Muh. Putra Basah BN Muhammadiyah University of Surakarta

What is Palliative Care? The World Health Organization describes palliative care as

"an approach that improves the quality of life of patients and their families facing the problems associated with lifethreatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."

DEFINITION Palliative care adalah sebuah pendekatan unuk memperbaiki kualitas hidup pasien dan keluarganya dalam menghadapi penyakit yang mengancam jiwa, melalui tindakan pencegahan dan pengobatan dari berbagai masalah yang terdiagnosa termasuk fisik, psikososial dan spiritualhttp://www.who.int/cancer/palliative/definition/en/

Lebih jauh lagi Secara umum, istilah keperawatan palliatif

bisa mengacu pada setiap perawatan yang meredakan gejala, apakah ada atau tidak ada harapan penyembuhan dengan demikian, perawatan paliatif dapat digunakan untuk meringankan effects samping perawatan kuratif seperti mengurangi rasa mual yang berhubungan dengan kemoterapi.

Orang bisa memulai perawatan paliatif sege

ra setelah klien didiagnosis dengan penyakit yang serius, bahkan jika mereka masih berharap dapat disembuh kan, kataThomas Smith, direktur medis perawatanpaliatif di Virginia Commonwealth UniversityMassey Can cer Center di Richmond.

Penerapan pengobatan paliatif Gambaran paliatif di negara maju

Pengobatan kuratif palliatif

Negara berkembangPengobatan kuratif

kematian

palliatif

kematian

Jenis jenis penyakit1.2. 3.

4.5. 6.

Cancer Chronic and progreessive pulmonary disorder CHF HIV / AIDS Progressive neurological conditions Renal disease

WHO Definition of Palliative CarePalliative care: provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death;

cont offers a support system to help the family cope during the

patients illness and in their own bereavement; uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

PRINSIP PALIATIF CAREPalliative care: tindakan pengobatan dari nyeri serta gejala2 lainnya yg timbul akibat penyakit yg diderita; pemahaman bahwa kehidupan dan proses menjelang ajal adalah normal; kematian bukanlah hal yang bisa dipercepat ataupun ditunda; penggabungan antara keperawatan terhadap psikologi dan spiritual pasien; memberi support sistem kepada pasien seefektif mungkin sampai meninggal Menawarkan support sistem untuk membantu keluarga selama masa sakit p asien dan dalam masa2 kematian

Continue... Menggunakan pendekatan team untuk menggali kebutuhan dari pasien dan keluarga termasuk counseling thd perpisahan thd pasien bila terdapat indikasi Akan meningkatkan kualitas kehidupan Dapat di gunakan pada awal dari peerjalanan penyakit atau sejalan dengan pemberian terapi yng di tujukan untuk memperpanjang kehidupan seperti kemotherapi atau terapi radiasi

Fokus Tujuan1. Mengurangi penderitaan2. Perawatan thd nyeri dan kondisi yang menyebabkan timbulnya stress

3. Perawatan psikologi dan layanan keagamaan4. Pemberian support sistem yang membantu pasien bisa beraktifitas seaktif mungkin

5. Pemberian support system yang mendukung dan bisa memulihkan keluarga pasien

Masalah yang meliputi pasien palliatif Nyeri Mual Kecemasan Sesak nafas Kehilangan peran sosial Ketergantungan Perubahan kepercayaan Denial Masalah finansial Dst.

atau agama Kesedihan Depressi

The History of Palliative Care Started as a hospice movement in the 19th century,

religious orders created hospices that provided care for the sick and dying in London and Ireland. In recent years, Palliative care has become a large

movement, affecting much of the population. Began as a volunteer-led movement in the United

states and has developed into a vital part of the health care system

Cont The first US hospital-based palliative care programs

began in the late 1980s at a few establishments including the Cleveland Clinic and Medical College of Wisconsin. Since then there has been a dramatic increase in hospital-based palliative care programs, now numbering more than 1400.

Hospice Care Hospice care is intended for people who are nearing

the end of life. Hospice care services are provided by a team of health care professionals who maximize comfort for a terminally ill person by reducing pain and addressing physical, psychological, social and spiritual needs. Unlike other medical care, however, the focus of hospice care isn't to cure or treat the underlying disease. The goal of hospice care is to provide the highest quality of life possible for whatever time remains.

Palliative vs. Hospice Care Division made between these two terms in the United

States Hospice is a type of palliative care for those who are at the end of their lives.

Palliative Care vs. Hospice Care Meskipun Istilah "perawatan paliatif" erat terkait

dengan hospice care,jenis perawatan paliatif tidak hanya untuk yang sekarat. Memang Pengertian Perawatan paliatif kadangkadang membingungkan dengan hospice care karena salah satu tujuan utama hospice care adalah kenyamanan juga dan kebanyakan pasien hospice care adaalah yang sekarat. Berikut adalah perbedaan antara perawatan paliatif dan hospice:

Berikut adalah perbedaan antara perawatan paliatif dan hospice:

paliatif care fokus pada manajemen nyeri dan gejala yang timbul pasien tidak harus terminal mungkin masih mencari pengobatan agresifhospice care fokus pada manajemen nyeri dan gejala yang timbul pasien memiliki diagnosis terminal dengan harapan hidup kurang dari enam bulan tidak mencari perawatan kuratif

Hospice difokuskan pada penyediaan layanan

berkualitas kepada orang-orang dibulan-bulan terakhir hidup yangtelah memutuskan untuk berhenti pengobatan yang dimaksudkan untuk menyembuhkan mereka. Perawatan paliatif di sisi lain dapat diberikan dari waktu pertama diagnosis. Anda dapat menjalani perawatan paliatif sekaligus sebagai pengobatan yang sifatnya kuratif.

