KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Selamat Datangdi Yuminar

(Zoom Seminar)

KULIAH ONLINE MST KEPERAWATAN POLTEKES- Collaboration in Palliative Care -

13 JUNI 2020

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

dr. Ika Syamsul Huda MZ, MPH, SpPDKetua Tim Perawatan PaliatifRSUP dr. Kariadi Semarang

KOLABORASIPADA PERAWATAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Mapping levels of palliative care development in 198 countries: the situation in 2017

Prof. David Clark, dkk 2017

INDONESIA: Isolated Palliative Care Provision

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

A country in this category is characterized by the development of palliativecare activism that is still patchy in scope and not well-supported; sources of

funding that are often heavily donor-dependent; limited availability ofmorphine; and a small number of palliative care services that are limited in

relation to the size of the population.

INDONESIA: Isolated Palliative Care Provision

Prof. David Clark, dkk 2017

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

ICD-10 Version:2019 https://icd.who.int/browse10/2019/en#/Z51.5

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Isu Aktual

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

http://www.who.int/en/news-room/fact-sheets/detail/palliative-care

PALLIATIVE CARE IS REQUIRED FOR A WIDE RANGE OF DISEASES

35.50% 34%

10.30%5.70%

4.60%9.90%

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Perawatan Paliatif

PALLIATIVE, END OF LIFE AND BEREAVEMENT CARE

http://www.jpalliativecare.com/articles/2010/16/3/images/IndianJPalliatCare_2010_16_3_107_73639_f1.jpg

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

What is the moment to start palliative care?https://bjgp.org/content/62/602/e625

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

http://www.who.int/cancer/palliative/definition/en/

WHO Definition of Palliative Care

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening 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.

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

TOTAL PAINTotal pain recognisespain as being physical, psychological, social and spiritual.

Dame Mary Cicely Saunders

INTERDISCIPLINARYTEAMWORK IN PALLIATIVE CARE

Dame Mary Cicely Saunders(22 Juni 1918 - 14 Juli 2005)

Hospice care movement

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

DO NOT FORGET THAT PAINIS NOT ALWAYS PHYSICAL

https://www.hospicetaranaki.org.nz/media/1069/generalistguidelineshti-march-2014.pdf

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Palliative care can focus on:

❖ controlling symptoms❖ independence❖ emotional, spiritual and cultural wellbeing❖ planning for the future❖ caring for patient's family and carers

https://www.health.qld.gov.au/news-events/news/what-is-palliative-care-Queensland

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

People are ‘approaching the end of life’if they are likely to die within the next 12 months.

People “at the end of life”people who are imminently dying and might be in the last few hours or days of life.

https://www.dyingmatters.org/sites/default/files/user/10Questions.pdf

Masa Akhir Kehidupan

Saatnya menjelang ajal

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

The clinical care domains for end of life include: ❑ Advance care planning❑ Recognise end of life❑ Assess palliative care needs❑ Provide palliative care❑ Work together❑ Respond to deterioration❑ Manage dying❑ Bereavement

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

INTEGRASI PERAWATAN PALIATIF

PASIEN

TIM PALIATIF

KELUARGA DAN

PERUMAT(CARE GIVER)

MASYARAKAT DAN

KOMUNITAS

MANAJEMEN DAN

FASILITAS

DPJP

(CURATIVE CARE)

KERJASAMA TIM

PALLIATIVE CARE

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

TIM PERAWATAN PALIATIF RUMAH SAKIT

• Dokter• Perawat• Fisioterapis• Rohaniawan• Pekerja sosial• Farmasis• …

MultidisiplinerKolaborasiKoordinatif

Pelayanan perawatan yang terintegrasi

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

The ideal multidisciplinary teamrequires→ medical staff→ nursing staff→ social worker→ physiotherapist→ occupational therapist→ chaplain or pastoral care worker

Very useful, but not essential, are→ dietician→ psychologist (or liaison psychiatrist)→ clinical pharmacist→ music and art therapists→ volunteers→ other personnel, as required

https://hospicecare.com/what-we-do/publications/manual-of-palliative-care/

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Delivered by an interdisciplinary team, palliative care adds an extra layer of support by addressing the physical, emotional, psychosocial and spiritual concerns associated with serious and chronic conditions.

https://csupalliativecare.instructure.com/courses/1005/pages/what-is-palliative-care?module_item_id=52419

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Palliative care involves an interprofessional collaborative approach in working with patients and their families and caregivers by providing patient-centered and individualized pain relief compassion, caring, and overall minimization of symptom severity.

https://austinpublishinggroup.com/palliative-care/fulltext/apc-v1-id1006.php

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Interprofessional collaboration occurs when health professionals from different disciplines work together to identify needs, solve problems, make joint decisions on how best to proceed, and evaluate outcomes collectively.

https://pubmed.ncbi.nlm.nih.gov/20925291/

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Interprofessional collaboration supports patient-centred care and

takes place through teamwork.

https://pubmed.ncbi.nlm.nih.gov/20925291/

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Providing good psychosocial care comes down to good communication skills, both verbal and non-verbal.

