CHC33015 Certificate III

in Individual Support
Specialising in Ageing

Palliative Care Services

Learner Guide - Cluster 5 (Ageing)
CHCPAL001 Deliver care services using a palliative approach

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TABLE OF CONTENTS
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1. What is Palliative Care?...........................................................................................................10
2. Brief History of Palliative Care................................................................................................11
3. Different Services.....................................................................................................................14
4. Impact of Diagnosis.................................................................................................................15
5. Legal and Ethical Considerations............................................................................................16
6. Advance Care Directive...........................................................................................................18
7. Pain Management....................................................................................................................19
8. End-of-Life Care......................................................................................................................21
9. Stages of Grief......................................................................................................................... 25
10. Managing Your Own Emotional Response.........................................................................26

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LEARNER GUIDE

Description

CHCPAL001 Deliver care services using a palliative approach

This unit focuses on the elements, performance criteria, performance evidence, and knowledge
evidence needed to show competency in caring for people with life-threatening or life-limiting
illness and normal ageing process within a palliative approach. In this unit, the essential outcomes
are:
 Apply principals and aims of a palliative approach when supporting individuals
 Respect the person’s preferences for quality of life choices
 Follow the person’s advance care directives in the care plan
 Respond to signs of pain and other symptoms
 Follow end-of-life care strategies
 Manage own emotional responses and ethical issues

About this Cluster of Units

These units were clustered together because they form the essential knowledge and skills that
anyone studying to become an individual support worker should know about working in an aged
care facility.

Your Learning Resource Kit

Your Learning Resource Kit for each unit consists of:

1. Learner Guide – Provides you with structured learning activities to help you absorb
knowledge and information and practice your skills and directs you to other sources of
additional knowledge and information about topics for this unit.

2. Assessment Workbook – Provides you with written assessments, case studies and
scenarios that are submitted to your assessor.

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Learning Program

As you progress through this unit of study, you will develop skills in locating and understanding an
organisation’s policies and procedures. You will build up a sound knowledge of the industry
standards within which organisations must operate. You will become more aware of the effect
that your own skills in dealing with people have on your success or otherwise in the workplace.
Knowledge of your skills and capabilities will help you make informed choices about your further
study and career options.

Additional Learning Support

To obtain additional support, you may:

 Search for other resources. You may find books, journals, videos and other materials which
provide additional information about topics in this unit.
 Search for other resources in your local library. Most libraries keep information about
government departments and other organisations, services and programs. The librarian
should be able to help you locate such resources.
 Contact information services such as Info link, Equal Opportunity Commission,
Commissioner of Workplace Agreements, Union organisations, and public relations and
information services provided by various government departments. Many of these services
are listed in the telephone directory.
 Contact your facilitator.
Facilitation

Your training organisation will provide you with a facilitator. Your facilitator will play an active role
in supporting your learning. Your facilitator will help you anytime during working hours to assist
with:
 How and when to make contact,
 what you need to do to complete this unit of study, and
 what support will be provided.
Here are some of the things your facilitator may do to make your studies easier:
 Give you a clear visual timetable of events for the semester or term in which you are
enrolled, including any deadlines for assessments.
 Provide you with online webinar times and availability.
 Use ‘action sheets’ to remind you about tasks you need to complete, and updates on
websites.
 Make themselves available by telephone for support discussion and provide you with
industry updates by e-mail where applicable.
 Keep in touch with you during your studies.

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Flexible Learning

Studying to become a competent worker is an interesting and exciting thing to do. You will learn
about current issues in this area. You will establish relationships with other students, fellow
workers, and clients. You will learn about your own ideas, attitudes, and values. You will also have
fun. (Most of the time!)
At other times, studying can seem overwhelming and impossibly demanding, particularly when
you have an assignment to do and you aren’t sure how to tackle it, your family and friends want
you to spend time with them, or a movie you want to see is on television.
Sometimes being a student can be hard.
Here are some ideas to help you through the hard times. To study effectively, you need space,
resources, and time.

Space

Try to set up a place at home or at work where:

1. You can keep your study materials,
2. you can be reasonably quiet and free from interruptions, and
3. you can be reasonably comfortable, with good lighting, seating, and a flat surface for
writing.
If it is impossible for you to set up a study space, perhaps you could use your local library. You will
not be able to store your study materials there, but you will have quiet, a desk and chair, and easy
access to the other facilities.