ContDalam hospice care dan perawatan paliatif, fokusnya adalah pada kualitas hidup pasien. Tujuan untuk kedua jenis perawatan : untuk menangani dengan penyesuaian apapun terhadap segala sesuatu yang berhubungan dengan penyakit atau isue tentang akhir hidup

Conclusion hospice services and palliative care programs share similar goals of providing symptom relief and pain

management. Non-hospice palliative care is appropriate for anyone with a serious, complex illness, whether they are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression. In contrast, although hospice care is also palliative, the term hospice applies to care administered towards the end of life

dimana perawatan hospice di berikan? Hospice care Kebanyakan disediakan di rumah dengan anggota keluarga biasanya berfungsi sebagai pengasuh utama. Namun, hospice care jugabisatersedia di rumahsakit,panti jompo dan fasilitas rumah sakit khusus.

PALLIATIVE CARE ORGANISATION 1973 International Association for the Study of Pain,

founded Issaquah, Washington, USA 1976 1st International Congress on the Care of the Terminally Ill, Montreal, Canada 1977 Hospice Information Service, founded at St Christophers Hospice, London, UK. 1980 International Hospice Institute, became International Hospice Institute and College (1995) and International Association for Hospice and Palliative Care (1999) 1982 World Health Organization Cancer Pain Programme initiated 1988 European Association of Palliative Care founded in Milan, Italy 1998 Poznan Declaration leads to the foundation of the Eastern and Central European Palliative Task Force (1999)

Cont.. 1999 Foundation for Hospices in sub-Saharan Africa

founded in USA 2000 Latin American Association of Palliative care founded 2001 Asia Pacific Hospice Palliative Care Network founded 2002 UK Forum for Hospice and Palliative Care Worldwide founded by Help the Hospices Hospice Information Service re-launched as Hospice Information a joint venture between Help the Hospices and St Christophers Hospice 2004 African Palliative Care Association founded 2005 First World Hospice and Palliative Care Day (11 October)

Pelaksana paliatif care1. Petugas medis : Perawat Manajer kasus Dokter, fisioterapis, nutrisionis 2.Keluarga pasien 3.Petugas sosial komunitas : lay support petugas LSM

TEAMWORK Perawatan dasar : keluarga, teman dan tetangga Layanankeperawatan: perawat umum dan perawat spesialis Perawatanmedis: dokterumum spesialis di kedokteran spes

ialis paliatif Perawatan Sosial : pekerja sosial Perawatan Spiritual : penasehat iman,ulama Terapis: ahli okupasi terapi, fisioterapi (terapi fisik),ahli Terapi bicara dan bahasa, seni, drama,ahli musik PerawatanPsikologi : konselor, psikolog klinis kesehatan, psikiater Staf Spesialis : ahli gizi, apoteker staf pendukung : asisten perawat, administrasi, tukang kebun,transportasi, dan pekerja lain staf Relawan

Permasalahan yang di alami oleh pearwat paliatif

Kadangkadang perawat bisakewalahan oleh peker

jaan dan merasa tidakmampu melaksanakan tugasnya, ini disebut 'burn-out'. kebosanan

Tanda tanda nya Kelelahan

Kurang konsentrasi Kehilangan minat dalam pekerjaan Pengabaian tugas Sifat lekas tersinggung Kemarahan Withdrawal - menghindari pasien dan rekan Perasaan tidak mampu, tidak berdaya dan rasa bersalah Depresi - kurangnya kesenangan, tearfulness

solusi Pastikan setiap orang mempunyai waktu libur yang teratur. Ketika seorang pasien meninggal, luangkan waktu untuk merenungkan, mengakui bahwa kehilangan dapat menimbulkan stess yang tidak terhindrkan Membuat waktu untuk bersantai bersama - sambil minum teh, atau makan bersama. memberikan penghormatan tuk seseorang dalam upaya pemberian perawatan yang baik untuk pasien Mendorong satu sama lain ketika ada yang dilakukan dengan baik.

Cont... Membuat waktu

yangteratur untuk membahas pasien dan masalahnya. Pastikan setiap orang tahu bagaimana cara untuk mendapatkan bantuan (misalnya bagaimana relawan dan keluarga dapat menghubungi seorang petugas kesehatan untuk backup). pelatihan dan pengawasan secara continue meningkatkan kepercayaan diri dan kompetensi.

CanSupport, Delhi, India A cancer survivor starts a HBC programme CanSupport was started by a cancer survivor who

recognised a lack of support and information for people diagnosed with cancer. She visited hospital patients to offer advice and support, and a telephone helpline was started. Together with a nurse she developed a home care service visiting the poorer areas of Delhi. Now five multidisciplinary teams cover the city, and CanSupport has been granted its own license for prescribing morphine.

CONTOH KASUS PALIATIVE . Imagine a young woman with three children she

lives in a shanty town. Her husband died six months ago and the neighbours say he must have had HIV. Now she is becoming sick, has lost weight and she is scared that she may also die

ContRecently she developed a painful ulcerating swelling on her leg which stops her sleeping. Some days she can barely get out of bed to care for her children, but her parents are far away in the village. The landlord is asking for rent but she has no income since her husband died. The neighbours are gossiping, saying that the family is cursed, and she wonders if they are right since she has prayed for help but none has come.

Cont.. We can imagine that her illness is only one of her

many problems. Her greatest worry might be how to put food on the table for her family, or what will happen to her children if she dies. She has no financial support, she is isolated and feels rejected by God. Palliative care is about people rather than diseases and seeks to address the problems which are of most concern to the patient

The benefit of palliative care one study of 151 people finds:

Median survival: Palliative care patients: 11.6 months Standard care patients: 8.9 months Percentage depressed: Palliative care patients: 16% Standard care patients: 38% Source: The New England Journal of Medicine