Skin considerations in palliative care

In recent months, I have become aware of several friends and family members who are facing the challenge of caring for loved ones at the end of their lives, commonly known as palliative care or hospice care.
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According to the National Pressure Ulcer Advisory Panel (NPUAP), approximately 300 million individuals, or 3% of the world’s population, need palliative or end-of-life care each year.1

Palliative care is designed to provide relief from suffering and enhance the quality of both the living and dying processes for the patient and family, while neither hastening nor prolonging death.2,3 This care may be provided in many settings, such as in the hospital, long-term care or rehabilitation facility, and even in the home.

As a wound care nurse, it is vital to consciously address the skin care needs of your patient or loved one in palliative care. Often, health care professionals and caregivers assume that pressure injury development is unavoidable during this phase of life, due to the many comorbidities of the individual. Prevention of pressure injuries should always be included in the goals of care. It is also often assumed that once an individual in palliative care develops a pressure injury, they do not have the ability to heal. Many factors, such as age, nutrition, immobility, friction, shear and moisture, play important roles in whether or not a patient will develop a pressure injury and/or if that pressure injury has the ability to heal.

It is important to begin with a therapeutic support surface that has the ability to provide pressure redistribution that will meet the individual needs of the patient. It is imperative to keep the patient as comfortable as possible, as the patient may experience pain and altered mental status. Individuals who are in pain may resist turning and repositioning, and those with altered mental status may not be aware that it is time to reposition, therefore increasing the risk of developing a pressure injury. Patients receiving pain medication may be less likely to turn and reposition themselves. A turning schedule should be instituted in the care plan, as well as planning ahead to medicate the patient 30 minutes prior to position changes.4 Pillows and foam cushions should be used to support bony prominences or the use of heel boots to protect the vulnerable heels. Care should also include products to protect the skin from contact with moisture that may result from incontinence.

During the end-of-life phase, it is important to protect the patient’s skin and implement care measures that allow for the safe and comfortable transition of the patient through this process. Therapeutic support surfaces will provide enhanced comfort and effective pressure redistribution to protect skin integrity during the end-of-life process, which also provides comfort to the caregiver at a very difficult time.

For assistance in determining the most appropriate support surfaces for your patients and/or loved ones across the continuum of care, contact Arjo or your local sales representative to discuss our therapeutic solutions that address the clinical needs of providing effective, safe and dignified care.

Support system solutions

References:

  1. Singer, P.A. and Bowman, K.W. Quality End-of-Life Care: A Global Perspective. BMC Palliative Care, 2002;1:4.
  2. Alvarez, O., Meehan, M. and Ennis W., et al. Chronic Wounds: Palliative Management for the Frail Population. Wounds, 2002;14 (8 suppl): 1S-27S.
  3. Cancer pain relief. Geneva: World Health Organization. http://www.who.int/iris/handle/10665/43944.
  4. Langemo, D.K., and Black, J. Pressure ulcers in individuals receiving palliative care: A National Pressure Ulcer Advisory Panel white paper. Advances in Skin & Wound Care, 2010;23:2, 59-72.