Study Resources

The most basic resources you will need are:

1. A chair
2. A desk or table
3. A computer with Internet access
4. A reading lamp or good light
5. A folder or file to keep your notes and study materials together
6. Materials to record information (pen and paper or notebooks, or a computer and printer)
7. Reference materials, including a dictionary

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Time

It is important to plan your study time. Work out a time that suits you and plan around it. Most
people find that studying, in short, concentrated blocks of time (an hour or two) at regular
intervals (daily, every second day, once a week) is more effective than trying to cram a lot of
learning into a whole day. You need time to ‘digest’ the information in one section before you
move on to the next, and everyone needs regular breaks from study to avoid overload. Be realistic
in allocating time for study. Look at what is required for the unit and look at your other
commitments.
Make up a study timetable and stick to it. Build in ‘deadlines’ and set yourself goals for completing
study tasks. Allow time for reading and completing activities. Remember that it is the quality of the
time you spend studying rather than the quantity that is important.

Study Strategies

Different people have different

learning styles. Some people learn
best by listening or repeating things
out loud. Some learn best by doing,
some by reading and making notes.
Assess your own learning style and try
to identify any barriers to learning
which might affect you. Are you
easily distracted? Are you afraid you
will fail? Are you taking study too
seriously? Not seriously enough? Do
you have supportive friends and
family? Here are some ideas for effective study strategies:
Make notes. This often helps you to remember new or unfamiliar information. Do not worry about
spelling or neatness, as long as you can read your own notes. Keep your notes with the rest of
your study materials and add to them as you go. Use pictures and diagrams if this helps.
Underline keywords when you are reading the materials in this Learner Guide. (Do not underline
things in other people’s books.) This also helps you to remember important points.
Talk to other people (fellow workers, fellow students, friends, family, or your facilitator) about
what you are learning. As well as help you clarify and understand new ideas; talking also gives you
a chance to find out extra information and to get fresh ideas and different points of view.

Using this Learner Guide

A Learner Guide is just that, a guide to help you learn. A Learner Guide is not a textbook. Your
Learner Guide will:

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 1. Describe the skills you need to demonstrate to achieve competency for this unit.
2. Provide information and knowledge to help you develop your skills.
3. Provide you with structured learning activities to help you absorb knowledge and
information and practice your skills.
4. Direct you to other sources of additional knowledge and information about topics for this
unit.

How to Get the Most Out of Your Learner Guide

Read through the information in the Learner Guide carefully. Make sure you understand the
material.
Some sections are quite long and cover complex ideas and information. If you come across
anything you do not understand:
1. Talk to your facilitator.
2. Research the area using the books and materials listed under the References section.
3. Discuss the issue with other people (your workplace supervisor, fellow workers, fellow
students).
4. Try to relate the information presented in this Learner Guide to your own experience and
to what you already know.
5. Ask yourself questions as you go. For example, ‘Have I seen this happening anywhere?’
‘Could this apply to me?’ ‘What if...’ This will help you to ‘make sense’ of new material, and
to build on your existing knowledge.
6. Talk to people about your study. Talking is a great way to reinforce what you are learning.
7. Make notes.
8. Work through the activities. Even if you are tempted to skip some activities, do them
anyway. They are there for a reason, and even if you already have the knowledge or skills
relating to a particular activity, doing them will help to reinforce what you already know. If
you do not understand an activity, think carefully about the way the questions or
instructions are phrased. Read the section again to see if you can make sense of it. If you
are still confused, contact your facilitator or discuss the activity with other students, fellow
workers or with your workplace supervisor.

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Additional Research, Reading, and Note-Taking

If you are using the additional references and resources suggested in the Learner Guide to take
your knowledge a step further, there are a few simple things to keep in mind to make this kind of
research easier.
Always make a note of the author’s name, the title of the book or article, the edition, when it was
published, where it was published, and the name of the publisher. This includes online articles. If
you are taking notes about specific ideas or information, you will need to put the page number as
well. This is called the reference information. You will need this for some assessment tasks, and it
will help you to find the book again if you need to.
Keep your notes short and to the point. Relate your notes to the material in your Learner Guide.
Put things into your own words. This will give you a better understanding of the material.
Start off with a question you want answered when you are exploring additional resource
materials. This will structure your reading and save you time.

