CUIDADO PALIATIVO NA UNIDADE DE TERAPIA INTENSIVA

2019 ◽  
Vol 1 (2) ◽  
pp. 68-94
Author(s):  
Raquel JESUS Melânia de Jesus Tassini ◽  
Joseph Fabiano Guimarães Santos ◽  
Maria Emídia de Melo Coelho
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
End Of Life Care ◽  
Critical Care Unit ◽  
Care Service ◽  
Palliative Care Service ◽  
Life Care ◽  
Comfort Care ◽  
Terapia Intensiva

No cotidiano da prática da medicina de urgência e emergência, mais especificamente na terapia intensiva, surgem diversas situações onde o paciente encontra-se na condição de um processo de morte inexorável, e muitas vezes já com o suporte avançado de vida instalado. Diante desta realidade, cada vez mais presente, necessitamos de intervenções que amenizem os sofrimentos consequentes à mesma, em que a capacidade humana de compaixão e misericórdia possam prevalecer. Neste estudo fez-se revisão sistemática, na busca de estudos observacionais e intervencionistas, além de estudos de revisão sistemática e meta-análise, obtidos através de pesquisa eletrônica realizada no banco de dados do Pubmed e Medline. O período pesquisado foi entre 2006 a 2018. Os termos pesquisados foram: “intensive care unit”, “critical care unit”, “palliative care”, “improving palliative care”, “palliative care service”, “palliative care consult”, “end-of-life care”, “comfort care” e “supportive care”. Fez-se descrição didática dos diversos aspectos encontrados na revisão, onde avaliou-se a importância e necessidade da integração dos cuidados paliativos com a terapia intensiva, por se tratar de uma opção com elevada eficiência e eficácia para dar suporte na assistência aos pacientes, principalmente àqueles com doença terminal e seus familiares. Conclui-se ser imprescindível a educação sobre a filosofia, princípios e prática dos cuidados paliativos na equipe multiprofissional, assim como nos especialistas envolvidos no cuidado do paciente.

Persepsi Perawat Neurosurgical Critical Care Unitterhadap Perawatan Pasien Menjelang Ajal

1970 ◽  
Vol 2 (1) ◽  
Author(s):  
Meilita Enggune ◽  
Kusman Ibrahim ◽  
Hana Rizmadewi Agustina
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life Care ◽  
Critical Care Unit ◽  
Life Care ◽  
Dying Patients ◽  
The Family ◽  
Dying Patient

Tingginya angka kematian yang terjadi di unit perawatan intensif, menuntut peningkatan pelayanan perawatan paliatif termasuk perawatan pasien menjelang ajal, yang melibatkan perawat perawatan kritis. Tujuan penelitian ini untuk memperoleh gambaran persepsi perawat terhadap perawatan pasien menjelang ajal di ruang Neurosurgical Critical Care Unit(NCCU). Delapan perawat pelaksana di ruang NCCU RSHS Bandung dilibatkan dalam penelitian deskriptif kualitatif ini dengan rentang usia antara 27– 43 tahun, dan bekerja selama 3–20 tahun. Teknik sampling yang digunakan adalah purposive samplingdan jumlah informan dibatasi setelah data jenuh. Pengumpulan data dengan melakukan wawancara semi terstruktur, dan analisis yang digunakan adalah content analysis. Hasil penelitian didapatkan 4 tema dan 15 subtema yaitu: (1) Pemahaman perawat tentang perawatan pasien menjelang ajal yaitu: membantu pasien meninggal dengan tenang, menghadirkan keluarga untuk memberikan dukungan, dan lebih berfokus pada bimbingan spiritual; (2) Cara menghadapi kematian yang sering terjadi yaitu: adaptasi perawat terhadap kondisi pasien menjelang ajal, kesulitan menentukan fase menjelang ajal pasien kritis, dilema dalam pengambilan keputusan, dan empati; (3) Peran perawat dalam mempersiapkan pasien menjelang ajal yaitu: pembimbing spiritual pasien, komunikator, fasilitator, dan pemberi dukungan emosional keluarga; (4) Hal-hal yang perlu diperbaiki dalam perawatan menjelang ajal yaitu: diperlukan pelatihan perawatan paliatif pada pasien kritis, diperlukan ruangan khusus pasien menjelang ajal, diperlukan pembimbing rohani khusus, dan diperlukan standar operasional prosedur (SOP) perawatan pasien menjelang ajal. Perawat perlu memberikan perawatan yang membantu pasien meninggal dengan tenang, memberikan dukungan untuk keluarga, dan lebih difokuskan untuk memenuhi kebutuhan spiritual pasien.Kata kunci: Intensive Care Unit, perawatan akhir hidup, persepsi perawat AbstractThe high number of death that occurred in the Intensive Care Unit, strive to improve palliative care services including the provision of care of dying patients by critical care nurses. The purpose of this study was to obtain a perception of nurses toward the care of dying patients in the Neurosurgical Critical Care Unit ( NCCU ). Eight nurses who work at NCCU were involved in this study, age between 27- 43 and have been working from 3 to 20 years. The sampling technique used the purposive sampling method and a limited number of informants after data saturated. Data collection was done by conducting semi- structured interviews, content analysis was used to analyse the data. There are four themes with 15 sub-themes include: 1) Nurse understanding about caring for dying patients: help the patients to die peacefully, presenting the family to provide supports, and more focused on spiritual guidance. 2) Way of handling the frequent of death occurance: adaptation of nurses to dying condition, difficulty determining the critical phase of the dying patient, dilemmas in decision-making, and empathy. 3) The role of nurses in preparing for the dying patient: the patient spiritual guides, communicators, facilitators, and providers of family emotional support. 4) The Things that need to be improved in end of life care: the palliative care training is required in critically ill patients as well as separate unit for dying patients, exclusive spiritual guide, and standard operating procedures (SOP) of care for the dying patients. It can be concluded that nurses need to provide treatment that helping patients to die peacefully, and providing support for the family, which is focused on meeting the spiritual needs of patients.Key words:Intensive Care Unit, end of life care, nurses perception

