Syllabus
1. Basics, definitions, organizational structure in the Czech Republic a. Definition, history and evidence. General and specialized care, multidisciplinary approach. b. Forms of provision of palliative care (depending on the place of provision: hospice, home specialized PP, hospital counseling team, outpatient PP, stationary, respite stays) c. Children's palliative care d. Options for providing care to geriatric patients (general, specialized, non-medical)
2. Interdisciplinary cooperation, coordination of care a. Interdisciplinary assessment and communication with the doctor of the basic field b. Indication of terminal palliative care, application to hospice c. Hospital palliative care - early intervention, request for a consultation of a palliative physician and a geriatrician
3. The needs of patients with serious illness and in geriatrics a. The most common symptoms of a serious illness i. pain: acute, chronic, breakthrough ii. GIT: damage and infection of the oral cavity, dysphagia, constipation, diarrhea, ileus, nausea, vomiting, intestinal obstruction iii. pulmonary: shortness of breath, cough iv. nutrition and fluids: nutritional support, anorexia, cachexia, thirst, sub/dehydration v. skin: pruritus, intertrigo, decubitus and chronic wounds vi. neuropsychiatric, neurodegenerative: cognitive disorders, delirium, confusion, insomnia, depression, anxiety, fear, communication and mobility disorders due to impaired sensory, motor or executive speech functions vii. venous access: possibilities, limitations and advantages viii. ostomies, catheters and drains: importance and risks ix. other: hypercalcemia, spinal cord compression, intracranial hypertension syndrome, anemic syndrome, fevers, pathological fractures, etc. b. Specifics of the geriatric patient i. characteristics of organism aging, polymorbidity, chronicity, polypragmasia, fragility, renal and hepatic dysfunction, nutrition ii. restriction of physical activity, osteoporosis (prevention and complications), arthrosis, degenerative diseases of the spine, joint replacements, iii. cognitive and neuropsychiatric changes, problems of care for patients with cognitive disorders and differentiation of communication and movement disorders due to sensory, motor or executive speech function disorders c. Psychological needs i. hierarchy of patient needs (Maslow's pyramid) ii. orientation in the trajectory of the disease iii. adaptation to illness, emotions iv. grief and mourning (child as survivor) d. Social needs i. orientation in the social support system (patients and caregivers/parents) ii. social ties, social role of the patient, caregivers and loved ones e. Spiritual needs i. Hope, faith, meaning of life, religious belief ii. Spiritual needs of a non-religious nature, traditions, rituals, a sense of wholeness, completion f. Care of the dying - picture and management of terminal symptoms, including intensive care
4. Communication with a focus on emotions in the doctor - patient - closed people relationship a. communication of unfavorable news incl. pediatric issues b. interview about prognosis c. communication about a reasonable and realistic goal of treatment d. conflicts - prevention and resolution e. family conference
5. Ethical and legal context of providing palliative care a. legal norms in relation to palliative care b. recommended procedures in pediatrics and adult patients c. ethical aspects: palliative sedation, euthanasia, assisted suicide
6. Deciding on the Adequacy of Treatment a. the patient's values and preferences, previously expressed wishes b. a close person and a person with the right of proxy consent for patients who are not competent c. treatment goal and therapeutic balance, procedure alternatives and their documentation d. prognostic uncertainty Practical exercises, seminars: practical solutions for selected symptoms (e.g. pain, shortness of breath, malnutrition, disorientation, agitation), long-term intensive care unit, geriatric unit, hospice.
Annotation
The course Palliative Medicine and Geriatrics is designed to learn the principles and meaning of specific diagnostic, treatment and nursing approach to geriatric patients and patients with otherwise incurable diseases diseases, with the aim of contributing to the improvement of their health, or quality of life, and with the aim of eliminating the burden of these patients with futile interventions regardless of their age, i.e. including children. Increased attention is paid the importance of multidisciplinary and multiprofessional collaboration, ethical and legal issues, communication skills and psychosocial issues, both in relation to the patient and his loved ones.
They are discussed individually options for solving significant symptoms of patients in palliative and geriatric care - e.g. pain, shortness of breath, gastrointestinal problems, nutrition, cognitive disorders, mobility limitations, communication disorders, etc.).