Dedication

iii

Acknowledge Meats

iv

About the Author

v

Introduction

x

Chapter 1

Where to Begin

Introduction

1

Guiding Principles of End of Life Care

2

Core Nursing Responsibilities: Skilled Clinician, Advocate, and Guide

4

What do Patients and Families Want for Care at the End of Life?

5

When do we Start Providing End of Life Are?

6

A Team Approach

7

Chapter 2

Advance Care Planning

The Courageous Conversation

11

Skilled Clinician: Understanding the Elements of Advance Care Planning

12

Advance Directives

15

A Note on DNR/DNI Stains and POLST Forms

16

Advocating in Advance Care Planning: Making Sure Wishes are Honored

16

Guiding in Advance Care Planning: Recognizing the Common Barriers

17

Common Questions Patients Ask About Advance Directives

19

Cultural Considerations in Advance Care Planning

20

Chapter 3

Pain Management: It’s More Than Knowing the MCDs

Listening to the Patient’s Pain

23

Skilled Clinician: Assessment and Management of Pain

25

Advocating: Ensuring Thai ihc Patient’s Pain Relief Goals are Met

29

Guiding Patients and Families: Addressing Common Fears

31

Know the Resources

33

Chapter 4

Physical Symptom Management

Common Symptoms

35

Skilled Clinician: Assessment and Management of Common Symptoms

36

Advocating: Linking the Needs of the Patient and Family to the Health Care System

43

Guiding Patients and Families: Preparing, Listening, and Assuring

44

Chapter 5

Suffering: It’s Not Just the Pain

What Ts Suffering at the End of Life?

47

Skilled Clinician: Assessing Suffering

48

Advocating for Patients: Ensuring a Holistic View

52

Guiding Patients and Families: Start with Yourself

53

Chapter 6

Active Dying: The Final Days and Hours

Active Dying: What Does it Mean?

57

Skilled Clinician: Assessing and Intervening When Death Is Near

58

Advocating for Both the Patient and Family: Communication Is the Key

63

Guiding: Walking That Difficult Path

64

A Note on Withdrawing Life-Sustaining or Life-Extending Treatment

65

Chapter 7

After the Death: The Long Journey to the Car

What Happens After a Patient Dies?

67

Skilled Clinician: Understanding Grief

68

Advocating for the Family: Accommodating Their Comfort Needs

69

Guiding the Family: Accepting [he Loss

70

Self Care

73

Chapter 8

When, I Child Ts Dying: Pediatric End of Life

Children Die, Too

75

Skilled Clinician: Assessing and Intervening in the Care of Children

77

Advocating for Children: Meeting die Needs of Both the Patient and the Family

80

Guiding Children and Families: Understanding the Needs of the Child

82

Chapter 9

Cultural Sensitivity: Looking through Different Eyes

Making Room for Cultural Diversity

85

Understand Your Own Beliefs

87

Listen Patients

88

Avoid Stereotyping and Making Assumptions

89

Use Trained Medical Interpreters

89

Use Community Resources

90

Advocating for Patients and Families

91

Chapter 10

Hospice

A Philosophy of Care

95

Who Qualifies for Hospice Carer

96

How do I Approach Patients and Families About Hospice Care?

97

The Hospice Medicare Benefit

98

Advocating for Your Patients

100

Chapter 11

Ethical Issues in End-of Life Care

Health Care Ethics

104

Common Ethical Dilemmas and Conflicts

105

Role of the Skilled Clinician in Difficult Decisions

106

Advocate: Making Sure Wishes Are Honored

107

Guide

108

What about a Nurse’s Personal Ethics, Beliefs, and Values?

109

Ethics and Culture

109

Chapter 12

A Final Note: Taking Care

Burning Brightly, Burning Dimly

113

Living in the Present Moment

114

The Joy and the Laughter

115

A Final Note

115

Index

117