Heart failure occurs in almost epidemic proportions, placing a huge burden on both the healthcare system, and sufferers and their families. This can only rise over coming years as the ageing population, particularly in industrialized countries, increasingly suffers from heart failure and its related comorbidities. The care of this group of patients has evolved significantly over recent years as our knowledge and understanding of the pathophysiology of heart failure has developed. It has become evident that supportive care is integral to comprehensive heart failure care, and this book provides an evidence-based overview of heart failure aetiology, its management, and the supportive care required by patients throughout the course of their disease. Supportive Care in Heart Failure integrates the complexities of heart failure care, bridging knowledge bases from cardiology and cardiothoracic surgery, general medicine and palliative care. The book reviews essential information about epidemiology and pathophysiology of heart failure, and evidence-based medical, device, surgical and interdisciplinary management. It addresses the evaluation and management of quality of life, common symptoms and problems associated with heart failure, and the holistic approach to supportive care throughout the course of the illness through the end of life. Prognostication, communication, and ethical decision making are reviewed in detail. Heart failure has traditionally presented a challenge to physicians, as a generally progressive condition with significant symptoms, a poor quality of life, and high mortality. But by applying the principles of palliative medicine, it is possible to offer a supportive care approach that synthesizes the experience of both the heart failure specialist and the palliative care physician, and offers the best possible quality of care to this group of patients.

This moving and insightful handbook collects wisdom and experience from pactitioners and those who have lost a loved one on the role of spirituality in end of life care. It addresses the place of spirituality in our modern society and the challenge of life and death, best practice in end of life care, belief systems, how spirituality can play a part in care workers' roles, as well as creative interventions and leadership challenges. The handbook is divided into seven sections covering modern society, spirituality and the challenge of end of life care; end of life care in practice; user, carer and professional perspectives; death as a gateway: belief systems; looking ahead; conclusions.

This innovative care program blends nursing care and meaningful activities to promote peaceful and relaxing end-of-life experiences for older adults with late-stage dementia. The first program created specifically for this hardest-to-serve population, Namaste Care also meets the latest regulatory guidelines for person-centered activity programming. The author has developed the program to be adaptable to individual as well as group settings, from nursing home to bedside at home. With this practical guide, skilled nursing facilities, assisted living settings, memory care communities, and hospices can easily and affordably implement a Namaste Care program not only to improve resident quality of life but also to increase family involvement and strengthen staff morale. New to the revised edition: Detailed descriptions of Namaste Care (NC) Group Program and the NC Individual Program, and instructions for implementing NC in any setting More case studies and stories to illustrate creative uses of Namaste Care and effective results Further international focus, incorporating programs and perspectives from Australia, the U.K., Europe, as well as Singapore and Indonesia. In-depth description of the physical setting and supplies needed for an effective NC program. Completely updated references

Death comes for us all, and the desire to ease into that death is as ancient as humankind. The idea that sometimes it is better to die quickly and in control of that death--rather than linger in pain and misery once impending death is certain--has troubled yet comforted humankind. In Doctor, Please Help Me Die, author Tom Preston, MD, presents a thorough overview and discussion of end-of-life issues and physician-assisted death in America.

Doctor, Please Help Me Die traces the history of patients seeking relief from suffering at the end of life and discusses how cultural and professional customs have inhibited many doctors from helping their patients at the end. Preston shows how most doctors fail their patients by not discussing dying with them and by refusing to consider legal physician aid in dying--ultimately deceiving the public in their refusal to help patients die. He discusses the religious, political, and legal battles in this part of the culture war and gives advice to patients on how to gain peaceful dying.

Preston presents a strong argument for why every citizen who is dying ought to be extended an inalienable right to die peacefully, and why every physician has an ethical obligation to assist patients who want to exercise this right safely, securely, and painlessly.