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PALLIATIVE CARE
There are illnesses that are life-threatening and incurable. Most of these can lead to other
illnesses and are causing the person pain and distress, both physically and psychologically. As
these illnesses are irreversible and the chance of the person’s recovery in the long-term is low, it is
recommended that the person is placed under palliative care.
Some of the illnesses that may require palliative care include:

Congestive heart Chronic obstructive

Cancer
failure pulmonary disease

Kidney failure Alzheimer's disease Parkinson's disease

Amyotrophic
Lateral Sclerosis
(ALS) 

Early diagnosis of these illnesses prepares the client and the family in coping with the treatment
and support to be provided until the person’s end-of-life stage.

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1. What is Palliative Care?

Palliative care is an approach to healthcare that specialises in improving the quality of life of the
client with a life-threatening and incurable illness. It aims to prevent and relieve the suffering of
the client from the symptoms brought about by the illness by providing medication and the care
and support while taking into consideration their needs, values, and preferences.
Palliative care does not only provide support and care to the client but also a support system to
their family and friends who are affected by the death of a loved one.
Palliative care, as further defined by the World Health Organisation (2016):
 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.
 Offers a support system to help the family cope during the patient’s illness and in their
own bereavement.
 Uses a team approach to address the needs of patients and their families, including
bereavement counselling, if indicated.
 Will enhance the 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.

Palliative care is available in most healthcare settings including residential and home and
community care, and paediatric services.

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2. Brief History of Palliative Care

The concept of palliative care began historically during the middle ages in Europe as hospices
established by religious orders. These hospices become shelters for pilgrim travellers who were
seeking shrines which they believed to miraculously cure their chronic and fatal illnesses. Many of
the pilgrims died on their journey. During the 16 th to 18th century, hospices were established to
care for the sick and dying.
In the late 1950s to 1960s, a British physician, nurse
and social worker named Cicely Saunders pioneered
the development of techniques for pain control in
advanced cancer. She had been working then with
cancer patients at St. Joseph’s Hospice in London.
After years of study and research, and presenting
lectures in the United States, Saunders opened St.
Christopher’s Hospice in London. Regarded as the first
modern hospice in the world, St. Christopher’s used a
multi-disciplinary approach to caring for the dying. Cicely Saunders
The regular use of opioids was introduced to relieve the
dying client’s physical pain from the symptoms of the illness. Saunders believed that clients also
need holistic care by responding to their physical, psychological, social, and spiritual needs,
including those of their families and friends.
Dr Elisabeth Kubler-Ross, in her book On Death and Dying published in 1969, wrote about the five
stages of grief which the person with a life-limiting illness and their family experience. The book
was based on her interviews with more than 500 dying patients. For Kubler-Ross, older persons
and the dying should not be institutionalised but rather be provided with spiritual, emotional, and
financial care while being cared for by individual support workers and their families in their own
homes.
Over the years, hospices following Saunders’s approach spread across the United States. The term
‘palliative care’ was coined by Dr Balfour Mount of Canada when he taught Saunders’s care
approach in hospitals. Since then, palliative care has been practised in different countries with its
primary goal of providing the ‘best possible quality of life’ for the client with life-limiting illness, as
well as support for their families and carers.
(Source: My Aged Care)

Hospices have remained to be facilities where care services are provided for the client while
palliative care treatment can be provided in the client’s home if preferred.

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Philosophy and Principles
The palliative care approach has the underlying philosophy:

It follows a holistic approach in supporting persons with life-

limiting illnesses.

Medical treatment alone is not enough to support persons with

life-limiting illnesses.

Palliative care approach includes nurturing the physical,

psychological, spiritual, and social needs of the person with
life-limiting illnesses.

Palliative care approach holds a positive and open attitude

towards dying and death.

Palliative care applies the following principles:

 Maintaining the dignity of persons with life-limiting illnesses.
 Considering the person’s needs, wants, values, and wishes in determining the type
of care to be delivered.
 Addressing psychological and spiritual needs of persons with life-limiting illnesses.
 Recognising the signs of imminent death.

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The increasing population of older people in the aged care sector and the prevalence of cancer
and chronic diseases associated with ageing have also increased the need for palliative care. It is
recommended as the best option of care for the person with a life-limiting illness as it aims to
provide the following benefits for the client and the family:

The approach helps patients achieve a sense of

control.

