When the first edition of this book (Terminal Care Support Teams: the hospital-hospice interface, 1990) was written, there were only a few advisory palliative care teams working in hospitals. Since then the number of teams has grown rapidly. The concept of these teams in now widely accepted but there is an increased need for information about setting up a team, how they work and how effective they are. This book looks at the need for hospital- based palliative care teams and the challenges of bringing palliative care into the acute hospital setting. It reviews the needs of patients, their families and their professional carers, and also looks at the theoretical and practical problems which may be encountered. For example there is practical advice on setting up hospital-based palliative care teams, the selection of team members as well as coverage of team dynamics, and the role of the pain clinic and palliation oncology.

This volume considers the specific medical, psycho-social and practical issues involved in caring for children dying from chronic diseases. The author, a consultant paediatrician in palliative care at the Hospital for Sick Children, London, recognizes the special needs of terminally ill children and their families. She confronts the problems and issues surrounding this emotive subject in order to help paediatricians and other professionals provide the very best possible care for such patients. A range of contributors experienced in palliative care for children provide comprehensive coverage of the subject including: consideration of the magnitude of the problem and the provision of services pain control symptom management family support and communication with children spiritual issues bereavement and stress.

This new edition of the Practical Management of Complex Cancer Pain has been fully updated and expanded, with five new chapters on novel interventional techniques in cancer pain amelioration. The book provides advice on advanced pain management, emphasising the suitability and selection of patients for different invasive and complex procedures based on patient history. Case histories are included throughout the text to give the reader insight into the complexities of holistic management, with pain being only one component in the distress that cancer causes for both patients and families. The book also covers cancer pain management for patients in a community setting, and the collaboration between pain and palliative medicine. Concise, practical, and evidence-based, this guide is essential reading for all pain and palliative care specialists in the community, hospital, and hospice settings.

Palliative care has become increasingly important across the spectrum of healthcare, and with it, the need for education and training of a broad range of medical practitioners not previously associated with this field of care. As part of the Integrating Palliative Care series, this volume on palliative care in nephrology guides readers through the core palliative knowledge and skills needed to deliver high value, high quality care for seriously ill patients with chronic and end-stage kidney disease. Chapters are written by a team of international leaders in kidney palliative care and are organized into sections exploring unmet supportive care needs, palliative care capacity, patient-centered care, enhanced support at the end of life, and more. Chapter topics are based on the Coalition for Supportive Care of Kidney Patients Pathways Project change package of 14 evidence-based best practices to improve the delivery of palliative care to patients with kidney disease. An overview of the future of palliative care nephrology with attention to needed policy changes rounds out the text. Palliative Care in Nephrology is an ideal resource for nephrologists, nurses, nurse practitioners, physician assistants, social workers, primary care clinicians, and other practitioners who wish to learn more about integrating individualized, patient-centered palliative care into treatment of their patients with kidney disease.

A handbook for acupuncturists and healthcare practitioners on the use of acupuncture for end-of-life care. The book covers the major hospice and palliative care diagnoses from a Chinese medicine perspective, as well as grief and loss, and includes the roots of Chinese historical perspectives on death and dying. The acupuncturist is introduced to the working medical model of hospice care and the interdisciplinary team approach and provided with evidence-based strategies for the use the acupuncture in symptom management.

