PERSPEKTIF KEPERAWATAN DAN

KONSEP KEPERAWATAN PALIATIF

Ns.Sri Yuliana.,S.Kep.MSc
 Outlines
• Background
• pengertian palliative care
• Perbedaan palliative care dan hospice care
• Pentingnya palliative care
• Peran perawat palliative care
• Prinsip dan tujuan perawatan palliative care
• Provider perawatan palliative care
“You matter because you are
you. You matter to the last
moment of your life and we
will do what we can not
only to help you die
peacefully but to live until
you die”
(Dame Cicely Saunders)
• Palliative care: "a support system to help
patients live as actively as possible until
death” (WHO 2004).
 PENDAHULUAN

WHO  Perawatan: Pendekatan untuk

meningkatkan kualitas hidup pasien dan
keluarga dalam menghadapi masalah yang
mengancam kehidupan

 Pencegahan, meringankan penderitaan

(fisik, psikologis, spiritual)
 LANJUTAN….

• Indonesia  belum memenuhi kebutuhan

pasien (penyakit terminal)  prioritas pada
kualitas hidup
• PALIATIF di Indonesia: Jakarta (RSCM &
Dharmais), Yogyakarta (RS. Dr. Soetomo),
Denpasar (RS. Sanglah), dan Makasar (RS.
Wahidin Sudirohusodo).
KENDALA:
• Jumlah pasien > Jumlah dokter (paliatif)
• Sarana belum merata
• Belum ada kebijakan (perawatan paliatif)
 KepMenkes RI No. 812/Menkes/SK/VII/2007 tentang Perawatan
Paliatif
 Scope of Problem

Without palliative care, people are:

– Less prepared to deal with death and dying
– Not likely to have a supportive team for
symptom management
– Sometimes given treatments that are not
beneficial at the end of life
– Less likely to have a “good” death

8
 The History of Palliative Care

 Started as a hospice movement in the 19th century,

religious orders created hospices that provided care
for the sick and dying in London and Ireland.

 In recent years, Palliative care has become a large

movement, affecting much of the population.

 Began as a volunteer-led movement in the United

states and has developed into a vital part of the health
care system.
 DEFINISI

• PERAWATAN PALIATIF adalah pendekatan

yang bertujuan memperbaiki kualitas hidup
pasien dan keluarga dalam menghadapi
penyakit yang mengancam jiwa melalui
pencegahan, identifikasi dini dan penanganan
masalah fisik, psikologis, spiritual dan lain
lain.
 LANJUTAN

• PALLIATIVE HOME CARE: Pelayanan

perawatan yang di lakukan di rumah oleh
tenaga kesehatan yang terlatih perawatan
paliatif

• HOSPICE CARE: Tempat dimana pasien

dengan penyakit terminal dirawat/ diberikan
tindakan. Pelayanan  mengendalikan gejala
dalam keadaan dan suasana nyaman (seperti
rumah sendiri)
 Palliative vs. Hospice Care

• Division made between these two terms in the United

States
• Hospice is a “type” of palliative care for those who are at
the end of their lives.

Image courtesy of
http://www.ersj.org.uk/content/32/3/796.full
 Palliative vs. Hospice Care

• Palliative care can be provided from the time of diagnosis.

• Palliative care can be given simultaneously with curative
treatment.
• Both services have foundations in the same philosophy of
reducing the severity of the symptoms of a sickness or old
age.
• Other countries do not make such a distinction
 Who receives Palliative Care?

 Individuals struggling with various diseases

 Individuals with chronic diseases such as cancer, cardiac

disease, kidney failure, Alzheimer's, HIV/AIDS and
Amyotrophic Lateral Sclerosis (ALS)
Why the palliative care is
important?
Importance of Palliative Care?

• Most people fear the thought of their own death

and medical intrusion in the dying process
– Death and dying are too rarely discussed
– Need better communication among patients,
their families, and health care providers
– Care should fit with needs and wishes of
patients
• Since nurses and doctors have close contact with
patients and families, they can take the lead in
better end of life care
 Prinsip Dan Tujuan Keperawatan Paliatif

PRINSIP
• Mengutamakan kenyamanan pasien
• Memperlambat kemajuan penyakit
• Bukan mengutamakan penyediaan obat
TUJUAN
• Mengurangi penderitaan
• Memperpanjang umur
• Meningkatkan kualitas hidup
• Memberikan dukungan pada keluarga
 Who Provides Palliative Care?
 Usually provided by a team of individuals
 Interdisciplinary group of professionals
 Team includes experts in multiple fields:
 Doctors
 Nurses
 social workers
 massage therapists
 Pharmacists
 Nutritionists
 Role of nursing in end of life care

• Attend to pain and symptom control

• Relieve psychosocial distress
• Coordinate care across settings with high-quality
communication between healthcare providers
• Prepare the patient and family for death
• Clarify and communicate goals of treatment and
values
• Provide support and education during the
decision-making process, including the benefits
and burdens of treatment
 Challenges for Physicians
• Limited training
– Need communication and behavior skills
– Need to see its value to patients (adding care, not
taking it away)
• Need insight into their own feelings
• Patient relationships are often built on hope for cure
• Unrealistic goals
• Significant time constraints

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 Challenges for Nurses
• Waiting on providers to:
– Make a prognosis
– Put in orders for care
– Discuss preferences for end of
life and resuscitation before an
emergency happens
Ethical
dilemmas • Thinking about palliative care as an
option even when there is not a
cancer diagnosis

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 Challenges (Continued)
• Needing to decrease confusion about what a DNR
(Do Not Resuscitate) order means
– Knowing how far to go with other invasive
treatments
– Understanding the many levels of comfort care
– Trying to get patient choices in writing
• Needing realistic prognosis and treatment outcomes
to set reasonable goals
• Acute care areas may not be open to palliative care

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 JENIS KEGIATAN PERAWATAN PALIATIF

• Penatalaksanaan nyeri
• Penatalaksanaan keluhan fisik lain
• Asuhan Keperawatan
• Dukungan Psikologis
• Dukungan Sosial
• Dukungan kultural dan spiritual
• Dukungan persiapan dan selama dukacita
TEMPAT PERAWATAN PALIATIF

• RUMAH SAKIT: Pasien yang memerlukan

tindakan dan peralatan khusus
• PUSKESMAS: Pasien yang memerlukan rawat
jalan
• RUMAH SINGGAH (HOSPICE): Pasien yang
tidak memerlukan pengawasan ketat, tindakan dan
peralatan khusus
• RUMAH PASIEN: Pasien yang tidak perlu
pengawasan ketat, tindakan dan peralatan khusus
 Conclusion:

• End of life discussions are very important to

understand the patient’s perspectives
• You can promote palliative care as a valuable option
to improve the quality of life for your patients
• Initiate communication with patients, nurses, and
doctors
• Use advance directives to communicate care choices
• You are uniquely positioned to have effective and
compassionate end of life conversations

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 ASSIGNMENT

• Apasih arti “good life” to you?

• Jika kamu seorang perawat paliatif,
kehidapan “end-life treatment” apa yang
akan kamu berikan kepada pasien
kamu?jelaskan apa kenapa kamu pilih itu!
• Apakah anda setuju ketika keluarga, tetap
ingin merawat keluarga di rumah sakit
sedangkan pasien dalam keadaan sakit parah!
Terima Kasih