The palliative care approach provides adequate

control of pain and other symptoms.The approach
helps patients achieve a sense of control.

It relieves the burden on family members and

strengthen their relationships as the person's end-
of-life approaches.

This approach allows the client and their family to

understand the benefits and disadvantages of the
available treatment while taking into consideration
the client's personal goals.

The palliative care approach helps persons with

life-limiting illnesses and their families gain a
realistic understanding of the nature of the illness.

Palliative care services help persons with life-

limiting illnesses and their families make
arrangements such as appointing decision-makers
in case the person has lost the capacity to decide.

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3. Different Services

Palliative care provides the following services:

Treatment of symptoms
The primary goal of palliative care is to alleviate the pain experienced by the person with the life-
limiting illness, including physical, psychological, and emotional symptoms. Most incurable
diseases cause a lot of physical pain in a client’s physical body. Take cancer as an example. There
are three (3) common pains experienced by a cancer patient. The most common cause of pain
occurs when a tumour spreads to the bone. Known as bone metastasis, this commonly occurs in
the person’s spine, pelvis and thighs. The second most common cause of pain is tumours
infiltrating the nerves or blood vessels, while the third most common pain is caused by treatment
such as chemotherapy, radiation, or surgery. Understanding what causes the pain is important in
determining the type of treatment to be provided.

Establishing goals of care

The type of care to be given is tailored according to the person’s preferences, wishes, and values.
It is important for the service providers to understand what the clients want regarding their
treatment. This can be achieved through proper communication between the multi-disciplinary
team providing the service and the client.

Psychosocial support
Knowing that a person has a life-limiting illness can be distressing for the client and their family.
Reports have associated depression with increased mortality rates, especially to those with life-
limiting illnesses. Depression can reduce the person’s quality of life and may even cause more
physical pain to the client, including thoughts of immediate death.
Palliative care includes providing psychological, spiritual, social, and bereavement support to the
person with the life-limiting illness and their families. Spiritual needs are an important aspect of
palliative care services as a person’s spiritual belief can be a key factor in how they will cope with
their illness.

Coordination of care
Palliative care services help organise the delivery of care from multiple settings (e.g. home care,
nursing homes, hospice care), specialists, to diagnostic and treatment interventions. In palliative
care, the trouble and stress of undergoing different processes within different healthcare setups
are minimised.

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4. Impact of Diagnosis

A diagnosis of a life-limiting illness can cause emotional setbacks for the person with the illness
and their family. They may undergo the following phases:

This is when the person realises that they may have an illness. It
Phase includes the phase of going through physical examinations, tests, and
before ends with the diagnosis.
diagnosis

The person is forced to understand the diagnosis. They are asked to

decide about their medical treatment.
Acute Phase

This is where palliative care takes place. The person undergoes

treatment and copes with its side effects, including pain. Their needs
Chronic and those of their family is also supported.
Phase

The person and their family cope with the effects of the illness—
physically, mentally, socially, financially, and spiritiually.
Recovery or When the person reaches the death phase, the support is provided to
Death Phase the family for comfort and relief from the pain of grieving.

(Source: Medicine.net.com)

When the person has accepted the diagnosis of an illness, the best option to support them is
through palliative care. The care needs of people in palliative care vary the same as how the needs
of people taking support services and care differ
from each other. When planning the type of care
to be provided for the person in palliative care, it
is important to identify their physical, spiritual
and psychosocial needs. Caring for people living
with a life-threatening or life-limiting illness needs
to be a holistic approach.
If you would remember the philosophy of Cicely
Saunders, when these needs are supported, the quality of life of the person is most likely to
improve. People living with a life-threatening or life-limiting illness need to be involved in the

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decision-making about their care. Their preferences, needs, wants, values and choices are also
considered. This is aligned with maintaining the dignity of the person. If the person with the life-
limiting illness chooses not to take medication, then this must be respected. People living with a
life-threatening or life-limiting illness need to be treated with dignity and respect by all who care
for them. The nature and level of the person’s health and support needs are also used to
determine the type of care to be provided for the person. Similar to providing support to a person
with disability, people in palliative care may want to spend their lives as independently as possible,
like they used to. The person’s social support and coping skills are also factors to be considered as
this prepares the person and their families to effectively accept and deal with the situation.