Aggressiveness of end-of-life care before and after the utilization of a palliative care service.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. 9135-9135
Author(s):  
W. Gonsalves ◽  
T. Tashi ◽  
T. Davies ◽  
S. Ortman ◽  
R. Thota ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Life Care ◽  
Before And After

Association between family satisfaction and caregiver burden in cancer patients receiving outreach palliative care at home

2017 ◽  
Vol 16 (3) ◽  
pp. 260-268 ◽  
Author(s):  
Yoko Naoki ◽  
Yoshinobu Matsuda ◽  
Isseki Maeda ◽  
Hideka Kamino ◽  
Yoko Kozaki ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Family Caregivers ◽  
Caregiver Burden ◽  
End Of Life Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Family Satisfaction ◽  
Life Care ◽  
Care At Home

ABSTRACTObjective:Little is known about the associations between family satisfaction with end-of-life care and caregiver burden. We conducted a researcher-assisted questionnaire survey to clarify the impact of caregiver burden on family satisfaction and to determine the types of burden that decrease family satisfaction.Method:Bereaved family caregivers of patients with advanced cancer who received our outreach palliative care service were retrospectively identified. Family satisfaction with the end-of-life care provided by the palliative care service and caregiver burden were quantified using the Japanese versions of the FAMCARE Scale and the Zarit Burden Interview (ZBI), respectively.Results:Our study subjects included 23 family caregivers. The mean scores on the FAMCARE Scale and the ZBI for the total population were 72.8 ± 11.2 and 22.8 ± 17.3, respectively, indicating moderate-to-high satisfaction and low-to-moderate burden. Caregiver burden had a strong negative correlation to family satisfaction with end-of-life care (Spearman's rho [ρ] = −0.560, p = 0.005), which remained after adjustment for potential confounders (standardized beta [β] = −0.563, p = 0.01). Several burden items—including loss of control, personal time, social engagement with others, feeling angry with the patient, feeling that the patient wants more help than he/she needs, and a wish to leave the care to someone else—were associated with decreased satisfaction. The major cause of dissatisfaction for family members included the information provided regarding prognosis, family conferences with medical professionals, and the method of involvement of family members in care decisions.Significance of results:Caregiver burden can be a barrier to family satisfaction with end-of-life care at home. A home care model focused on caregiver burden could improve end-of-life experiences for patients and family caregivers.

The Growth of Palliative Practice and End of Life Care in an Academic Teaching Intensive Care Unit

2022 ◽  
pp. 088506662110690
Author(s):  
Daniel King ◽  
Erica Schockett ◽  
Ghazi Rizvi ◽  
Daniel Fischer ◽  
Richard Amdur ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Univariate Analysis ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Comfort Care ◽  
Over Time

