...members of the caring professions need all the counselling skills that we can muster. Readers of this book will end up feeling less helpless in the face of death but we should not expect to find communication easy. "What can we say?" Once we think we know what to say we are wrong. Rather this book will help us to learn when to speak of dying and when not to, what not to say and when to keep silent and wait patiently for what gliding instructors call an 'up-draught'. We must start from wherever the other person may be and we must take the time and trouble to discover the language with which this person speaks about death and dying, the assumptions they make and their needs and wishes to speak or not to speak. - From the Foreword by Dr Colin Murray Parkes, Life President of Cruse Bereavement Care Good counselling skills are often not taught to the professionals who need them most. Compassionate and tactful communication skills can make the difference between an awkward encounter with a dying patient, and an engaging, empathic bond between two people. Louis Heyse-Moore draws on his wealth of experience as a trained counsellor and palliative medicine specialist. Covering difficult subjects such as breaking the news of terminal illness to a patient, euthanasia and the effect of working with patients on carers, Speaking of Dying is a practical guide to using counselling skills for all clinical disciplines working in palliative care, whether in a hospice, hospital or at home. Complete with a clear explanation of both counselling and medical terminology, this hands-on guide will be an invaluable companion to anyone working in palliative care.

Riveting in their emotional clarity and utterly jargon free, these 30 stories from real life penetrate how we grieve and how we can help those who grieve- whether the griever is oneself, someone we care about, or a client or patient. Lynne Dale Halamish, an internationally respected grief counsellor with more than 20 years' experience, and Doron Hermoni, a family physician, researcher, and educator, present vignettes from practice that show how death- lingering, unexpected, violent, or self-inflicted- and the loss of a relationship- to oneself or with a child, sibling, parent, mate, grandparent, or friend- give life to grief, together with the process by which each person fully encounters his or her grief. Each story is no more than two or three pages, and the authors follow each one with a short summary of its teachings and a selection of annotated recent references for those who wish to read more about a topic. Looked at in relief, the stories reveal a master grief counsellor at work.

Improving care for the patients who are in the last phase of their lives has been a field that most health care providers have struggled with during last few years. Having worked with hundreds of providers throughout the country, these experienced authors know what providers need when it comes to implementing a quality improvement project. This guide will provide user-friendly, step-by-step instructions on how to implement a quality improvement project in the full range of care settings. The instructions will be brought to life with specific examples from actual successful projects and key information on the best practices in the industry. Readers will also be pointed to resources available online and elsewhere, with information on how to access them. The guide will be written in an informal, maximally helpful style, with checklists, tables, and boxed information. Answering 80% of the questions in less than half the space, The Common Sense Guide is the perfect portable companion to Dr. Lynn's desk reference, Improving Care for the End of Life. The book will be of great interest to all health care professionals involved in the care of those with serious chronic illness -- doctors, nurses, social workers, chaplains, clinic administrators, quality improvement experts, and so forth.

This text introduces the reader to the key issues surrounding care of the dying patient, as well as highlighting the importance of context in the social management of dying. Written in a pragmatic style, it provides a foundation from which to consider the theoretical and practical concerns that are central to terminal care in institutional as well as community-based settings. Illustrated with case studies that demonstrate how the themes of the book can be applied in practice, this text encourages readers to reflect on research findings so that they are stimulated to formulate their own ideas about caring for dying patients.

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.

This volume reviews the state of the art in caring for patients dying in the ICU, focusing on both clinical aspects of managing pain and other symptoms, as well as ethical and societal issues that affect the standards of care recieved, The book also addresses the changing epidemiology of death in this setting related to managed care, practical skills needed to provide the highest quality of care to terminal patients, communicating with patients and families, the mechanics of withdrawing life supporting therapies, and the essential role of palliative care specialists in the ICU. The book briefly describes unique issues that arise when caring for patients with some of the more common diseases that preciptate death in the ICU. Contributors for the book were chosed because they have experience caring for patients in the ICU, and are also doing curent research to find ways to improve care for terminal patients in this setting.

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.