5. Legal and Ethical Considerations

Individual support workers in a palliative care setting can become overly involved with the client
they care for and their family, especially in the emotional aspect. As palliative care respects the
needs and wishes of the client in terms of care and support to be provided, health professionals
are faced with ethical issues.

Read the case study below.

Kelly has been diagnosed with chronic liver disease. She lives with
her only daughter who is also providing support for her own family.
Kelly has been in palliative care for some time, and she knows that
the medication required for her treatment is causing financial
constraint and stress to her daughter. Kelly wants her daughter to
save up for her family’s future. One day, Kelly went to her doctor
for advise that she wishes to stop her treatment and wants to die peacefully in her home.
The doctor knows that stopping the treatment will worsen the symptoms of her
condition.
Question: Should the doctor allow Kelly’s request? Why or why not?

     

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There are legal and ethical considerations that the health team, including the individual support
worker, must understand when working in palliative care:

Duty of care
This is the legal obligation of individual support workers in palliative care to ensure that clients’
rights to self-determination, independence, and dignity are upheld.

Dignity of risk
It means respecting the autonomy and independence of a person receiving palliative care and
allowing them to make choices for themselves.

Human rights
All human beings, no matter what their race, religion, nationality, sex, or status, has a basic
privilege to access palliative care.

Privacy, confidentiality and disclosure

In providing palliative care services, these requirements must be followed when collecting and
handling client’s personal information. An individual support worker must not share personal
information of the client with people at work. Unauthorised disclosure of client and staff
information such as personal and medical information can put the client and the staff at risk. If the
client wishes not to discuss their condition with their family, then the individual support worker
must maintain this information.

Work role boundaries

Individual support workers have a responsibility to support the person receiving the palliative
care, their family, carer, and/or significant other, but they should not be overly involved or
attached to a client and their family. They should always follow the client’s advance care
directives, no matter how much they or the family disagrees with the consequences of the
decision. Individual support workers should also report any ethical issues or concerns that they
may have with the client or their co-workers to their supervisor.

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6. Advance Care Directive

An advance care directive or advance health directive is a legal document that serves as the
client’s ‘living will’ in palliative care. There will come a time in the life of a person with life-limiting
illness when they will be unable to communicate and choose what they want in terms of their
treatment. It is used to prepare for instances when a patient is no longer able to make a decision
such as through a sudden accident, dementia or similar condition.
An advance care directive:
 Outlines the medical treatment and care plan that the client wants when they lose
their capacity for decision-making. It can include the client’s decision to refuse a
particular treatment in the future.
 Enables the client to appoint an attorney for health and personal matters, including
a substitute decision-maker on their behalf.
 May include the patient’s wishes, preferences and instructions for their health care,
end of life arrangements, and or other personal matters.
 Includes information that the health professionals need to know including their
physical, cultural or spiritual needs.

The client can also provide specific instructions in their advance care directive as to the quality of
life they want to receive. They may indicate if life-sustaining measures must be withheld or
withdrawn. This is considered in the event that a person has:

Severe and irreversible

A terminal illness with
brain damage, and they
no known cure or
are unable to
chance of recovery
communicate

A severe illness or
injury that have no
chance of recovery

(Source: Queensland Government)

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Unlike in an individualised plan where the client and the health team are involved in writing the
care plan, an advance care directive can be written personally by the client as long they are 18
years old or over. It is recommended that the client write their advance care directive even before
they become aware of a health condition that could result in life-limiting illness. It is important to
write one if they are admitted to the hospital, diagnosed with a medical condition that may affect
their capacity for decision-making in the future, or once diagnosed with a life-limiting illness.
Once completed, the document is to be signed by a doctor and a witness who is a justice of the
peace or commissioner for declarations, lawyer, or notary public. The client’s appointed attorney,
substitute decision-maker, family members, or individual support workers cannot serve as their
witness.

Check out an example of an advance care directive

from this link: Advance Health Directive (QLD)

The document is then maintained for safekeeping and a copy is provided to the client’s doctor,
their family members or friends, and appointed attorney. This must be reviewed every two (2)
years as the client may want to change or cancel their care directive. Any changes to the
document must be in writing and signed by a witness.