After the Nancy Cruzan case was decided by the Supreme Court in 1990, and ultimately resolved by the Courts of the State of Missouri, the decision to withhold or withdraw life-prolonging nutrition and hydration appeared to many to be as noncontroversial as decisions to refuse respirators or dialysis. Even the Catholic Church held that, although there should be a presumption in favor of providing nutrition and hydration, the patient or the patient's surrogate could overrule this presumption, if either believed the treatment was disproportionate or burdensome. The Schiavo case changed all that. Although the decision to remove Terri Schiavo's nutrition and hydration was made by her husband - her legal surrogate - based on his wife's belief that such treatment was disproportionate, Schiavo's immediate family protested so much that the case took years to resolve. It eventually involved all branches of government at both the state and federal levels. The ethical dilemmas that such cases pose continue to stir great controversy. This in-depth examination of these dilemmas provides information and documentation from many perspectives. The editors have included a foreword by Dr. Jay Wolfson, Terri Schiavo's court-appointed guardian ad litem, as well as Dr. Wolfson's report to Gov. Jeb Bush on the case and Gov. Bush's reply; public statements by President George Bush and Senators David Weldon, Rick Santorum, Tom DeLay, Bill Frist, and Barney Frank; statements by the pope and other representatives of the Catholic Church on this issue; plus much medical and legal background material on both precedents to the Schiavo case and its aftermath, including the results of the autopsy report. For anyone wishing an in-depth understanding of these complex ethical issues, issues many of us will have to confront in our own families, this volume is indispensable.

Over a period of almost 10 years, the work of the Project on Death in America (PDIA) played a formative role in the advancement of end of life care in the United States. The project concerned itself with adults and children, and with interests crossing boundaries between the clinical disciplines, the social sciences, arts and humanities. PDIA engaged with the problems of resources in poor communities and marginalized groups and settings, and it attempted to foster collaboration across a range of sectors and organizations. Authored by medical sociologist David Clark, whose research career has focused on mapping, archiving and analyzing the history and development of hospice, palliative care and related end of life issues, this book examines the broad, ambitious conception of PDIA - which sought to 'transform the culture of dying in America' - and assesses PDIA's contribution to the development of the palliative care field and to wider debates about end of life care within American society. Chapters consider key issues and topics tackled by PDIA grantees which include: explorations of the meanings of death in contemporary American culture; the varying experiences of care at the end of life (in different settings, among different social and ethnic groups); the innovations in service development and clinical practice that have occurred in the US in response to a growing awareness of and debate about end of life issues; the emerging evidence base for palliative and end of life care in the US; the maturation of a field of academic and clinical specialization; the policy and legal issues that have shaped development, including the ethical debate about assisted suicide and the Oregon experience; the opportunities and barriers that have been encountered; and the prospects for future development. A final chapter captures developments and milestones in the field since PDIA closed in 2003, and some of the challenges going forward.

A holistic view of the factors that impact the health of a patient beyond the illness itself, this book examines what it is like to be a patient. It espouses the view that terminal illness may not be a tragedy but, an opportunity for emotional growth. The inadequacies of medical care today are discussed, from the failure of health care professionals to see the person with the disease, to the many ways in which managed-care organizations jeopardize the doctor/patient relationship.

The work reviews concrete ways in which health care professionals can enhance the quality of their care, by remaining compassionate, continuing to offer patients hope (even if their condition is terminal), acknowledging and addressing patients' suffering, and counseling patients so that they can obtain the support needed. A new advocacy role for doctors is presented that enables patients to make advised decisions about their own treatment. This book encourages patients to take back their lives from the diseases that overwhelm them. It also discusses advance directives, living wills, cardiopulmonary resuscitation, and do not resuscitate orders. Information is provided to help patients assume self advocacy on end-of-life issues from an emotional perspective as well as a legal perspective.

How do doctors and nurses communicate with frightened patients who are dying, address the needs and concerns of the patients, and help the patients arrive at an acceptance of death? This work deals with the relationship that the health care team has with the dying and how well that team is prepared to address the fears of the dying. In addition, the health care team must learn to deal with their own emotions and ignorance concerning death. This work should be of interest to those professions that deal closely with dying people.

This issue of Nursing Clinics, Guest Edited by Margaret Mahon, PhD, RN, FAAN, on the topic of Palliative and End of Life Care will include the following article topics: "I Want to Live Until I Don't Want to Live Anymore": Understanding Children's Involvement in Medical Decision Making; Symptom Management at the End of Life; Assessing Respiratory Distress when the Patient Cannot Self Report; Legislative Issues in Palliative Care; Barriers to Palliative Care; Saving Lives as Role in Palliative Care; End Stage Liver Disease: Symptoms and Practice Implications; Dying Children; Decision Making in Palliative Care; Children and Family Perspectives; Cognitive Impairments in Long Term Care; Withdrawal of Life and Sustaining Therapy: Good Death, Bad Death; Living with Cancer; and Palliative Concepts in the Sickle Cell Population.

