Family Physician. The Family Physician coordinates the person’s medical care and offers a listening ear and compassionate response. The Family Physician is responsible for discussing advance directives with the person and family. At the time of death, he/she attends to the certification of death, facilitates the transfer of the deceased and provides support to the bereaved family. Nurse. The nurse works with the person and family to assess needs and establish goals related to coping, comfort and the effects of decreased mobility or weakness. The nurse plans, implements and evaluates nursing interventions and performs delegated medical acts such as those related to medications, wound care, catheters and suctioning. He/she also advocates for the dying person and fosters his/her autonomy. Personal Support Worker. The Personal Support Worker assists with activities of daily living such as personal care (bathing and toileting) and observes and reports changes in physical symptoms and emotional responses of the person and family to the case manager, nurse and/or doctor. He/she may also provide some light housekeeping, laundry, shopping and respite services. Volunteer. The volunteer provides companionship and emotional support as well as encouragement, comfort and practical assistance for the dying person and family members. (See next section, The Role of the Volunteer on the Team for more detail.) Spiritual Advisor. The Spiritual Advisor assesses the person’s and family’s spiritual needs and supports their search for meaning and hope in changing circumstances. He/she provides opportunities for meaningful rituals, prayer and meditation, and may provide counseling. He/she assists clients and families with funerals and memorial services. If the person and family follow a particular faith, the Spiritual Advisor liaises with the faith leader (priest, rabbi, Imam) if directed to do so by the person and family. Social Worker. The Social Worker assesses the psychosocial needs of the client and family. This includes exploring the emotional basis for intractable pain. He/she assists other team members with interactions with the person and family, and provides the person and family with individual, marital and family counseling if necessary. The Social Worker assists with practical matters: finances, wills, powers of attorney and funeral planning. The Social Worker also provides bereavement support. Pain and Symptom Management Program Director. The Pain and Symptom Management Program Director provides telephone consultation support for team members and gives clients and families information about hospice palliative care and pain and symptom management. He/she advocates for clients in need of pain and symptom management and assists in developing local hospice palliative care and pain and symptom management expertise. Palliative Care Physician. The Palliative Care Physician is a medical advisor or consultant to the other members of team. He/she has in-depth knowledge of all aspects of care of the dying and family, particularly pain and symptom control, client and family support, community resources and ethics. In most cases, the palliative care physician works with but does not replace the family physician. Pharmacist. The Pharmacist prepares, dispenses and distributes medications and completes a medication assessment and pharmacy care plan.
10
Made with FlippingBook Annual report maker