Palliative care in Islamic hospital
9/27/16
PALLIATIVE CARE
PALLIATIVE CARE IN
ISLAMIC HOSPITALS
ERNA ROCHMAWATI
DISTRIBUSI KEBUTUHAN PALLIATIVE CARE BERDASARKAN AREA
(Global Atlas of Palliative Care At the End of Life, 2014)
(WHO, 2003)
“Palliative care is an approach that improves the quality of life of
patients and their families facing the problem associated with lifethreatening illness, through the prevention and relief of suffering by
means of early identification and impeccable assessment and treatment
of pain and other problems, physical, psychological and spiritual.”
DISTRIBUSI KEBUTUHAN PERAWATAN PALIATIF
BERDASARKAN PENYAKIT
Global Atlas of Palliative Care at the End of Life, 2014)
(
PERKEMBANGAN PALLIATIVE CARE DI NEGARA
MAYORITAS BERPENDUDUK MUSLIM
(Aljawi
& Harford 2012, Lynch et al 2013)
SYMPTOMS PREVALENCE: PHYSICAL AND
PSYCHOLOGICAL
(Solano et al 2006)
1
9/27/16
SPIRITUAL SYMPTOMS
TYPE OF PALLIATIVE CARE
(Hospice Foundation Irlandia)
•
•
•
•
anger at God
feelings of isolation from God, community or others
loss of faith and despair
difficulties in accepting the disease and difficulties in being available for
others
• (Puchalski et al 2009, Byrne 2002, Effendy et al 2014)
• Gomez-Castillo et al. (2015) highlighted that spiritual distress led to a
lower quality of life and higher rates of morbidity
PALLIATIVE CARE APPROACH
JOURNEY IN PALLIATIVE CARE
(Rochmawati, Wiechula & Cameron 2016)
Merupakan bagian yang penting dan terintegrasi di semua praktek klinik
yang harus berlandaskan pada pengetahuan dan prinsip praktek
perawatan paliatif.
• Quality of life
• A whole person approach
• Care for both the dying person and those that matter to the person
• Patient autonomy and choice
PALLIATIVE CARE NURSING
(Bashaireh )
PROVISION OF PALLIATIVE CARE
(Rochmawati, Wiechula & Cameron 2016)
VALUING
connecting
empowering
Doing for
Preserving
integrity
Finding
meaning
2
9/27/16
CHALLENGES
COMPLEXITY OF CARE
• Often being referred in the late stage
• Many symptoms occurred
• Lack of integration with other mainstream health care services
• Previous family problems
• Stand alone unit
• Aggressive interventions
• Many needs of the patients
RECOGNISING THE UNIQUENESS OF THE
PATIENTS
CARE TO MAINTAIN DIGNITY
(CHOCHINOV, 2002)
• Cultural background
• Patient’s autonomy
• Person centred care
• Patient’s functional capacity
• Personal history
• Patient’s cognitive state
• Patient’s continuity of self
FAMILY CAREGIVER
END OF LIFE CARE
• Sangat penting
• End of life care discussions
• Indonesia à strong family ties à keluarga inti, extended family
• Understanding and preparing for death and dying
• Role: physical care, spiritual care, managing aspect of patient’s
care
• BURDEN à physical & psychological exhaustions, financial
3
9/27/16
END OF LIFE DISCUSSION
EOL DISCUSSIONS
• Influenced by country and culture
• Providing honest information about the patient’s condition
à Mostly indirect particularly with the patients
• Asking the relatives to fulfill the patient’s wishes (if any) and to provide
spiritual support
à More detailed and direct with the patient’s relatives
• EOL discussions generally commenced when the patient’s
condition deteriorated
• Encouragement of spiritual practices (reciting Qur’an, kalimat thoyibah)
• Asking the patient to seek and provide forgiveness à forgiving relates to
quality of life
• Asking the relatives about dying and death preparations (place of funeral,
GOOD DEATH
WESTERN PERSPECTIVES
(Gustafson 2007, Davies 2006)
• Western perspectives
• Free from avoidable sufferings
• Treatment preferences
• Islamic perspectives
• Preferences for a specific dying
process
• Dignity
• Pain-free status
• Religiosity/spirituality
• Emotional well-being
• Life completion
ISLAMIC PERSPECTIVES
(Tayeb et al 2010)
• Family
• Quality of life
• Relationship with the health care
providers
GOOD DEATH IN ISLAMIC PERSPECTIVES
(Tayeb et al 2010)
• Religious faith and beliefs
Religious faith and belief
Self esteem and body image
Concern about family
security
• Self esteem and body image
• Ada yang membimbing untuk
membaca syahadat
• Ada yang membacakan AlQur’an disamping pasien
• Menghadap kilbat
• Mencegah bau, deformitas
setelah meninggal
• Menjaga jasad tetap utuh
• Menjaga kebersihan jasad
• Ekonomi
• Sosial
• Concern about family security
• Meninggal di tempat dan
waktu yang baik
4
9/27/16
GOOD DEATH IN ISLAMIC PERSPECTIVES
FREE RESOURCES
• Importance of respecting human dignity and privacy
• www.thewhpca.org/resources/global-atlas-on-end-of-life-care
(Tayeb et al 2010)
• Valuing emotional and spiritual support
• www.caresearch.com.au
• Importance of access to emotional and spiritual support
SUMBER PUSTAKA
• www.thewhpca.org/resources/global-atlas-on-end-of-life-care
• http://cdn.intechopen.com/pdfs/27618/InTechPalliative_care_in_the_muslim_majority_countries_the_need_for_more_and_better_ca
re.pdf
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886872/
• http://www.dailymail.co.uk/health/article-3517258/What-makes-good-death-want-dieStudy-reveals-11-important-factors-dying-well.html
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874514/
5
PALLIATIVE CARE
PALLIATIVE CARE IN
ISLAMIC HOSPITALS
ERNA ROCHMAWATI
DISTRIBUSI KEBUTUHAN PALLIATIVE CARE BERDASARKAN AREA
(Global Atlas of Palliative Care At the End of Life, 2014)
(WHO, 2003)
“Palliative care is an approach that improves the quality of life of
patients and their families facing the problem associated with lifethreatening illness, through the prevention and relief of suffering by
means of early identification and impeccable assessment and treatment
of pain and other problems, physical, psychological and spiritual.”