An on-the-go reference for hospice nurses and those interested in end-of-life care, this practical guide covers the essential elements in the compassionate and holistic care of terminally ill patients and their families. Nurses care for patients facing end-of-life issues in every practice specialty, and as the American population continues to age the need for proficiency in end-of-life skills will become increasingly important. This book is an invaluable resource that provides emotional, administrative, and palliative support, whether in a hospice, long-term care facility, or even in acute care settings. This vital go-to text clearly and concisely lays out not only how to care for patients facing end-of-life issues, but also how to engage in self-care and cope with occupational stress. Beginning with an overview of hospice care, including its history and philosophy, this book offers a timeline of the growth of the hospice movement in the U.S. Subsequent sections include up-to-date information on the clinical responsibilities of the hospice nurse in addressing the physical, psychological, and spiritual needs of terminally ill patients and their families in a culturally sensitive way. This book also outlines the administrative duties of the hospice nurse, including hospice documentation, a review of hospice regulations, and quality management. The closing section focuses on occupational stress in hospice nursing and how to engage in self-care. This text can serve as a useful clinical resource and also as a reference for nurses seeking hospice certification from the Hospice and Palliative Credentialing Center. This book was originally published under the Fast Facts series by Springer Publishing Company.

This book lays a clear foundation of knowledge for any nurse involved with palliative care. It focuses on the needs and perspectives of the patient, and seeks to give the reader a strong, broad understanding of how best to deliver full, rounded care. Covering the wide range of care provision in hospices, hospitals and patients' homes, the book draws widely from practice examples to explain and expand theoretical issues. Research evidence underpins each of the chapters while guided activities enable readers to reflect in a focused way on their experience and current practice. While recognising the importance of team work in providing good quality palliative care, the book unashamedly concentrates on the unique nursing skills and knowledge required for this demanding work. Covering key issues in palliative care nursing such as spirituality, sexuality, ethics, loss and grief, this book defines and develops palliative care as a key nursing specialty. A clear, broad-based approach offers a thorough introduction for the non-specialist nurse. Written and edited by an experienced team of nurses working in this field, grounding it in current practice. Learning outcomes listed at the start of each chapter aid learning and comprehension. Reflective practice activities and an outline of CPD is especially useful for students working independently. Case histories, recommended reading lists, and references provide a solid evidence base for clinically based practice and facilitate further study. Thoroughly revised and updated to reflect changes in policy direction. A new chapter on pain and symptom management. Revised content reflects the recent shift in the evidence base concerning spirituality. Includes psychosocial issues of loss for the patient, their family, and careers.

Children with life-threatening and terminal illnesses- and their families- require a unique kind of care to meet a wide variety of needs. This book, now in its third edition, provides an authoritative source for the many people involved in the care of dying children. Written by leading authorities in pediatrics and palliative medicine, this comprehensive resource emphasizes practical topics and covers the entire range of issues related to the hospice care from psychological stress to pain and symptom management. The text has been fully updated and includes an international perspective chapter and a chapter written cy Children's Hospice International with detailed all-inclusive care plans.

"Now I Lay Me Down...The Owner's Manual for the Dying Patient, Their Caregivers and Their Loved Ones" was written to help those with a terminal illness, and those who care for them, to improve the quality of their physical and spiritual life. It also gives guidance to the loved ones after death. During Mrs. Stringer's work as a hospice nurse she came to realize the importance of an open and honest relationship in the last months and days of a person's life. This is reflected in the book, as she has condensed an enormous amount of information in a straight-forward, easy to understand guide, while remaining sensitive and compassionate.

Intractable illnesses such as advanced cancer, AIDS, and chronic progressive neurological diseases present health-care professionals with an array of symptoms and ethical issues that demand extensive exploration and consideration. As the quest for advances in symptomatology continues, it is imperative to disseminate and integrate the knowledge currently available in palliative medicine. The International Symposium on Current Perspectives and Future Directions in Palliative Medicine was held in Tokyo in October 1997 to provide health-care professionals with a multidisciplinary approach for improving comprehensive palliative care. With invited speakers from North America, Europe, and Japan, the symposium focused on standard management and clinical trials of control of symptoms such as pain and cachexia, ethics in palliative medicine, the economics of health care, quality-of-life research, management of depression, and patient education.

