Principles of Palliative and End of Life Care for Paramedics

Description

Paramedics are often the first port of call for those requiring emergency medical attention and, as such, they frequently encounter patients who are receiving palliative or end of life care. But as professionals whose training focuses on how to save a life, how can they best deal with patients who are approaching the end of theirs? In this situation, paramedics often need to make the difficult decision as to whether it is appropriate to transfer their patient to hospital, a decision which can have a significant impact not only on the patient and their family, but also on the paramedic themselves. This means that it is vital for paramedics to have an understanding of palliative and end of life care. This book provides a comprehensive guide to the philosophy, ethics, symptom control, emergencies and psychosocial aspects that underpin palliative and end of life care in paramedic practice. Chapters are written by paramedics and specialists in palliative and end of life care, who have decades of experience in providing care for patients in the community. Clinical chapters feature paramedic case study scenarios, aimed at allowing the reader to think about applying theory to practice. This is the first book aimed solely at supporting paramedics in their role caring for palliative and end of life patients. Contents: 1. Death & Dying in Society 2. Defining Palliative Care 3. Palliative Care Emergencies 4. Symptom Control in Palliative Care 5. Enhanced Communication 6. Care of the Dying Patient in the Last Days of Life 7. Ethics 8. Resilience in Paramedic Practice 9. The Paramedic as a Palliative Care Specialist Palliative and End of Life Care for Paramedics Title Page Copyright Contents Disclaimer Acknowledgements Abbreviations and Acronyms About the Authors Foreword Chapter 1: Death and Dying in Society Introduction Death in the Pre-Modern Era Death in the Modern Era Funeral Poverty The Effect of the Biomedical Model and Death Denial on Clinical Practice Clinical Language Used in Palliative and End of Life Care The Biopsychosocial Model Conclusion References Chapter 2: Defining Palliative Care Introduction Defining Palliative and End of Life Care World Health Organization Definition and Principles of Palliative Care The International Association for Hospice and Palliative Care Definition of Palliative Care The Foundation of the Hospice Movement UK Policies and Frameworks in Palliative and End of Life Care The Liverpool Care Pathway One Chance to Get It Right Document End of Life Care Strategy Gold Standards Framework Ambitions for Palliative and End of Life Care (2015) ReSPECT The National Institute for Health and Care Excellence Guidelines Preferred Place of Care and Advance Care Planning Paramedic Practice and Palliative Care Specifics What Is Already Known About the Topic? References Chapter 3: Palliative Care Emergencies Introduction Superior Vena Cava Syndrome Background Impact Pathophysiology and Clinical Aspects How Do I Recognise It? Management In-Hospital Treatment Conclusion Malignant Hypercalcaemia Background Impact Pathophysiology How Do I Recognise It? Pattern Recognition Management In-Hospital Treatment Metastatic Spinal Cord Compression Background Impact Pathophysiology How Do I Recognise It? Management In-Hospital Treatment Holistic Care Neutropenic Sepsis Background Impact Pathophysiology The 3 Rs – Recognition, Resuscitation, Referral How Do I Recognise It? Resuscitation and Referral In-Hospital Treatment Catastrophic Events in Terminal Patients Background Terminal Haemorrhage Complete Airway Obstruction Case Studies References Chapter 4: Symptom Management Introduction Pain Management Pain Assessment Pain Assessment in Patients with Cognitive Impairment The World Health Organization (WHO) Pain Ladder Opioids for Pain Commonly Used Drugs Pain Pathways and Sites of Action Non-Pharmacological Approaches Key Points Nausea and Vomiting Mechanisms of Vomiting The Emetic Pathway – What Initiates Vomiting? Nausea and Vomiting – Clinical Triggers Management of Nausea and Vomiting Key Points Breathlessness Assessment Reversible Causes The ‘Breathing, Thinking, Functioning’ Model Managing Breathlessness – Break the Cycle Pharmacological Interventions Breathlessness in the Last Days of Life Key Points Delirium Definition Causes Recognising Delirium Hyperactive, Hypoactive and Mixed Delirium at End of Life Screening for Delirium Management Drug Therapy The Effects of Delirium on Families Key Points Respiratory Secretions at End of Life Causes Explaining to Patient’s Family Management Urinary Retention Key Points Constipation Causes History and Examination Management Key Points Hiccups Assessment Management Intractable Hiccups Key Points Case Studies Further Reading References Chapter 5: Enhanced Communication Skills in Palliative and End of Life Care Introduction Communication with Patients, Family and Friends Barriers to Communication: FEARS/FIBS Patient Advocacy Interprofessional Communication Skills Breaking Bad News Truth-Telling in Clinical Practice Referrals, Documentation and Follow Up Hope and Communication Conclusion Case Studies References Chapter 6: Care of the Dying Patient Introduction Ten Key Elements for Care of the Dying Patient Recognising Death Anticipatory Medication Pain at End of Life The Conversion of Oral Opioids to Subcutaneous Opioids Key Points Nausea at End of Life Antiemetic Drugs at End of Life Delirium and Agitation at End of Life Drugs Used for Delirium at End of Life Drugs Used for Agitation at End of Life Respiratory Secretions and Dyspnoea at End of Life Drugs Used for Respiratory Secretions at End of Life The Doctrine of Double Effect Do Not Attempt Cardiopulmonary Resuscitation Order (DNACPR) What is a Good Death? Care After Death Bereavement, Grief and Loss Bereavement Grief and Loss Do Our Own Beliefs and Views About Death Affect Our Clinical Practice? Key Points Case Studies References Chapter 7: Ethics Introduction Summary of the Mental Capacity Act 2005 Ethical Theories Deontology and Utility Critique of Deontology and Utility Ethical Decision Making Cross Cultural Values Advance Directives and Advance Care Planning Ethics in Practice: Best Interests, Autonomy, Consent and Capacity Summary References Chapter 8: Professional Resilience Introduction Paramedic Culture Around Death Conflict and the End of Life Patient Palliative Care Research and ‘Getting it Right’ Psychological Demands of Paramedic Practice Professional Resilience Detachment, Compartmentalising and Emotional Blunting The Use of Humour Conclusion Case Studies References Chapter 9: The Paramedic as an End of Life Specialist Introduction The Extended Role of Paramedics in the Care of Palliative and Dying Patients Paramedics and Clinical Decision Making at the End of Life The Changing Education Requirements of Paramedics for Effective Palliative Care and the Impact of Research The Way Forward for Paramedics in the Care of Palliative and End of Life Patients References Index