Objective Dying in the intensive care unit (ICU) has changed over the last twenty years due to increased utilization of palliative care. We sought to examine how palliative medicine (PM) integration into critical care medicine has changed outcomes in end of life including the utilization of do not resuscitate (no cardiopulmonary resuscitation but continue treatment) and comfort care orders (No resuscitation, only comfort medication). Design: Retrospective observational review of critical care patients who died during admission between two decades, 2008 to 09 and 2018 to 19. Setting: Single urban tertiary care academic medical center in Washington, D.C. Patients: Adult patients who were treated in any ICU during the admission which they died. Interventions and Measurements We sought to measure PM involvement across the two decades and its association with end of life care including do not resuscitate (DNR) and comfort care (CC) orders. Main Results: 571 cases were analyzed. Mean age was 65 ± 15, 46% were female. In univariate analysis significantly more patients received PM in 2018 to 19 (40% vs. 27%, p = .002). DNR status increased significantly over time (74% to 84%, p = .002) and was significantly more common in patients who were receiving PM (96% vs. 72%, p < 0.001). CC also increased over time (56% to 70%, p = <0.001), and was more common in PM patients (87% vs. 53%, p < 0.001). Death in the ICU decreased significantly over time (94% to 86%, p = .002) and was significantly lower in PM patients (76% vs. 96%, p < 0.001). The adjusted odds of getting CC for those receiving versus those not receiving PM were 14.51 (5.49-38.36, p < 0.001) in 2008 to 09 versus 3.89 (2.27-6.68, p < 0.001) in 2018 to 19. Conclusion: PM involvement increased significantly across a decade in our ICU and was significantly associated with incidence of DNR and CC orders as well as the decreased incidence of dying in the ICU. The increase in DNR and CC orders independent of PM over the past decade reflect intensivists delivering PM services.

scholarly journals Patterns of End-of-Life Care in Children With Advanced Solid Tumor Malignancies Enrolled on a Palliative Care Service

2015 ◽  
Vol 50 (3) ◽  
pp. 305-312 ◽  
Author(s):  
Tamara Z. Vern-Gross ◽  
Catherine G. Lam ◽  
Zachary Graff ◽  
Sara Singhal ◽  
Deena R. Levine ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Solid Tumor ◽  
End Of Life Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Life Care ◽  
Advanced Solid Tumor

A nurse practitioner-led community palliative care service in Australia

2019 ◽  
Vol 25 (5) ◽  
pp. 245-253 ◽  
Author(s):  
Julie Edwards ◽  
Dawn Hooper ◽  
Gillian Rothwell ◽  
Kerrie Kneen ◽  
John Watson ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Nurse Practitioner ◽  
End Of Life Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Community Setting ◽  
Essential Elements ◽  
Life Care ◽  
Community Based

Background: Patients want community-based palliative care, but there was no continuity of care for patients at the Sydney Adventist Hospital to receive palliative and end-of-life care within a community setting. A nurse practitioner (NP)-led community palliative care service was developed. Aims: To present the background, design, function, and essential elements of the Sydney Adventist Hospital Community Palliative Care Service (SanCPCS). Methods: Semi-structured and cyclical discussions with key informants alongside internal document reviews. Findings: This is the first description of an NP-led community palliative care service model. The NP role ensured specialist training and extended clinical practice within the community setting. The SanCPCS delivers accessible, continuous, community-based palliative care throughout the patient's palliative and end-of-life journey. Conclusion: NP-led models for palliative and end-of-life care in the outpatient or community setting are a logical direction to meet patient need.

The importance of identifying preferred place of death

2015 ◽  
Vol 9 (1) ◽  
pp. 84-91 ◽  
Author(s):  
Maimoona Ali ◽  
Margred Capel ◽  
Gareth Jones ◽  
Terri Gazi
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Service ◽  
Healthcare Providers ◽  
Palliative Care Service ◽  
Service Evaluation ◽  
Place Of Death ◽  
Life Care ◽  
At Home

ObjectivesThe majority of people would prefer to die at home and the stated intentions of both statutory and voluntary healthcare providers aim to support this. This service evaluation compared the preferred and actual place of death of patients known to a specialist community palliative care service.DesignAll deaths of patients (n=2176) known to the specialist palliative care service over a 5-year period were examined through service evaluation to compare the actual place of death with the preferred place of death previously identified by the patient. Triggers for admission were established when the patients did not achieve this preference.ResultsBetween 2009 and 2013, 73% of patients who expressed a choice about their preferred place of death and 69.3% who wanted to die at home were able to achieve their preferences. During the course of their illness, 9.5% of patients changed their preference for place of death. 30% of patients either refused to discuss or no preference was elicited for place of death.ConclusionsDirect enquiry and identification of preferences for end-of-life care is associated with patients achieving their preference for place of death. Patients whose preferred place of death was unknown were more likely to be admitted to hospital for end-of-life care.

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