Cancer and Creativity is a dialogue between accounts by cancer patients and survivors and a more clinical consideration and theoretical discussion from a psychoanalytic point of view of using creativity in coping with serious illness. The contributions featured demonstrate the power of creative expression as a tool for dealing with somatic, chronic and potentially life-threatening illnesses, giving patients a way of expressing and managing their individual cancer journeys and its attendant emotional sequelae. Ten artist-patients and survivors, who were involved in several long-term art therapy groups, give accounts of their experiences with cancer and with their support group, where they create paintings, embroidery, digital photography, comic books, maps and other works to express their experiences of being diagnosed and treated for cancer. The contributors describe their symptoms and their relationships to physicians and family members in words and visual representations. The book also addresses the experience of the public when they are confronted with art by cancer patients. Dreifuss-Kattan's own work as a psychoanalyst and art therapist informs her approach to the art space as what Winnicott calls a "transitional space," influenced by both the personal psychological experience and the physical environment. Dreifuss-Kattan closes her discussion with a reflection on terminal cancer care and the complex transferential and countertransferential relationship between patient and therapist. The book ends with a practical guide for both therapy groups, as well as individuals at home, to creatively address their experiences with cancer and its treatments. Cancer and Creativity will be of great interest to psychoanalysts, psychoanalytic psychotherapists, psychooncologists and art therapists, as well as health professionals working in oncology and in palliative care.

Nurses are positioned on healthcare's front line, intimately connected to individuals, families, and communities. How can they leverage this position to work for the common good? In Toward a Better World, Mark Lazenby, a philosopher and a nurse, presents a plan of action. He argues that nurses advance the good society when they fulfill fundamental obligations. Promoting equality, peace and respect, providing assistance and safety, and safeguarding the health of our planet are among these obligations. By acting upon them, nurses become a force for social change in their communities. But through the collective power of more than 20 million nurses worldwide, nurses become a global force for making the world a better place-in the present and for the future. A companion to Caring Matters Most, Lazenby's ethics book, Toward a Better World challenges readers to lead good lives of service to others. This book will invigorate all, nurses and non-nurses alike, who wish to spend their lives making the world a better place.

Nearly half of people at the end of life will receive hospice care, but few psychologists, nurses, physicians, chaplains, and hospice workers have been trained specifically to recognize and address the psychological, social, and emotional issues that may arise in patients who are dying. Patients in the midst of advanced terminal illness may experience a variety of distressing emotions, and may feel anxious, frightened, regretful, or desperate. This guide was created specifically to guide helping professionals of all kinds through the process of working through patients' psychological issues to allow them peace and comfort in their final moments.

The Helping Professional's Guide to End-of-Life Care clarifies the spiritual and emotional care that patients need and presents an evidence-based approach integrating cognitive behavioral therapy (CBT), transpersonal psychotherapy, hypnosis, mindfulness, and guided imagery to help patients manage emotional distress at the end of life. Through case conceptualizations and detailed treatment planning guidance, readers learn to formulate comprehensive assessment and treatment plans for patients and gain skills that will help them manage the emotional intensity of this work. This secular, professional treatment model can be applied to patients of any religious or spiritual background. The book also addresses integrating the patient's therapeutic team with the medical team, addressing the emotional needs of friends and family of the dying, crisis intervention for suicidal patients, working with clients on psychotropic medications, and how helping professionals can manage their own emotions to become more effective clinicians.

The fifth edition of this seminal reference and text in palliative care nursing helps the practitioner and student offer comprehensive, targeted interventions responsive to the needs of palliative and hospice patients and families. Based on the best level of evidence available, reference to clinical practice guidelines, and palliative care order sets to address critical symptoms, the knowledge presented in this edition supports compassionate, timely, appropriate and cost-effective care to achieve quality health outcomes for diverse palliative care populations across the illness trajectory. Noteworthy features of the new edition include broadening population health management by helping the reader to identify patterns and connections within and across population and utilize information to respond to the needs of populations. This strategy allows the reader to apply strategies that are consistent with IHI's Triple Aim that includes Improving the patient experience of care, Improving the health of populations and reducing the per capita cost of health care. Every Chapter in Sections 1, 2, and 3 includes an Evidence Based Box with a current study including a commentary written by someone from a discipline other than nursing or by an interdisciplinary team.

