| List of Education Plans for Achieving Competencies | p. xiii |
| Contributors | p. xv |
| Foreword | p. xvii |
| Preface | p. xix |
| Looking at the Whole Person in Palliative Care | p. 1 |
| Spirituality and Culture as Domains of Quality Palliative Care | p. 3 |
| The Spiritual Nature of the Person | p. 4 |
| Suffering as a Human Condition | p. 6 |
| Spiritual and Religious Perspectives on Death | p. 10 |
| Research Regarding Spirituality | p. 13 |
| Quality Nursing Care: Addressing the Spiritual Needs of Patients and Their Families | p. 15 |
| Life and Death Across Cultures | p. 20 |
| Cultural Perspectives Regarding Illness and Death | p. 23 |
| Quality Nursing Care: Developing Cultural Competence | p. 28 |
| Nurses' Need for Self-Reflection and Self-Healing in Palliative Care | p. 32 |
| Conclusion | p. 34 |
| References | p. 45 |
| Holistic Integrative Therapies in Palliative Care | p. 51 |
| Specific Holistic Healing Modalities | p. 53 |
| Herbology | p. 63 |
| Homeopathy | p. 65 |
| Prayer | p. 65 |
| The Healing Journey at the End of Life | p. 66 |
| Self-care for the Healer | p. 67 |
| Exercises | p. 69 |
| Key Points | p. 78 |
| Resources | p. 82 |
| References | p. 84 |
| Social and Professional Issues in Palliative Care | p. 87 |
| Death and Society | p. 89 |
| Changes in the Definition of Death in Society | p. 89 |
| Beyond Taboos in Acknowledging Death | p. 91 |
| Where People Die | p. 93 |
| Death Trajectories | p. 94 |
| Patient-Requested Euthanasia and Assisted Suicide | p. 95 |
| The Evolution of Hospice and Palliative Care | p. 99 |
| Generalist and Specialist Palliative Care | p. 102 |
| Changes in Health Care Economics | p. 102 |
| Promoting Quality Palliative Care | p. 103 |
| Conclusions | p. 106 |
| References | p. 112 |
| Professional Organizations and Certifications in Hospice and Palliative Care | p. 117 |
| Evolutionary Perspective of Hospice and Palliative Care Nursing | p. 118 |
| Developing the Scope, Standards, and Competencies of Palliative and Hospice Nursing Practice | p. 122 |
| Competencies | p. 125 |
| Certification in Hospice and Palliative Care Nursing | p. 127 |
| Future Visions for Hospice and Palliative Care Nursing | p. 129 |
| References | p. 132 |
| The Nurse's Role as a Member of the Interdisciplinary Palliative Care Team | p. 133 |
| Palliative Care Frameworks | p. 133 |
| Delivery Model of Care | p. 133 |
| Principles of Palliative Care | p. 134 |
| The Interdisciplinary Team | p. 136 |
| Characteristics of an Effective Interdisciplinary Team | p. 137 |
| The Developing Role of Nursing in Practicing Palliative Care | p. 140 |
| The Nurse's Role in Interdisciplinary Care | p. 141 |
| Continuing Professional Education | p. 144 |
| Conclusion and Future Direction | p. 144 |
| References | p. 149 |
| Ethical Aspects of Palliative Care | p. 151 |
| Ethics and Ethical Theory | p. 152 |
| Ethical Theories | p. 154 |
| Ethical Principles and Concepts | p. 157 |
| Elements of a Decision-Making Framework | p. 164 |
| Conceptual Confusion and Difficult Decisions in End-of-life Care | p. 165 |
| From Letting Die to Assisted Dying: Background Issues | p. 167 |
| Conclusion | p. 172 |
| References | p. 183 |
| Legal Aspects of End-of-Life Care | p. 187 |
| Law and Ethics: Same or Different? | p. 188 |
| Nursing and the Law | p. 188 |
| The Right to Die | p. 189 |
| Purpose and Types of Advance Directives | p. 189 |
| The Support Study | p. 190 |
| The Patient Self-Determination Act | p. 195 |
| Do Not Resuscitate Directives | p. 196 |
| Informed Consent | p. 200 |
| Intractable Pain Legislation | p. 202 |
| Ethics Committees | p. 203 |
| Education of Nurses and Other Health Care Professionals Regarding Advance Directives | p. 206 |
