Principles of Palliative and End of Life Care for Paramedics

233 Pages·2020·30.069 MB·English

by  Tania Blackmore

COLLEGE OF COLLEGE OF COLLEGE OF
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PALLIATIVE AND L PALLIATIVE AND
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END OF LIFE CARE for Paramedics I
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E END OF LIFE CARE

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Paramedics are often the first port of call for those requiring emergency medical N
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attention and therefore frequently encounter patients who are receiving palliative

or end of life care. As professionals whose training focuses on saving lives, how can E for Paramedics
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paramedics help patients who are approaching the end of theirs? D

Palliative and End of Life Care for Paramedics provides a comprehensive overview O
of palliative and end of life care and how it fits in with the role of the paramedic. F

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Bringing together a range of authors, including paramedics and palliative care specialists,
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the book covers relevant aspects of caring for patients at the end of life. Topics include E
philosophy, ethics and psychosocial factors as well as how to deal with palliative care C
emergencies, symptom control and caring for the dying patient. It also covers enhanced A
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communication skills and how to support relatives and loved ones along with a chapter
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on professional resilience as a paramedic and coping with death.
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Putting end of life care within the context of the paramedic role, the book also r

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contains case study scenarios which allow the reader to apply theory to their practice.
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It is essential reading for all those hoping to better understand the complexities of r
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caring for patients approaching the end of life. m
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Tania Blackmore is a Senior Lecturer for the School of Health Sciences at the
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University of Greenwich where she specialises in palliative and end of life care. s
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Class Professional Publishing
The Exchange, Express Park, TTaanniiaa BBllaacckkmmoorree
Bridgwater, Somerset UK TA6 4RR
classprofessional.co.uk
PROFESSIONAL
Palliative and End of Life
Care for Paramedics
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Disclaimer
Class Professional Publishing have made every effort to ensure that the information, tables,
drawings and diagrams contained in this book are accurate at the time of publication. The book
cannot always contain all the information necessary for determining appropriate care and cannot
address all individual situations; therefore, individuals using the book must ensure they have the
appropriate knowledge and skills to enable suitable interpretation. Class Professional Publishing
does not guarantee, and accepts no legal liability of whatever nature arising from or connected to,
the accuracy, reliability, currency or completeness of the content of Palliative and End of Life Care
for Paramedics. Users must always be aware that such innovations or alterations after the date of
publication may not be incorporated in the content. Please note, however, that Class Professional
Publishing assumes no responsibility whatsoever for the content of external resources in the text or
accompanying online materials.
Text © Tania Blackmore 2020
All rights reserved. Without limiting the rights under copyright reserved above, no part of this
publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in
any form or by any means (electronic, mechanical, photocopying, recording or otherwise) without
the prior written permission of the publisher of this book.
The information presented in this book is accurate and current to the best of the authors’
knowledge.
The authors and publisher, however, make no guarantee as to, and assume no responsibility for, the
correctness, sufficiency or completeness of such information or recommendation.
Printing history
This edition first published 2020
The authors and publisher welcome feedback from the users of this book. Please contact the
publisher:
Class Professional Publishing,
The Exchange, Express Park, Bristol Road, Bridgwater TA6 4RR
Telephone: [phone]
Email: [email protected]
Website: www.classprofessional.co.uk
Class Professional Publishing is an imprint of Class Publishing Ltd
A CIP catalogue record for this book is available from the British Library
Paperback ISBN: 9781859596715
eBook ISBN: 9781859596722
Cover design by Hybert Design Limited, UK
Designed and typeset by S4Carlisle Publishing Services
Printed in the UK by Cambrian Printers Ltd
Refer to local recycling guidance on disposal of this book.
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Contents
Disclaimer x
Acknowledgements xi
Abbreviations and Acronyms xiii
About the Authors xv
Foreword: Karen Cleaver xix
1: Death and Dying in Society 1
Tania Blackmore
Introduction 1
Death in the Pre-Modern Era 1
Death in the Modern Era 3
Funeral Poverty 5
The Effect of the Biomedical Model
and Death Denial on Clinical Practice 6
Clinical Language Used in Palliative and End of Life Care 6
The Biopsychosocial Model 7
Conclusion 9
References 9
2: Defining Palliative Care 11
Tania Blackmore
Introduction 11
Defining Palliative and End of Life Care 12
World Health Organization Definition and Principles