The first resource on end-of-life care for healthcare practitioners who work with the terminally ill and their families, "Living with Dying" begins with the narratives of five healthcare professionals, who, when faced with overwhelming personal losses altered their clinical practices and philosophies. The book provides ways to ensure a respectful death for individuals, families, groups, and communities and is organized around theoretical issues in loss, grief, and bereavement and around clinical practice with individuals, families, and groups.

"Living with Dying" addresses practice with people who have specific illnesses such as AIDS, bone marrow disease, and cancer and pays special attention to patients who have been stigmatized by culture, ability, sexual orientation, age, race, or homelessness. The book includes content on trauma and developmental issues for children, adults, and the aging who are dying, and it addresses legal, ethical, spiritual, cultural, and social class issues as core factors in the assessment of and work with the dying. It explores interdisciplinary teamwork, supervision, and the organizational and financing contexts in which dying occurs.

Current research in end-of-life care, ways to provide leadership in the field, and a call for compassion, insight, and respect for the dying makes this an indispensable resource for social workers, healthcare educators, administrators, consultants, advocates, and practitioners who work with the dying and their families.

The syringe driver is a simple and cost-effective method of delivering a continuous subcutaneous infusion (CSCI). A CSCI provides a safe and effective way of drug administration and can be used to maintain symptom control in patients who are no longer able to take oral medication. There have been several developments in this field since the third edition of this highly successful book. The text in this edition has been completely revised, incorporating new treatment options and an extensive list of new compatibility data. This book serves as a valuable reference source, providing comprehensive review of syringe driver use and administration of drugs by CSCI. The first chapter provides an overview of syringe drivers and CSCIs, including a useful array of frequently asked questions. The second chapter provides information about the chemistry of drug incompatibility and degradation. The third chapter comprises revised and referenced information relating to most drugs likely to be administered by CSCI using a syringe driver. The fourth chapter discusses the control of specific symptoms that are often encountered when CSCIs are required. The fifth and final chapter contains an extensive, referenced list of compatibility and stability data relating to drug combinations administered by CSCI.

Palliative care is an essential element of our health care system and is becoming increasingly significant amidst an aging society and organizations struggling to provide both compassionate and cost-effective care. Palliative care is also characterized by a strong interdisciplinary approach, and nurses are at the center of the palliative care team across settings and populations. The sixth volume in the HPNA Palliative Nursing Manuals series, Social Aspects of Care provides an overview of the financial and mental stress illness places, not just on the patient, but on the family as well. This volume contains information on how to support families in palliative care, cultural considerations important in end-of-life care, sexuality and the impact of illness, planning for the actual death, and bereavement. The content of the concise clinically focused volumes in the HPNA Palliative Nursing Manuals series is an ideal resource for nurses preparing for certification exams and provides a quick-reference in daily practice.

Palliative care is an essential element of our health care system and becoming increasingly significant amidst an aging society and organizations struggling to provide both compassionate and cost effective care. Palliative care is also characterized by a strong interdisciplinary approach. Nurses are at the center of the palliative care team across settings and populations. The third volume in the HPNA Palliative Nursing Manuals series, Physical Aspects of Care: Nutritional, Dermatologic, Neurologic and Other Symptoms, provides an overview of the principles of symptom assessment and management for symptoms including: fatigue, anorexia and cachexia, artificial nutrition and hydration, urinary tract disorders, lymphedema, skin disorders such as pressure ulcers, wounds, fistulas, and stomas, pruritus, fever, sweats, neurological disorders, anxiety and depression, and insomnia. The content of the concise, clinically-focused volumes in the HPNA series prepares nurses for certification exams as well as quick-reference in daily practice. Plentiful tables, figures, and practical tools such as assessment instruments, pharmacology tables, and patient teaching points make these volumes useful resources for nurses.

Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform provides an introduction to the principles of palliative care; describes current models of delivering palliative care across care settings and examines opportunities in the setting of healthcare policy reform for palliative care to improve outcomes for patients, families and healthcare institutions. The United States is currently facing a crisis in health care marked by unsustainable spending and quality that is poor relative to international benchmarks. Yet this is also a critical time of opportunity. Because of its focus on quality of care, the Affordable Care Act is poised to expand access to palliative care services for the sickest, most vulnerable, and therefore most costly, 5% of patients- a small group who nonetheless drive about 50% of all healthcare spending. Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness-whatever the diagnosis or stage of illness. The goal is to improve quality of life for both the patient and the family.Research has demonstrated palliative care's positive impact on health care value. Patients (and family caregivers) receiving palliative care experience improved quality of life, better symptom management, lower rates of depression and anxiety, and improved survival. Because patient and family needs are met, crises are prevented, thereby directly reducing need for emergency department and hospital use and their associated costs. An epiphenomenon of better quality of care, the lower costs associated with palliative care have been observed in multiple studies. Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, a roadmap for effective policy and program design, brings together expert clinicians, researchers and policy leaders, who tackle 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value.

The first volume in the HPNA Palliative Nursing Series, Structure and Processes of Care provides an overview of palliative nursing care, reviews National Consensus Project guidelines, and offers tools for initiating and maintaining palliative care programs. The content of the concise, clinically-focused volumes in the HPNA series prepares nurses for certification exams as well as quick-reference in daily practice. Plentiful tables, figures, and practical tools such as assessment instruments, pharmacology tables, and patient teaching points make these volumes useful resources for nurses.

50 Studies Every Internist Should Know presents key studies that have shaped the practice of internal medicine. Selected using a rigorous methodology, the studies cover topics including: preventative medicine, endocrinology, hematology and oncology, musculoskeletal diseases, nephrology, gastroenterology, infectious diseases, cardiology, pulmonology, geriatrics and palliative care, and mental health. For each study, a concise summary is presented with an emphasis on the results and limitations of the study, and its implications for practice. An illustrative clinical case concludes each review, followed by brief information on other relevant studies. This book is a must-read for health care professionals and anyone who wants to learn more about the data behind clinical practice.

Is there a place for palliative care within mental health? This inspirational book offers an excellent foundation for integrating best-practice specialist palliative care into serious and enduring mental health service delivery. The shared practice values and vision between these two disciplines provide an optimistic starting point from which to address the lack of palliative care service delivery in mental health practice. Focusing on the similarity in philosophy between palliative care and mental health practice, it incorporates: . person-centred practice . relationship-based connectedness . a belief in compassionate care . respect for autonomy and choice . quality-of-life issues. The book addresses the practice skills needed in preparation for competent intervention and treatment. Each chapter develops a theoretical framework which is supported by practical application. Both professionals and students of palliative care will find the interactive text and practical case studies especially valuable, as will the professional working in substance use. Its userfriendly approach will appeal to a wide range of readers in various related disciplines. 'While it could be assumed that mental health has a lot to offer palliative care, we both [feel] that palliative care could offer more to mental health practice...It is a neglected area. There is little or no literature related to palliative care within serious mental health practice, and that which does exist relates to care of the dying in terms of cancer.' From the Preface

Amytrophic Lateral Sclerosis (ALS or motor neurone disease) is a progressive neurodegenerative disease that can cause profound suffering for both the patient and their family. Whilst new treatments for ALS are being developed, these are not curative and offer only the potential to slow its progression. Palliative care must therefore be integral to the clinical approach to the disease. Palliative Care in Amyotrophic Lateral Sclerosis: From diagnosis to bereavement reflects the wide scope of this care; it must cover not just the terminal phase, but support the patient and their family from the onset of the disease. Both the multidisciplinary palliative care team and the neurology team are essential in providing a high standard of care and allowing quality of life (both patient and carer) to be maintained. Clear guidelines are provided to address care throughout the disease process. Control of symptoms is covered alongside the psychosocial care of patients and their families. Case studies are used to emphasise the complexity of the care needs and involvement of the patient and family, culminating in discussion of bereavement. Different models of care are explored, and this new edition utilizes the increase in both the evidence-base and available literature on the subject. New topics discussed include complementary therapies, personal and family experiences of ALS, new genetics research, and updated guidelines for patient care, to ensure this new edition remains the essential guide to palliative care in ALS.

