be eligible to receive a Carer Payment if you:
• provide constant care at home for someone with a severe disability, mental illness, medical condition or an older person with care needs
• provide that care for a significant period (usually a minimum of six months)
• satisfy a means test based on your income and assets.
whats carer allowance
The Carer Allowance is for carers who provide additional daily care to someone with a disability or medical condition, or an older person with care needs.
To be eligible to receive a Carer Allowance you must:
• provide care every day for a dependent child aged under 16 years who has a disability or medical condition (the child must live with you), or
• provide care every day for two dependent children with disabilities or medical conditions, who do not individually qualify for Carers Allowance but together have a substantial caring responsibility and live with you, or
• provide care every day for a person aged 16 years or older who has a disability, medical condition, or who is frail aged, and
• provide the care in either your home or the home of the person you are caring for.
whats carer supplement
If you are already receiving the Carers Payment or Carer Allowance, the Carer Supplement is an annual lump sum payment to help with the costs of caring for a person with a disability or medical condition.
You do not need to apply for the Carer Supplement. Centrelink will automatically make the payment into your bank account if you are eligible. A letter will be sent to people who receive the payment.
communication skills for Client with terminal illness
- Recognised there is not always a need to respond to or to answer a question
- Not every question is a question- it may be a statement
- Ok to say Im not sure what to say
- Listen with sensitivity
- There is not one “right “way
- You need to include your own personality and style into your communication.
- The approach may vary for individual patients/carers
- The approach may vary for different tasks. – Home assessment (bathroom counselling) – Self care assessment
- Sitting with someone as they struggle is very active
- Some are scared of being ignored and abandoned because they’re dying
- Its OK to cry with people
- Patients and families identify poor communication as harmful
- Crucial to identify patient needs, concerns & queries
- Consider timing, delivery and content of communication
engagement tips for client with life limiting illness
- Explain to the client the importance and benefits of engagement in meaningful occupations for them.
- Explain the role of an Occupational Therapist for them.
- Communicate with the client different ways you can help them and listen to them.
- Hammill, Bye, & Cook (2014) demonstrated that participants considered being part of the hospice programme by sitting and watching others complete activities was just as important as actually doing the activity. Attending the hospice day programme gave participants a sense of belonging, enjoyment, and support. There was a sense of ‘becoming’ felt by participants who engaged in reflective activities that promoted self-affirmation and a greater insight into themselves as people. 3
o It demonstrates the importance of grading and communicating with the client to see if they may life to participate in this way.
factors influencing whether staff cope or not
- Personal awareness of the job
- Maintaining a healthy balance between work and social life
- Availability of support and willingness to accept support
- Organisation
- Taking a break when its needed
- Ability to devise own personal stress management strategies
advice on exploring how to work with people who are potentially dying
- Be aware of your own feelings. When showing empathy, it is appropriate to be sad.
- Be mindful they cannot solve everyone’s problems. You are not expected to have all the answers.
- Don’t ignore the death.
- Be ready to listen. Allow the bereavement time and space to tell their story and express their anger.
- Remember every person reacts to grief in their own way
principles underpinning a rehabilitative approach in palliative care
- Increase independence and confidence in ADLs and managing a changing body, appearance of a healthy me, increase emotional functioning and coping skills
- Significant functional gains made following rehab
- Gains made irrespective of patients age, cancer type, stage, active treatment
- Statistical vs clinical significance full to moderate assistance= home
occupatioanal performance issues faced by Jenny
Self-care - upper limb weakness issues e.g. brushing teeth
Driving and working impacted
Moderate assistance for bed and chair transfers
Family - household activities and providing assistance to Jenny
Unable to ambulate
Financial impact of situation for family
Change in activities with daughters - no longer active lifestyle
Gardening activities
- Outline potential care needs and equipment requirements of a person with terminal illness who wishes to receive care at home.
- Medicine/medication
- Carer
- Carer support
- Possible Home adaptations
- Home nurses
- Home assessment
- Emergency contacts/plan
- Outline how an occupational therapist can assist carers and family of the person dealing with the end of their life?
Family and friends:
- Families are not neutral bystanders
- Provide care, witness care, receive care & evaluate care
- Routinely work with families as patients are too tired & unwell
- May be at different stages of acceptance
- Relationships can be strengthened or complicated
- Provides support, education and training to informal caregivers to reduce risk of injury, negative experiences and complex bereavement. The informal caregiver role can be challenging, generating anxiety and stress in an already uncertain situation
- Explain why rehabilitation is an important intervention approach in palliative care?
Palliative care rehabilitation:
- Increase independence and confidence in ADLs and managing a changing body, appearance of a healthy me, increase emotional functioning and coping skills
- Significant functional gains made following rehab
- Gains made irrespective of patients age, cancer type, stage, active treatment
- Statistical vs clinical significance full to moderate assistance= home
- Describe the factors an OT needs to consider when setting goals with a person receiving palliative care.
Client centred priority setting: - Have clear rehab goals - Ongoing review and reframing of goals - Twin tracking Don’t assume you know what is important
Goal setting:
- Standardised versus non-standardised
- COPM
- GAS
- “What is most important for you to to do or keep doing?”