| Conclusion | p. 206 |
| Resource | p. 207 |
| References | p. 212 |
| Psychosocial Considerations | p. 219 |
| Communicating with Seriously Ill and Dying Patients, Their Families, and Their Health Care Providers | p. 221 |
| Introductory Phase | p. 222 |
| Working Phase | p. 229 |
| Termination Phase | p. 234 |
| Conclusion | p. 237 |
| Keypoints | p. 237 |
| References | p. 244 |
| Caring for Families: The Other Patient in Palliative Care | p. 247 |
| Families and End-of-life Care | p. 248 |
| Caring for Families Across the Health Care Continuum | p. 251 |
| Assessing Families During End-of-life Care | p. 253 |
| Family Structure | p. 254 |
| Roles and Expectations | p. 255 |
| Swot Analysis | p. 257 |
| Knowledge Deficits Related to EOLC | p. 257 |
| Site of Care | p. 259 |
| Goals and Plans for Care | p. 261 |
| Barriers to Developing an Effective Plan of Care | p. 262 |
| Interventions: Facilitating Role Development for Family | p. 263 |
| Teaching Plans | p. 264 |
| Conclusions | p. 265 |
| References | p. 271 |
| Loss, Suffering, Bereavement, and Grief | p. 273 |
| Loss and Suffering | p. 273 |
| Living with and Dying from Life-Threatening Illness | p. 274 |
| Experience of Loss and Suffering Across the Life Span | p. 275 |
| Theoretical Underpinnings and Theories on Death and Dying | p. 276 |
| Dimensions of Loss, Suffering, Grief, and Bereavement | p. 279 |
| Significance and Meaning of the Relationship to Loss and Suffering | p. 281 |
| Assessment-Where Am I (The Nurse) on the Journey? | p. 283 |
| Assessment-Where is the Patient on the Journey? | |
| The Life Cycle Continuum-across the Life Span on the Journey | p. 285 |
| Assessment-Where Are the Significant Others on the Journey? | p. 286 |
| Child's Experience of Loss | p. 289 |
| Risk Factors for Complicated Grief | p. 293 |
| Context of Caregiving and Related Interventions | p. 296 |
| Conclusions | p. 300 |
| Acknowledgments | p. 300 |
| References | p. 313 |
| Physical Aspects of Dying | p. 317 |
| Symptom Management in Palliative Care | p. 319 |
| Assessment at the End of Life | p. 320 |
| Interventions at End of Life | p. 322 |
| Dyspnea Near the End of Life | p. 324 |
| Assessment of Dyspnea | p. 324 |
| Interventions for Dyspnea | p. 325 |
| Medications | p. 325 |
| Nonpharmacologic Interventions | p. 327 |
| Nausea and Vomiting Near the End of Life | p. 328 |
| Anxiety and Altered Cognition | p. 329 |
| Constipation | p. 332 |
| Fatigue | p. 334 |
| Terminal Dehydration | p. 335 |
| Conclusions | p. 336 |
| References | p. 342 |
| Pain Assessment and Pharmacological Interventions | p. 345 |
| Pain Assessment and Pharmacological Interventions | p. 345 |
| Pharmacological Therapy | p. 355 |
| Pain Management in Special Populations | p. 380 |
| Special Considerations for Older Adults | p. 383 |
| Conclusions | p. 385 |
| References | p. 395 |
| Nondrug Pain Interventions | p. 407 |
| Psychological Interventions | p. 408 |
| Physiatric Interventions | p. 417 |
| Neurostimulatory Interventions | p. 422 |
| Invasive Interventions | p. 422 |
| Integrative Interventions | p. 425 |
| How to Integrate Nondrug Interventions into a Comprehensive Pain Management Plan | p. 430 |
| The Role of Nurses in Implementing Nondrug Interventions | p. 430 |
| References | p. 438 |
| Peri-Death Nursing Care | p. 443 |
| Peri-Death 1: Symptoms and Experiences Before Death | p. 443 |
| Pain | p. 444 |
| Peri-Death 2: Death | p. 453 |
| Peri-Death Religious and Cultural Rituals | p. 457 |
| Peri-Death 3: Funerals as a Ceremony of Death | p. 461 |
| References | p. 468 |
| Index | p. 470 |
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