All About Nursing · Hospice & Palliative Care

Pain Management at the End of Life (Reading and Sharing)

The prevalence of pain varies by dx, stage of disease, and setting of care. Approximately 1/3 of patients with cancer experience pain at the time of diagnosis, while 2/3 with metastatic disease report pain. Less is known about the prevalence of pain in those with diagnoses other than cancer.

Pain is described by the World Health Organization as a “multidimensional phenomenon with sensory, physiological, cognitive, affective, behavioral and spiritual components.” Pain is a complex biopsychosocial phenomenon, an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in these terms. (Pain is whatever the patient says it is.)

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All About Nursing · Hospice & Palliative Care

Reading and Sharing My Notes (5)

  • Quality improvement is not a department or a single entity, but an ongoing conglomeration of approaches for improving cost reduction, efficiency, satisfaction scores, and overall outcomes. Research-based outcomes are now the standard for implementing changes within an organization. Bechmarking against successful organizations is another tool used in quality improvement, as well as surveys, root cause analysis, and a continual re-evaluation process.
  • Medicare is very particular as to what is covered under hospice care. The patient’s prognosis must be 6 months or less to live. Focus is not on heroic intervention or expensive testing for simple symptom management. Also, keep the goals of care in mind when considering orders, and continue to discuss the patient’s case at interdisciplinary meetings.
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When the Movies Promoted Smoking (Piece of History – Reading & Sharing)

When Columbus landed in the New World in 1492, he and his men were astonished to find the native Indians smoking rolled-up tobacco leaves, the forerunners of present-day cigars. In the 16th century, Sir Walter Raleigh set London on its ear by puffing away on an elaborate pipe that he brought back from America. Soon tabacco smoking spread to Europe, and the craze was on. Doctors, noting its soothing effects, prescribed tobacco for all sorts of ailments, including lockjaw. In time, the craze was taken up by America’s new settlers. By the 1800s, cigarettes, which were really tiny cigars wrapped in paper, were a major industry, with billions being sold each year.

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All About Nursing · Hospice & Palliative Care

Reading and Sharing My Notes (4)

  • Veracity is the duty to tell the truth
  • Beneficence is the duty to act in a way that would best benefit the patient
  • Non-maleficence is the duty to do no harm
  • Justice is fairness for all
  • The HITECH Act’s modification to the HIPPA Privacy Rule, effective January 2018, grants access to a patient’s personal health information (PHI) 50 years after a patient has died.
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All About Nursing · Hospice & Palliative Care

Reading and Sharing My Notes (3)

  • Risk factors for complicated grief include a history of mental illness, substance abuse, previous loss, and sudden unexpected death. Medicare pays for bereavement counseling for up to 1 year after the patient’s death. Additional grief counseling would then be through a local support group. Studies have shown that men are less likely than women to openly express emotions or openly cry. This is felt to be a reflection of social norms for males having to show strength, and crying being perceived as a sign of weakness. Men often prefer to grieve alone or in private.
  • Portal hypertension often occurs in the presence of cirrhosis. Increased intrahepatic vascular resistance, and increased blood flow through the portal venous system, leads to the development of portosystemic collateral veins. With medium to large veins in the esophagus, the patient has up to a 30% chance of bleeding out within 2 years.
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