Read more about making an advance care directive

from this link: Advance Care Planning (QLD)

7. Pain Management

Pain management is one of the primary goals of palliative care. The level of pain experienced by a
client varies depending on the stage of the illness and the cause of the pain. Pain is a distressing
sensation in the body that physically and mentally hurts a person and causes discomfort. Feelings
of pain and discomfort can lead to behaviour of concern. A person’s tolerance for pain increases or
decreases because of the following factors:

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 Pain tolerance is increased by:
Relief of symptoms
Sleep
Support
Diversion
Finding meaning and significance

Pain tolerance is decreased by:

Discomfort
Fatigue
Sleeplessness
Depression
Social isolation

Pain is mostly managed through medication, and it involves the assessment and monitoring of the
pain. Read through the statements in the boxes below. Which of these are true about using
medication as pain relievers? Check them.

Pain relief should only be Doctors and nurses are the best Pain relief is only given when
given for pain that is judges of a client's pain. the cause has been
currently present. determined.

Strong analgesics may Pain relievers may cause the Pain relievers can make the
shorten life. client’s inability to communicate client addicted.
with their family.

How many statements did you check?

The statements in the boxes below are misconceptions that people have when taking medication
as pain relievers. Some clients do not report the actual level of pain they experience because of
the following reasons:

They think that increasing pain might

They don’t want to appear weak.
be a sign of a worsening condition.

They think that they won’t be They think that strong painkillers

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 able to decide about their own may not affect increasing pain in the
pain relief. future.

(Source: Palliative Care Australia)

Pain management and relief require good communication amongst the staff and the client. The
client’s report of what they feel can assist the health professionals to plan ahead to help the
person even before the pain increases. It does not, however, take away the client’s right to accept
or refuse the medication to be given to them.
Aside from providing medication, there are other strategies which can be used to promote
comfort for the client:
 Regular observation
 Reporting and documenting client’s comfort
 Providing pain-relieving measures by an appropriate staff member
 Other comfort promotion measures:
o Massage

o Relaxation

o Distraction

o Aromatherapy

o Music therapy

When supporting the client with pain management and relief, always be aware of the scope of
your responsibilities. Administering pain medication and facilitating therapy will require the
assistance of another health specialist.

8. End-of-Life Care

After some time, the person with life-limiting illness becomes weaker, their body slowly
deteriorates. The pain they experience significantly increases as if no amount of medication or
treatment can alleviate it. This is when the client reaches the end-of-life stage or the final chapter
of life. Their treatment and medication continue, however, at this stage, the client and their family
are being prepared for end-of-life decisions and feelings of grief and loss. These are some of the
signs that a client needs end-of-life care:
 The client has been in and out of the hospital several times within the year with the
symptoms of the illness worsening.

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  The client has been brought to the emergency room, their condition stabilises but
the illness progresses.
 The client wishes to stay at home rather than be brought to a hospital.
 They start refusing treatments.
(Source: Late Stage and End-of-Life Care)

End-of-life care employs the following strategies to ensure that both the client and the family are
supported:
 Identifying the dying client, allowing them and their carers and family to reorient priorities
and make necessary arrangements.
 Supporting both client and their family.
 Attending to not only the physical needs but also the psychosocial and spiritual needs of
the dying client and their families.
 Proactively addressing physical problems for the comfort of the dying (e.g. pain, delirium,
agitation, etc.).

During this stage, the client becomes concerned with their belief concerning death and dying. The
belief that a person has about death and dying is usually influenced by their culture and religion.
Below are some of the beliefs that different cultures and religion have about death.

Beliefs about death and dying

Aboriginals
Family members mourn their loss through a practice called ‘sorry business’. This
includes attending funerals and taking part in mourning activities with the
community.

Catholicism
They believe that if the person has committed a grave offence and has not
repented at the time of death, then that person would not enter heaven.

Christianity
They believe that when they die, they will go to heaven to be with God. A funeral,
in some respects, can be a time of joy and sadness as the person will be missed by
friends and loved ones.

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 Islam
They believe that they should be prepared for death at any time that is why their
daily prayers are so important.

Judaism
When a person is dying, family and friends will gather, and a rabbi may be called to
offer comfort and to pray for the dying person. They believe that a dying person
should not be left alone.