of Palliative Care 12
The International Association for Hospice and Palliative
Care Definition of Palliative Care 12
The Foundation of the Hospice Movement 13
UK Policies and Frameworks in Palliative and End of Life Care 15
The Liverpool Care Pathway 15
One Chance to Get It Right Document 16
End of Life Care Strategy 16
Gold Standards Framework 18
iii
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Contents
Ambitions for Palliative and End of Life Care (2015) 19
ReSPECT 19
The National Institute for Health and Care Excellence Guidelines 20
Preferred Place of Care and Advance Care Planning 21
Paramedic Practice and Palliative Care Specifics 23
What Is Already Known About the Topic? 23
References 24
3: Palliative Care Emergencies 27
Fiona Kiely
Introduction 27
Superior Vena Cava Syndrome 29
Background 29
Impact 29
Pathophysiology and Clinical Aspects 30
How Do I Recognise It? 31
Management 33
In-Hospital Treatment 35
Conclusion 36
Malignant Hypercalcaemia 37
Background 37
Impact 37
Pathophysiology 37
How Do I Recognise It? 38
Pattern Recognition 39
Management 40
In-Hospital Treatment 42
Metastatic Spinal Cord Compression 42
Background 42
Impact 44
Pathophysiology 46
How Do I Recognise It? 47
Management 51
In-Hospital Treatment 54
Holistic Care 54
Neutropenic Sepsis 54
Background 54
Impact 56
iv
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Contents
Pathophysiology 56
The 3 Rs – Recognition, Resuscitation, Referral 57
How Do I Recognise It? 58
Resuscitation and Referral 59
In-Hospital Treatment 60
Catastrophic Events in Terminal Patients 61
Background 61
Terminal Haemorrhage 61
Complete Airway Obstruction 63
Case Studies 66
References 68
4: Symptom Management 71
Stephen Cox
Introduction 71
Pain Management 72
Pain Assessment 73
Pain Assessment in Patients with Cognitive Impairment 75
The World Health Organization (WHO) Pain Ladder 77
Opioids for Pain 77
Commonly Used Drugs 80
Pain Pathways and Sites of Action 83
Non-Pharmacological Approaches 83
Key Points 83
Nausea and Vomiting 85
Mechanisms of Vomiting 85
The Emetic Pathway – What Initiates Vomiting? 86
Nausea and Vomiting – Clinical Triggers 87
Management of Nausea and Vomiting 90
Key Points 92
Breathlessness 92
Assessment 93
Reversible Causes 93
The ‘Breathing, Thinking, Functioning’ Model 94
Managing Breathlessness – Break the Cycle 95
Pharmacological Interventions 96
Breathlessness in the Last Days of Life 97
Key Points 98
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Contents
Delirium 98
Definition 98
Causes 99
Recognising Delirium 99
Hyperactive, Hypoactive and Mixed Delirium at End of Life 99
Screening for Delirium 100
Management 101
Drug Therapy 101
The Effects of Delirium on Families 102
Key Points 102
Respiratory Secretions at End of Life 102
Causes 102
Explaining to Patient’s Family 102
Management 102
Urinary Retention 103
Key Points 103
Constipation 103
Causes 103
History and Examination 104
Management 104
Key Points 105
Hiccups 106
Assessment 106
Management 106
Intractable Hiccups 107
Key Points 107
Case Studies 107
Further Reading 110
References 110
5: Enhanced Communication Skills in Palliative
and End of Life Care 115
Alison Rae
Introduction 115
Communication with Patients, Family and Friends 116
Barriers to Communication: FEARS/FIBS 118
Patient Advocacy 120
vi
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Contents
Interprofessional Communication Skills 121
Breaking Bad News 121
Truth-Telling in Clinical Practice 122
Referrals, Documentation and Follow Up 123
Hope and Communication 123
Conclusion 124
Case Studies 125
References 127
6: Care of the Dying Patient 129
Tania Blackmore
Introduction 129
Ten Key Elements for Care of the Dying Patient 130
Recognising Death 130
Anticipatory Medication 133
Pain at End of Life 133
The Conversion of Oral Opioids to Subcutaneous Opioids 134
Key Points 135
Nausea at End of Life 135
Antiemetic Drugs at End of Life 136
Delirium and Agitation at End of Life 136
Drugs Used for Delirium at End of Life 137
Drugs Used for Agitation at End of Life 137
Respiratory Secretions and Dyspnoea at End of Life 137
Drugs Used for Respiratory Secretions at End of Life 138
The Doctrine of Double Effect 138
Do Not Attempt Cardiopulmonary Resuscitation
Order (DNACPR) 139
What is a Good Death? 139
Care After Death 141
Bereavement, Grief and Loss 142
Bereavement 142
Grief and Loss 143
Do Our Own Beliefs and Views About Death
Affect Our Clinical Practice? 144
Key Points 145
Case Studies 146
References 149
vii
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Contents
7: Ethics 153
Marlon Stiell
Introduction 153
Summary of the Mental Capacity Act 2005 154
Ethical Theories 156
Deontology and Utility 156
Critique of Deontology and Utility 157
Ethical Decision Making 158
Cross Cultural Values 159
Advance Directives and Advance Care Planning 162
Ethics in Practice: Best Interests, Autonomy,
Consent and Capacity 166
Summary 169
References 170
8: Professional Resilience 175
Lindsay Hart
Introduction 175
Paramedic Culture Around Death 176
Conflict and the End of Life Patient 177
Palliative Care Research and ‘Getting it Right’ 179
Psychological Demands of Paramedic Practice 180
Professional Resilience 181
Detachment, Compartmentalising and Emotional Blunting 182
The Use of Humour 183
Conclusion 184
Case Studies 184
References 186
9: The Paramedic as an End of Life Specialist 189
Kath Jennings
Introduction 189
The Extended Role of Paramedics in the Care of Palliative
and Dying Patients 190
Paramedics and Clinical Decision Making at the End of Life 193
viii
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Contents
The Changing Education Requirements of Paramedics for Effective
Palliative Care and the Impact of Research 196
The Way Forward for Paramedics in the Care of Palliative
and End of Life Patients 198
References 199
Index 203
ix
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