DISTRIBUSI KEBUTUHAN PERAWATAN PALIATIF
BERDASARKAN PENYAKIT
Global Atlas of Palliative Care at the End of Life, 2014)
(
PERKEMBANGAN PALLIATIVE CARE DI NEGARA
MAYORITAS BERPENDUDUK MUSLIM
(Aljawi
& Harford 2012, Lynch et al 2013)
SYMPTOMS PREVALENCE: PHYSICAL AND
PSYCHOLOGICAL
(Solano et al 2006)
1
9/27/16
SPIRITUAL SYMPTOMS
TYPE OF PALLIATIVE CARE
(Hospice Foundation Irlandia)
•
•
•
•
anger at God
feelings of isolation from God, community or others
loss of faith and despair
difficulties in accepting the disease and difficulties in being available for
others
• (Puchalski et al 2009, Byrne 2002, Effendy et al 2014)
• Gomez-Castillo et al. (2015) highlighted that spiritual distress led to a
lower quality of life and higher rates of morbidity
PALLIATIVE CARE APPROACH
JOURNEY IN PALLIATIVE CARE
(Rochmawati, Wiechula & Cameron 2016)
Merupakan bagian yang penting dan terintegrasi di semua praktek klinik
yang harus berlandaskan pada pengetahuan dan prinsip praktek
perawatan paliatif.
• Quality of life
• A whole person approach
• Care for both the dying person and those that matter to the person
• Patient autonomy and choice
PALLIATIVE CARE NURSING
(Bashaireh )
PROVISION OF PALLIATIVE CARE
(Rochmawati, Wiechula & Cameron 2016)
VALUING
connecting
empowering
Doing for
Preserving
integrity
Finding
meaning
2
9/27/16
CHALLENGES
COMPLEXITY OF CARE
• Often being referred in the late stage
• Many symptoms occurred
• Lack of integration with other mainstream health care services
• Previous family problems
• Stand alone unit
• Aggressive interventions
• Many needs of the patients
RECOGNISING THE UNIQUENESS OF THE
PATIENTS
CARE TO MAINTAIN DIGNITY
(CHOCHINOV, 2002)
• Cultural background
• Patient’s autonomy
• Person centred care
• Patient’s functional capacity
• Personal history
• Patient’s cognitive state
• Patient’s continuity of self
FAMILY CAREGIVER
END OF LIFE CARE
• Sangat penting
• End of life care discussions
• Indonesia à strong family ties à keluarga inti, extended family
• Understanding and preparing for death and dying
• Role: physical care, spiritual care, managing aspect of patient’s
care
• BURDEN à physical & psychological exhaustions, financial
3
9/27/16
END OF LIFE DISCUSSION
EOL DISCUSSIONS
• Influenced by country and culture
• Providing honest information about the patient’s condition
à Mostly indirect particularly with the patients
• Asking the relatives to fulfill the patient’s wishes (if any) and to provide
spiritual support
à More detailed and direct with the patient’s relatives
• EOL discussions generally commenced when the patient’s
condition deteriorated
• Encouragement of spiritual practices (reciting Qur’an, kalimat thoyibah)
• Asking the patient to seek and provide forgiveness à forgiving relates to
quality of life
• Asking the relatives about dying and death preparations (place of funeral,
GOOD DEATH
WESTERN PERSPECTIVES
(Gustafson 2007, Davies 2006)
• Western perspectives
• Free from avoidable sufferings
• Treatment preferences
• Islamic perspectives
• Preferences for a specific dying
process
• Dignity
• Pain-free status
• Religiosity/spirituality
• Emotional well-being
• Life completion
ISLAMIC PERSPECTIVES
(Tayeb et al 2010)
• Family
• Quality of life
• Relationship with the health care
providers
GOOD DEATH IN ISLAMIC PERSPECTIVES
(Tayeb et al 2010)
• Religious faith and beliefs
Religious faith and belief
Self esteem and body image
Concern about family
security
• Self esteem and body image
• Ada yang membimbing untuk
membaca syahadat
• Ada yang membacakan AlQur’an disamping pasien
• Menghadap kilbat
• Mencegah bau, deformitas
setelah meninggal
• Menjaga jasad tetap utuh
• Menjaga kebersihan jasad
• Ekonomi
• Sosial
• Concern about family security
• Meninggal di tempat dan
waktu yang baik
4
9/27/16
GOOD DEATH IN ISLAMIC PERSPECTIVES
FREE RESOURCES
• Importance of respecting human dignity and privacy
• www.thewhpca.org/resources/global-atlas-on-end-of-life-care
(Tayeb et al 2010)
• Valuing emotional and spiritual support
• www.caresearch.com.au
• Importance of access to emotional and spiritual support
SUMBER PUSTAKA
• www.thewhpca.org/resources/global-atlas-on-end-of-life-care
• http://cdn.intechopen.com/pdfs/27618/InTechPalliative_care_in_the_muslim_majority_countries_the_need_for_more_and_better_ca
re.pdf
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886872/
• http://www.dailymail.co.uk/health/article-3517258/What-makes-good-death-want-dieStudy-reveals-11-important-factors-dying-well.html
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874514/
5