For patients and family caregivers the journey through illness and transitions of care is characterized by a series of progressive physical and emotional losses. Grief reactions represent the natural response to those losses. Grief is defined by a constellation of physical, cognitive, emotional and spiritual manifestations, varying in length and severity. While grief reactions are common and expected responses to loss, they have the potential to cause significant suffering. And, while grief is not a disease, it can develop into a pathological process warranting specialized treatment. Additionally, some aspects of grief overlap with the symptoms of clinical depression and anxiety, making diagnosis difficult. Grief and Bereavement in the Adult Palliative Care Setting provides practical, evidence-based, and clinically effective approaches to understanding the multifaceted nature of grief and bereavement in patients with advanced illness and their caregivers. This handbook is an ideal tool for palliative care providers of various disciplines who provide direct clinical services to patients and family members. It assists clinicians in recognizing and identifying grief reactions as unique expressions of patients and caregivers' history and psychological functioning. Primary care physicians who provide care to patients and families will also find this practical assessment and treatment guide helpful. They will learn how to best support bereaved patients and caregivers when grief is uncomplicated, and when to choose more active interventions that may include appropriate referrals to mental health professionals.

When a person suffers from advanced, progressive illness, palliative care -- treatments that improve the physical and psychological quality of life of patients and their families -- can be just as important as treatments that aim to slow or prevent disease progression. Aimed at general practitioners and trainees in the field, Palliative Care in Clinical Practice offers an accessible and practical introduction to palliative medicine, including a chapter devoted to each of the key areas of symptom management. Clearly and concisely written and fully illustrated throughout, it will be a useful resource for all healthcare professionals who wish to gain an understanding of this important aspect of medicine.

Soul Midwives, a movement begun by Felicity Warner, has changed the face of modern holistic and spiritual palliative care in the UK and abroad. Soul Midwives are holistic and spiritual companions to the dying. They draw on traditional skills, now largely forgotten, applying them to our modern world to ease the passage of those who are dying. Their services are used within people's own homes, in hospices and in care homes. Anyone with an open and compassionate heart and a desire to help others can train to become a Soul Midwife. This book will guide you through the core principles and techniques of this practice.

Political, economic, social, cultural and technological changes have led to profound transformations in the ways that death and loss are perceived and managed in contemporary society. Over the last few decades, the long term shift to chronic illness as a major causal factor has significantly increased the time scale of dying. Most people die in institutions and 'care' is typically medical. Many communities and ordinary citizens now relinquish control and involvement to experts in the last stages of life.
At global and local levels, however, new arrangements are emerging to govern the changing face of death, and a reorientation model is being developed to counter claims of the 'creeping medicalisation' of death and dying. With an international authorship and scope, this book illustrates the interlinking nature of society, death and loss, and it gives examples of governance that promotes the empowerment, participation and the increasing need for the involvement of ordinary people and communities in differing social and cultural contexts.
Chapters come from collaborations of academics and practitioners in end of life care - from sociologists, anthropologists or the arts but also from nursing, social work, or medicine. The result is a reflective, academic and practical discussion of the outline of the problem we face in the contemporary governance of death, and an exploration of the critical, theoretical and practice-based ways forward for us all.

