Teaching mobility Iasi

Transcription

1 Teaching mobility Iasi Véronique Fromont May 2013 RN, MSc

2 Program Introduction Structure - Legislation LEIF Care for patient Care for caregiver Students evaluation IP Feedback

3 Introduction IC nurse Reference nurse for palliative care LEIF nurse Lecturer at Karel de Grote University College, Antwerp, Belgium Coordinator for practical placements Coordinator for ENM and IP p.3

4 Antwerp Belgium some pictures some facts some figures p.4

5 Belgium in Europe Belgium is a Federal state with 11 million inhabitants Consisting of 3 regions: Flanders, Wallonia, Brussels And 3 communities: The Dutch, French, German speaking community

6 Flanders Number/inhabitants: 6,2 mio Geography: flat land bordered by the sea Language: Dutch Info:

7 Antwerp Antwerp by the river Scheldt Largest city of Flanders inhabitants Medieval & historic centre 2nd largest harbour of Europe High concentration of care providers Important student city higher education students

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12 p.12

13 p.13

14 Palliative care in Belgium Introduction Structure Legislation LEIF p.14

15 What do you think? Is palliative care important/necessary? What is palliative care in Belgium? What does it mean? p.15

16 Introduction Palliative care more than just tender loving care In Flanders : professional care with high standards Funding by government p.16

17 Palliative care Advance care planning (will of the patient, place of care, place of death..) Pain & symptomcontrol Psychosocial-spiritual care Ethical issues (stopping starting treatments) Medical decisions at the end of life (sedation, euthanasia..) p.17

18 By whom? Family Volunteers : in hospitals, palliative care units, home care Professionals : multiprofessional care Intramural : palliative care support teams on general wards specialized palliative care units Extramural : mobile home teams palliative day care centres p.18

19 By whom? Medical doctors : GP s, oncologists, geriatrics, palliative care, pain clinic (pall care is not an approved specialty in Belgium!!) Education nowadays covered in basic graduate training Postgraduate courses (basic and advance level) Nurses : Education nowadays in basic graduate training Postgraduate courses Psychologists Social workers Spiritual care workers (pastoral care, p.19 chaplains..)

20 For whom? Patients Ideal : for patients in their last year of life ( surprise question ), with incurable and progressive disease In reality : in the last 3 months of life In hospitals : in the last week, terminal care!! Families : the hidden patient!! p.20

21 Structure Flemish association in Flanders dutch-speaking part in the north 6 mill inhabitants approx. 60,000 deaths per year Brussels association, capital region bi-lingual (1 mill inhabitants) Wallonian association in Wallonia french-speaking part in the south 4 mill inhabitants p.21

22 Flanders 15 networks bring together the local partners Education Mobile home care teams (nurses, doctors, psychologists) : specialized advice / volunteers Coöperation with intramural care p.22

23 Palliative Day care In Flanders 5 units 5-10 patients Early stage palliative care Admission : last year of life Multiprofessional care team Special bathing facilities Own transport facilities p.23

24 Palliative Day Care km-gh0jasu ua79cq4cig p.24

25 Intramural care Palliative ward In hospital 360 beds for Belgium Units of 6 to 12 beds Multiprofessional team p.25

26 Intramural care palliative support team Multiprofesional team : palliative care physician, nurse, psychologist Available in every hospital all-in the hospital p.26

27 Home care In association with network With general practioner Support for carer p.27

28 Legislation?? Do we need a legislation for EOL? p.28

29 What happened? p.29

30 p.30

31 p.31

32 Time before and after 3 laws Patients rights Palliative care Euthanasia p.32

33 Patients rights August 2002 Multidisciplinary consultations Quality medical service Free choice Information Permission/refusal Privacy Access to patient record Analgesia p.33

34 Palliative care Law Right to palliative care at the end of life Right to information about the health situation and possibilities of palliative care p.34

35 Euthanasia 23 September p.35

36 Aims of the law Legal certainty for patient and physician Autonomy of patient and selfdetermination, Protection of the patient from abuse Transparancy and control of the community p.36