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Barriers to palliative care implementation, include:

• corporate power (“PC must remain in our service…”); • denial (“we are already doing so…”); • personal (resistance to accept end-of-life care);• misunderstandings (PC seen as death or euthanasia); • competition (“we have been doing so much better over

many years”); and • conflict

https://www.uicc.org/sites/main/files/atoms/files/Gomez-Batiste_X_Connor_S_Eds._Building_Integrated_Palliative_Care_Programs_and_Services._2017.pdf

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

In particular, the limits of information sharing have been pointed out as important barriers to the quality of inter-professional collaboration

https://www.oatext.com/inter-professional-communication-in-palliative-care-general-practitioners-and-specialists-in-switzerlandc.php#gsc.tab=0

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

PROVIDING A PALLIATIVE APPROACH TO CARE

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

INFORMATIONBREAKING BAD NEWSFAMILY SUPPORTADVANCED CARE PLANNING

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

1. Pain 2. Anorexia3. Nausea and vomiting4. Constipation5. Diarrhoea6. Dyspnea7. Fatigue8. Delirium9. Depression10. Anxiety11. Respiratory tract secretions

11 SYMPTOMS

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

WITHHOLD & WITHDRAWTidak memberikan dan Menghentikan

Obat-obatan, Tindakan dan Pemeriksaanmungkin perlu dipertimbangan untuk tidakdiberikan, dan yang sudah diberikan tidak

diberikan lagi.

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Stopping unnecessary medicationsDecisions about which medications to stop should be made by balancing the likely prognosis from the palliative care diagnosis, with short, medium, and long-term risks associated with stopping medications to manage co-morbidities.

https://www.caresearch.com.au/caresearch/ProfessionalGroups/NursesHubHome/Clinical/MedicationManagement/PalliativeMedications/tabid/1554/Default.aspx

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

deprescribing

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

PALLIATIVE CARE

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Rumah sakit menetapkan proses untuk mengelolaASUHAN PASIEN DALAM TAHAP TERMINAL.

Proses ini meliputia) intervensi pelayanan pasien untuk mengatasi nyeri;b) memberikan pengobatan sesuai dengan gejala dan

mempertimbangkan keinginan pasien dan keluarga;c) menyampaikan secara hati-hati soal sensitif seperti autopsi

atau donasi organ;d) menghormati nilai, agama, serta budaya pasien dan keluarga;e) mengajak pasien dan keluarga dalam semua aspek asuhan;f) memperhatikan keprihatinan psikologis, emosional, spiritual,

serta budaya pasien dan keluarga.http://www.pdpersi.co.id/kanalpersi/manajemen_mutu/data/snars_edisi1.pdf

STANDAR NASIONAL AKREDITASI RUMAH SAKIT (Edisi 1)

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Team interactions require trust, confidence and an equal effort by all team members.

https://symbiosisonlinepublishing.com/palliative-medicine-care/palliative-medicine-care16.php

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

Nama:Prof. Raden Sunaryadi Tejawinata,dr. SpTHT(K-Onk), FICS, FAAO, PGD, Pall.Med.(ECU)

Lahir:Cirebon, 23 Agustus 1934

Prof. Sunaryadi

BAPAK PALIATIF INDONESIA

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

DEKLARASI PERDOPIN

(Perhimpunan Dokter Paliatif Indonesia)

Surabaya, 22 Februari 2014

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

AMAN - LANCAR - SELAMATSAMPAI TUJUAN

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

THANK YOU

Palliative Care Indonesia (PCI)https://bit.ly/palliativecareindonesia

KULIAH MST KEPERAWATAN POLTEKES 13 JUNI 2020 – KOLABORASI PADA PERAWTAN PALIATIF

KULIAH KOLABORASI PADA PERAWATAN PALIATIFDownload materi:https://bit.ly/kolaborasiperawatanpaliatif