This "comforting...thoughtful" (The Washington Post) guide to maintaining a high quality of life-from resilient old age to the first inklings of a serious illness to the final breath-by the New York Times bestselling author of Knocking on Heaven's Door is a "roadmap to the end that combines medical, practical, and spiritual guidance" (The Boston Globe). "A common sense path to define what a 'good' death looks like" (USA TODAY), The Art of Dying Well is about living as well as possible for as long as possible and adapting successfully to change. Packed with extraordinarily helpful insights and inspiring true stories, award-winning journalist Katy Butler shows how to thrive in later life (even when coping with a chronic medical condition), how to get the best from our health system, and how to make your own "good death" more likely. Butler explains how to successfully age in place, why to pick a younger doctor and how to have an honest conversation with them, when not to call 911, and how to make your death a sacred rite of passage rather than a medical event. This handbook of preparations-practical, communal, physical, and spiritual-will help you make the most of your remaining time, be it decades, years, or months. Based on Butler's experience caring for aging parents, and hundreds of interviews with people who have successfully navigated our fragmented health system and helped their loved ones have good deaths, The Art of Dying Well also draws on the expertise of national leaders in family medicine, palliative care, geriatrics, oncology, and hospice. This "empowering guide clearly outlines the steps necessary to prepare for a beautiful death without fear" (Shelf Awareness).

Death strips away all of the superficial and mundane details of living and leaves behind life's bare essentials. Death is inevitable in life. It knows no boundaries. It knows no skin color, no financial or social standing. It knows nothing but itself. The paradox of Dying Declarations: Notes from a Hospice Volunteer is in its warm affirmation of life through the 'dying declarations' of patients who are peering into the cold face of death. The author reveals personal experiences about life, death, and the courage to strip away the unimportant aspects of life to make way for a clearer understanding on just what is truly important. Simple, moving stories invigorate and spark insightswhile discussing all aspects of hospice volunteering. By facing death on a regular basis, one can no longer maintain a tight grip on the masks, games, and trivialities that one uses to hide from truth. The person who looks death in the eye becomes more honest, grateful, compassionate, and humble. In Dying Declarations: Notes from a Hospice Volunteer, the author shares his experiences and the lessons he learned from the dying while working as a hospice volunteer. The stories, rather than being sad and depressing, present the author's hospice experience as being some of the most personally uplifting and enriching experiences of his life. In Dying Declarations: Notes from a Hospice Volunteer you will learn: about training for hospice work why hospice volunteers are at times more beneficial to the well-being of dying patients than family, clergy, or medical personnel the three basic tasks for a hospice volunteer how children and dogs can be beneficial for patients the impact that a dying patient can have on the life of a hospice volunteer words of wisdom about living life, directly from hospice patients Dying Declarations: Notes from a Hospice Volunteer will inspire and enlighten hospice volunteers, nurses, physicians, clergy, social workers or anyone who works for hospice or provides end-of-life care.

End-of-life decision making is often viewed from an academic perspective, which can obscure the debate's central human concerns. This guide introduces general readers to people with personal stakes in the right-to-die conundrum. Putnam provides practical assistance to readers and their loved ones, simultaneously incorporating the abstract and theoretical analysis essential to examining how we die in contemporary Western society. She also presents the backgrounds of the Hospice and Right-to-Die (Hemlock) Movements.

To elucidate the human side of the debate, Putnam profiles and interviews six important figures:

Dame Cicely Saunders, founder of the modern Hospice Movement

Derek Humphry, founder of The Hemlock Society in the U.S.

Herbert Cohen, an early leader in euthanasia circles in The Netherlands

Timothy Quill, whose assistance in a patient suicide resulted in a case before the U.S. Supreme Court

Joanne Lynn, founder of Americans for Better Care for the Dying

Jack Kevorkian (profiled, but unavailable for interview)

Another unique feature of this book is the application of philosopher Judith Jarvis Thomson's general theory of rights to the very specific right to die. Pointing to potential compatibilities between the two positions, she concludes that heroic compassion does not require a final choice between Hospice and Hemlock--there may be room enough for both.