Even for the most experienced healthcare professional, managing the last few days of life can be difficult. This unique book provides guidelines for the care of the dying based on the Liverpool Integrated Care Pathway for the Dying Patient (LCP). Developed at a hospice, the information can be disseminated and adapted to fit different settings such as hospitals and nursing homes.
The LCP is a multiprofessional document that incorporates evidence-based practice and appropriate guidelines related to care of the dying. It provides a template which describes the process of care which is generally delivered in a clinical situation and incorporates the expected outcome of care delivery. The LCP replaces all other documentation in this phase of care. Care pathways can provide a potentially powerful aid to professionals involved in palliative care. Basic principles of treatment are translated into daily practice, including bedside documentation systems, policies and procedures, standards of practice, continuing education and quality improvement programmes. This book also includes chapters on symptom control, ethical issues, communication skills, and spiritual care written by experts in the field which underpin the use of the LCP.
Care of the Dying Second Edition will prove invaluable to all healthcare professionals involved in the care of the dying patient, organisations and Trusts who want to develop demonstrable measures and outcomes of care.

The Art and Science of Compassion, A Primer offers a succinct, all-in-one introduction to the full gamut of compassion, from the evolutional, biological, behavioural, and psychological, to the social, philosophical, and spiritual. Drawing on her diverse background as a clinician, scientist, educator, and chaplain, Dr. Wong presents a wealth of scientific evidence supporting that compassion is both innate and trainable. By interleaving personal experiences and reflections, she shares her insights on what it takes to cultivate compassion to support the art of medicine and caregiving. The training described in this book draws on both contemplative and scientific disciplines to help clinicians develop cognitive, attentional, affective, and somatic skills that are critical for the cultivation of compassion. With striking illustrations for key concepts and concise summaries for each chapter, this book provides a solid conceptual framework and practical approaches to cultivate compassion. Advance Praise for The Art and Science of Compassion, A Primer "Well-written, deeply personal and scientifically-grounded, this book provides strong physiological, psychological, and ethical reasons why cultivating compassion is essential-and provides a thoughtful roadmap for promoting compassion in healthcare and in all of life." - Ron Epstein, MD, author of Attending: Medicine, Mindfulness, and Humanity "Dr. Agnes Wong, a highly distinguished physician and exceptional researcher at the University of Toronto, has written an absolutely uplifting masterpiece about meaning, compassionate care, and the universal journey that all healers must take to sustain their inner being and nobility of purpose. This book is partly her journey to a deeper state of being that places compassionate care in its rightful place in the healing art; it is also a fabulous scientific presentation of the practice and impact of compassionate care on patients and on one's own flourishing as a physician. This is a book that touches the soul and should be read by every medical student or clinician worldwide as they reflect on what it means to really succeed in their "whole selves" as healers and human beings." - Stephen G. Post, PhD, Director, Center for Medical Humanities, Compassionate Care and Bioethics; Professor of Family, Population and Preventive Medicine, Stony Brook University "Compassion and empathy are traits that make us human, and as Dr. Wong shows, these qualities can be developed, encouraged, and cultivated. In our struggling world, we need this awareness as never before. The future of our species likely depends on it. This book is an example of how science and spirituality can come together in a brilliant synthesis." - Larry Dossey, MD, author of One Mind: How Our Individual Mind Is Part of a Greater Consciousness and Why It Matters

Every one of us will die, and the processes we go through will be our own unique to our own experiences and life stories. It is reasonable to reflect on what kinds of dying processes may be better or worse for us as we move toward our end. Such consideration, however, can raise troubling ethical concerns for patients, families, and healthcare providers. Even after forty years of concerted focus on biomedical ethics, these moral concerns persist in the care of lethally impaired, terminally ill, and inured patients. End-of-Life Care and Pragmatic Decision Making provides a pragmatic philosophical framework based on a radically empirical attitude toward life and death. D. Micah Hester takes seriously the complexities of experiences and argues that when making end-of-life decisions healthcare providers ought to pay close attention to the narratives of patients and the communities they inhabit so that their dying processes embody their life stories. He discusses three types of end-of-life patient populations adults with decision-making capacity, adult without capacity, and children (with a strong focus on infants) to show the implications of pragmatic empiricism and the scope of decision making at the end of life for different types of patients.