Hinduism
In preparation for death, some of their rituals involve tying a thread around the
neck and wrist of the dying patient, the sprinkling of Ganges water, or placing a leaf
from the sacred basil bush on the tongue.

Buddhism
They believe in rebirth and that when they die, they will be reborn again. Their
ultimate goal is to escape this cycle and achieve nirvana or ‘perfect peace and
happiness’.

Signs of Imminent Death

No one can tell the exact hour of death of a person, even in palliative care. Some people can die
while unconscious, while some are awake and slowly deteriorates. There are signs and symptoms
that can be observed from a person when death is near:

Mental
Laboured
Loss of appetite confusion or
breathing
disorientation

Excessive fatigue Social Decreasing

and sleep withdrawal vision

Darkened or
Skin becomes
Incontinence decreased
cold
amount of urine

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These signs and symptoms are caused by the progressively decreasing function of the person’s
body system. In cases where the client is experiencing pain, it may be difficult to control the pain.
Some of the signs indicating that death occurred may include:
 Loss of breathing or pulse
 The inability of the eyes to move or blink
 Pupils are dilated
 Jaw becomes relaxed, and mouth is slightly opened
 Bowel and bladder contents are released
 Unresponsiveness to touch or voice

After death has occurred, it is important to follow any wishes specified by the client in their
advance care directive. This is to maintain their dignity. Such wishes may include honouring
any cultural or religious requirements for the deceased, returning their personal
possessions to their family, and allowing the immediate family to grieve.
A medical practitioner must be called to pronounce that the client has died. Death is
documented through a medical certificate which must be signed by a doctor. If a client dies
at home, the general practitioner or palliative care nurses are called for instead of an
ambulance. A funeral director is also contacted to assist the family with the arrangements
for the deceased person. The process following the funeral allows the family to grieve for
the loss of their loved one.

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9. Stages of Grief

Palliative care does not end with the death of the client. Its goal is also to provide care to the
client’s family and friends who are experiencing grief. Expression of grief and loss varies across
cultures, and time of healing for a person may depend on their ability to cope with their emotions.
It has been a widely held belief that a person undergoes different stages of grief. Someone who
has lost a loved one may go through the following stages:

Denial and Shock Anger

This is the initial reaction of the This reaction results from feeling
person after receiving news about helpless and powerless. This can
the loss of a loved one. The person stem from feeling of abandonment
tends to have a feeling of numbness. from the loss of a loved one.
Denial and shock help the person to
cope with grief.

Depression Bargaining
This occurs after realising the true Persistent thinking about what could
extent of the loss. This may include have been done to prevent the loss
sleep and appetite disturbances, of a loved one.
loneliness, emptiness, isolation, and
self-pity.

Acceptance
This is coming into terms with the
loss.

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People experiencing grief express a wide range of emotions, thoughts, behaviours. Grief can be
unpredictable, and each will go through each process in their unique way. Some people take years
to go through acceptance, while some may accept the loss after a few weeks.
The following can be effective strategies for managing different reactions to grief:
 Cry as a means of emotional release.
 Seek others’ emotional support.
 Acknowledge and accept negative feelings.
 Allow time to experience thoughts and feelings.
 Seek professional help when the feelings become too difficult to handle.

10. Managing Your Own Emotional Response

Individual support workers in palliative care are also vulnerable to feelings of loss and grief when a
client dies. As individual support workers, they may have known the client for quite some time. To
be able to provide the best care to other clients as a part of their continuing roles and
responsibilities, individual support workers must manage their own emotional response to death
and grieving. Palliative care services have standards for bereavement support:

Standard 1: Access

Standard 2: Coordination of bereavement services

Standard 3: Training and support

Standard 4: Screening and assessment

Standard 5: Bereavement support strategies

Standard 6: Clinical handover and referral to specialist services

Standard 7: Community education and health promotion

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 Standard 8: Privacy, confidentiality and consent

Standard 9: Integration with the health and support system

Standard 10: Resource allocation

Standard 11: Program evaluation, quality improvement, and research

Read more about these standards from this link:

Bereavement Support Standards

After a client dies, the best thing to do seek help and advice from your co-workers and supervisor,
so they can help you deal with your feelings of sadness and grief. Tell them how you feel but
continue with your roles and responsibilities. You will encounter several deaths throughout your
work role, but that shouldn’t stop you from providing care to other clients.

End of Document

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