37 Definition Euthanasia is intentional ending of life (intentional act) on request of the patient, by an other person (i.c. physician) p.37

38 Conditions Age > 18 Mentally competent Voluntary, repeated request Medically hopeless Unbearable suffering Second doctor ( 3 rd when not terminally ill) p.38

39 Juridical consequences Right of the patient to ask, but no absolute right to get euthanasia!! Right of the physician to refuse The obligation of the physician to refer to other physician Afterdeath certificate : natural dying p.39

40 After death!! After death Federal Evaluation commission ie/index.html p.40

41 Aims Brochure Formation ACP Documents Facts LEIF

42 LEIF Life End Information Forum Humane end of life p.42

43 Aims Information for caregivers and common people Legal documents Training Physicians Nurses Caregivers Telephone connection for emergencies or call for information p.43

44 Brochure Practical guide Free available Pharmacy Town hall Library General practitioner p.44

45 Content of brochure Information: End of life decisions Laws 2002 Advanced care planning Contact FAQ Legal documents p.45

46 Life End Information Forum Established in February 2003 Following 3 laws (2002) Patients rights Palliative care Euthanasia Lack of information p.46

47 One certainty in life... We are all going to die Uncertainty... the way how we re going to die p.47

48 Unbearable suffering caused by an incurable disease is often the result of Therapeutic obstinacy Insufficient palliative care p.48

49 Advanced Care Planning What if in future ACP Removal of uncertainty Be certain about the end of life! p.49

50 ACP Patient-oriented medical care Continuous communication between patient and caregiver Preferences for future care p.50

51 ACP Giving information Search for preferences Emotional care Define confidential p.51

52 ACP Patients are more prepared Discussing values with relatives Keep control p.52

53 ACP When? The sooner the better? Time of diagnosis More adequate = general practioner confidential relationship p.53

54 Documents Negative declaration Declaration of euthanasia Declaration of organ donation Declaration of funeral Registered at town hall p.54

55 Negative declaration earlier called living will Legally enforceable Valid indefinitely No witnesses needed No registration possible Legal representative Defend the rights p.55

56 Negative declaration Indicate what treatment is not desirable Distribute the form Family General practitioner p.56

57 Declaration of euthanasia Duration of 5 years Mandatory data The object of the declaration Personality Characteristics of the declaration Witnesses Valid for irreversible coma p.57

58 Request for euthanasia This moment Handwritten One month wait between request and performance ( when not terminally ill) p.58

59 Procedure terminal disease Patient has knowledge about disease All therapeutic and palliative therapy has been discussed Talks with team Talks with family ( with permission patient) Registration in patient file 2nd opinion by 2nd physician p.59

60 Procedure non-terminal disease Patient has knowledge about disease All therapeutic and palliative therapy has been discussed Talks with team Talks with family ( with permission patient) Registration in patient file 2nd opinion by 2nd physician 3rd opinion by 3rd physician 1 month waiting period p.60

61 Implementation Physician Prescription Medication IV Overdose barbiturate Nurse can assist! Not mandatory p.61

62 After death Document/registration Commission Bereavement care p.62

63 Facts deaths in Flanders 40% is medically guided p.63

64 Facts End of life decisions (50% of all deaths) Stop the treatment Don t start the treatment 44% Increase pain medication End life without request 2% Assisted suicide 2% Euthanasia p.64

65 Facts 44% is palliative care 2% end of life decision with request 50% other deaths?? Sudden deaths Soft deaths: therapeutic obstinacy? Or useless therapeutic cure p.65

66 Need for palliative care! Need for information! p.66

67 LEIF offers information about end of life In 2010, people called for information. Professionals: Common: p.67

68 LEIF Topics of conversation 70% ACP 30% immediate care p.68

69 Summary LEIF offers information about end of life decisions for professionals and common people p.69

70 Right to a dignified end of life for everyone p.70