Konsep Keperawatan Paliatif

Konsep dan Perspektif
Keperawatan Paliatif
Definition of Palliative Care
Palliative care has been traditionally defined as ‘ . . . specialised health
care of dying people, aiming to maximise quality of life and assist
families and carers during and after death’
(PCA 1999).
Perawatan paliatif dimulai sebelum situasi dying, fase

perawatan yang telah menjadi praktik multidisiplin yang
melibatkan interaksi dengan bagian lain yang relevan dari
sistem perawatan kesehatan.
Physical Emotional
Health Health
World Health Organisation defines health

as well-being at physical, emotional,
social and spiritual dimensions.
Social
Spiritual Health
Health
History of palliative care
The modern hospice movement is attributed to Dame Cicely Saunders
who founded the first modern hospice - St Christopher’s Hospice in
London in 1967.
Pada tahun 1988, Asosiasi Eropa untuk Perawatan Paliatif (EAPC)

dibentuk
pertengahan 1990-an International Association of Hospice

dan Perawatan Paliatif (IAHPC) didirikan di Amerika Serikat
Pada tahun 2006, sebuah Deklarasi disusun bahwa

menekankan perlunya peningkatan penelitian perawatan paliatif dalam
negara-negara miskin sumber daya, yang mengarah pada janji untuk meningkatkan paliatif
perawatan di seluruh Eropa pada tahun 2007
Principles Of Palliative Care
From inability to let alone,
From too much zeal for the new and contempt for what is old,
From putting knowledge before wisdom, and science before

art, and cleverness before common sense,
From treating patients as cases, and making cure of the disease

more grievous than the endurance of the same,
Good Lord, deliver us.
Pelaksanaan perawatan paliatif didasarkan pada nilai-nilai dan prinsip-
prinsip berikut :
1. Martabat pasien dan keluarga

2. Perawatan penuh kasih pasien dan keluarga
3. Kesetaraan dalam akses ke layanan perawatan paliatif
4. Menghormati pasien, keluarga, dan care giver
5. Advokasi atas nama keinginan yang diungkapkan pasien, keluarga, dankomunitas
6. Menyediaan pelayanan yang excellence
7. Akuntabilitas kepada pasien, keluarga, dan masyarakat luas.
Key points in the WHO Palliative Care approach
● provides relief from pain and other distressing symptoms;
● affirms life and regards dying as a normal process;
intends neither to hasten nor to 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;
● The palliative approach comes early in the course of an illness, not just as end-of-life
care.
● There is an emphasis on impeccable assessment, early identification of problems and
implementation of appropriate treatments.
● The care runs in conjunction with disease modifying treatments such as chemotherapy
and radiotherapy
● Palliative care can be provided in any setting – in hospital, out- patient or as home
based care.
● There is an emphasis on a team approach to care
What is different about palliative care?
Usually, healthcare professionals tend to focus

mainly on physical problems – organs and their Biasanya, profesional kesehatan cenderung berfokus
diseases. Palliative care recognizes that people terutama pada masalah fisik – organ dan
are much more than organs put together; their penyakitnya. Perawatan paliatif mengakui bahwa
minds, spirits and emotions are all part of who manusia terdiri dari ; minds, spirits and emotions.
they are. It also recognizes the families and Itu juga mengakui keluarga dan komunitas tempat
communities to which they belong. So the mereka berasal. Jadi masalah yang dihadapi orang
problems facing a sick person and their family sakit dan keluarganya tidak hanya bersifat fisik;
are not just physical in nature; there may be mungkin ada perhatian psikologis, sosial dan
psychological, social and spiritual concern spiritual yang sama pentingnya. Terkadang masalah
which are just as important. Sometimes di satu area dapat memperburuk area lain, mis. rasa
problems in one area may worsen others e.g. sakit sering lebih buruk ketika orang cemas atau
pain is often worse when people are anxious or depresi. Hanya ketika kita menangani semua area
depressed. It is only when we address all these ini, kita membantu seluruh orang. Pendekatan
areas that we are helping the whole person. It is holistik inilah yang membedakan perawatan paliatif
this holistic approach that distinguishes dari perawatan medis konvensional
Palliative care from the conventional medical
care
How did Palliative Care evolve?
Modern medicine has been competent in

handling acute medical problems and The huge need for the
achieved prominence in the health care ongoing care for those
sector through analytical research and who have long term
intense study of etiological and therapeutic diseases, progressive
factors. It has expanded to include diseases or incurable
prevention, through public health measures, diseases are unmet within
vaccination programs and health education. the current healthcare
Presently most of our health services are delivery system
disease centred; specifically designed for
acute episodic care.
What is different about palliative care?
Pendekatan holistik
membedakan perawatan
paliatif dari perawatan medis
konvensional.
Table 1.1 – Comparison of conventional bio-medical and palliative care
approaches
Conventional approach Palliative approach

● Disease is the central concern ● Human dignity is the central value
● Physician is the General ● Patient is the Sovereign
● Intent – Curing ● Intent – Healing
● Disease, a problem to be solved ● Disease an experience to be lived
● “Don’t just be there, do ● “Don’t just do something… be
something” there..”
● Goal is to improve quantity of ● Goal is also to improve quality of
life living
● Death: A failure of treatment, to ● Death: An inevitable reality, neither
be prevented at all cost to be hastened nor postponed
● Valuable approach in caring for ● Valuable approach in caring for
acute episodic diseases chronic progressive disease
There may be limits to
cure,
but care and comfort have no
limits…….
Why is Palliative Care Training Required?
Fifty-two million people die each year; of which about five

million people die of cancer each year, to which can be added
the numbers of patients dying with AIDS and other chronic
progressive diseases. That many of them die with needless
suffering has been well documented in many studies and
published in scientific papers and reports.
Palliative Care can improve the quality of life of all these

patients.
ETIOLOGY BASED ANNUAL PALLIATIVE CARE NEED IN INDIA
·2.5 million cancer patients in

India
·80% stage IV at time of
diagnosis
·Only 0.4% have access to
Palliative Care
Who needs Palliative Care?
Patients with Retinoblastoma

Cancer Chronic Renal
disease Diabetic foot ulcer
Old age / dementia
Paraplegia
Where can Palliative Care be given?
Hospital based palliative care
Stand-alone In-patient palliative care unit [Hospice]:
Day palliative care unit:
Home based palliative care services
Community based palliative care services:

Konsep Keperawatan Paliatif

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Konsep dan Perspektif

Perawatan paliatif dimulai sebelum situasi dying, fase

World Health Organisation defines health

Pada tahun 1988, Asosiasi Eropa untuk Perawatan Paliatif (EAPC)

pertengahan 1990-an International Association of Hospice

Pada tahun 2006, sebuah Deklarasi disusun bahwa

From inability to let alone,

From putting knowledge before wisdom, and science before

From treating patients as cases, and making cure of the disease

1. Martabat pasien dan keluarga

Usually, healthcare professionals tend to focus

Modern medicine has been competent in

Conventional approach Palliative approach

Fifty-two million people die each year; of which about five

Palliative Care can improve the quality of life of all these

·2.5 million cancer patients in

Patients with Retinoblastoma

Old age / dementia

Hospital based palliative care

Stand-alone In-patient palliative care unit [Hospice]:

Day palliative care unit:

Home based palliative care services

Community based palliative care services:

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