Palliative care is an approach that aims to improve the quality of life of patients and their families facing a life-threatening illness. Prevention and relief of suffering is achieved by means of early identification, thorough assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
End-of-life care can be divided into three key components:
A comprehensive baseline assessment – involves identification of the lead practitioner, assessment of clinical needs, sensitive and open communication and clear documentation.
Ongoing assessment – with emphasis on the importance of developing individualised care plans.
After death care – includes verification of death and the need of the family/whānau for information and privacy.
Each of these stages of care needs to be addressed in a way that respects the cultural, spiritual, religious and family issues that are unique to the dying person.
Ko tēnei te ara kei runga Ko te ara o tēnei Tipua Ko te ara o tēnei Ariki Ko te ara o tēnei Mātua-a-iwi Ko te ara o Ranginui e tu nei, O Papatūānuku e takoto nei Kia rarau iho ra ngā tapuwae o Tāne Ko tēnei te pō, nau mai te ao Tihei mauri ora
A Māori palliative care framework for hospices
Mauri mate is a framework with palliative care guidelines for hospices in New Zealand, aiming to provide adult Māori with good palliative care.
The 3 main aims of the framework include:
good (quality) care in the lead-up to the end-of-life
good comfort (compassionate) care at the end-of-life
helpful whānau support during and after the illness, and the end-of-life (including spiritual care and grief support).
The framework is also applicable to primary care, aged residential care, hospital teams and whānau care.
You can find the main framework along with a roadmap and a literature review report below.
The development of a model of palliative care for NZ
In November 2013,the Ministry of Health commissioned the Palliative Care Council to investigate developing an appropriate palliative care model for NZ. This led to development of a NZ focused model, Te Ara Whakapiri, which was released in December 2015.
The following 7 principles were used to help define Te Ara Whakapiri:
Care is patient-centred and holistic.
The health care workforce is appropriately educated and is supported by clinical champions.
Communication is clear and respectful.
Services are integrated.
Services are sustainable.
Services are nationally driven and supported to reduce variation and enhance flexibility.
Resources and equipment are consistently accessible.
These 7 principles are underpinned by Te Whare Tapa Whā, a model of care that is concerned with the total wellbeing of the person and their family/whānau.
Underpinning this model of care is the recognition that if a person in the last days of life has a level of need that exceeds the resources of the primary palliative care provider, that provider should refer them to specialist palliative care.
Supportive & palliative care indicators tool (SPICT™)
The SPICT™ is a guide to identifying people with one or more advanced conditions, deteriorating health and a risk of dying for assessment and care planning.
It is used around the world and was first developed as a collaborative project between NHS Lothian and The University of Edinburgh Primary Palliative Care Research Group.
The aim of this resource is to make palliative care understandable for healthcare professionals, using clear logical layout and understandable explanations of how to manage and cope with problems that can be very challenging. It includes sections on dementia, nutrition and prescribing. The Handbook is useful in any place where palliative care happens – it gives confidence to those who use and it and therefore hopefully comfort to the people approaching the end of their lives.
We all probably have a conversation we’re avoiding. It’s important, but it feels tricky. Often, we feel daunted by the strong emotions involved. We’re not sure how to begin, or whether we should try to. ‘Tender Conversations’ will consider the principles that help us to open, begin, continue and finish these important yet daunting conversations in a way that is helpful and safe.
You can watch the video, answer questions and claim hours with a certificate.
Professor Paddy Stone, MA, MD, FRCP talks about the role of prognostic information and communication play in reducing the prevalence of burdensome treatments at the end of life.
(Mobile Health, NZ, 2021)
The principles of palliative care
Ann Laramee, Nurse Practitioner at the University of Vermont Medical Center, discusses principles in palliative care including how to integrate palliative care in heart failure management, how to affirm life and regard dying as a normal process, how to discuss prognosis, and when to refer to specialty palliative care or hospice.