None of the literature in the field of terminal care provides a full treatment of the laws, documents, and policies relating to the difficult issues arising at the end of life. When Life Ends was written to fill this gap by an attorney who serves on the bioethics committee of a large public hospital. It is an invaluable resource and practical tool for physicians, nurses, medical staffs, legal professionals, hospital administrators, and hospital bioethics committees because it provides: 1) in-depth legal commentaries on the refusal of life-sustaining treatment, advance directives, surrogate decision making, and the Patient Self-Determination Act; 2) more than 70 medical and legal documents to be used in connection with end of life decisions; and 3) hospital policies and procedures to suggest guidelines to hospital bioethics committees as they carry out their functions of developing policies and procedures to address end of life legal and ethical issues.

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.

In recent years hospice care has gone from a little-known medical alternative to a major movement in health care. By emphasizing palliative care and pain management rather than curative treatment, hospices allow the terminally ill to spend the last days, week, or months of their lives in their own homes, cared for by their families under the supervision of a team of specially trained hospice workers that includes doctors, nurses, social workers, and volunteers. The Hospice Handbook assures us that the terminally ill do have options, and the quality of their lives can still be within their control.

This work deals with the pressures experienced by nurses caring for patients with a wide range of problems and needs. Two particular situations that nurses face are covered - the terminally ill patient and the acute patient, where the first will die and the second will eventually recover. The book poses the question Are there differences in the way that nurses care for the living and the dying? and Do the disparate needs of these two groups result in role conflict for the nurses who care for them?

Just as everyone must die, almost everyone will deal with death among close friends or loved ones. This collection explores the often difficult issues of human relationships with the dying, as well as the many stresses and burdens faced by the survivors.

This singular work offers a truly interdisciplinary team perspective on caring, presented by 21 veterans of hospice service representing the array of disciplines in effective teams-physicians, nurses, certified nurse assistants, social workers, chaplains, music therapists, bereavement counselors, a volunteer coordinator, and a volunteer of more than 26 years. Contributors share professional and personal experiences that encompass the medical, emotional, intellectual, spiritual, interpersonal, social, cultural, and economic dimensions of dying and bereavement. These are brought together through a person-centered approach that champions knowing each person being cared for to create the necessary opportunity for communication and trust that are the hallmarks of high-quality hospice care.

The Textbook of Palliative Care Communication is the authoritative text on communication in palliative care, providing a compilation of international and interdisciplinary perspectives. This volume was uniquely developed by an interdisciplinary editorial team to address an array of providers including physicians, nurses, social workers, and chaplains, and it unites clinicians with academic researchers interested in the study of communication. By featuring practical conversation and curriculum tools stemming from research, this text integrates scholarship and inquiry into translatable content that others can use to improve their practice, teach skills to others, and engage in patient-centered communication. The volume begins by defining communication, explicating debatable issues in research, and highlighting specific approaches to studying communication in a palliative care context. Chapters focus on health literacy and cultural communication, patient and family communication, barriers and approaches to discussing palliative care with specific patient populations, pain, life support, advance care planning, and quality of life topics such as sexuality, spirituality, hope, and grief. Team communication in various care settings is outlined, and current research and education for healthcare professionals are summarized. Unique to this volume are chapters on conducting communication research, both qualitatively and quantitatively, to promote further research in palliative care.

The Clinical Pocket Guide to Advanced Practice Palliative Nursing is a companion guide to Advanced Practice Palliative Nursing, the first text devoted to advanced practice nursing care of the seriously ill and dying. Each chapter of this pocket guide presents point-of-care guidance on palliative care issues for quick reference in daily practice. Edited by leaders in the field, this handbook provides consistency in the nursing process from assessment to management and evaluation of symptoms and various clinical situations. The Clinical Pocket Guide to Advanced Practice Palliative Nursing contains clinical pearls developed from the textbook and practical tools on pain and symptom assessment, functional status, and communication, making it an ideal resource for practicing APNs.

From the internationally acclaimed author of the groundbreaking and award-winning book Dementia Beyond Drugs comes another eye-opening exploration of how to improve the lives of people with dementia and those who care for them. In this revised edition-including updated facts, studies, and terminology-Dr. G. Allen Power demonstrates how to achieve sustainable success in dementia care by changing the caregiving lens to focus on well-being and the ways in which it can be enhanced in people living with dementia. Revealing how drug-based interventions as well as completely holistic approaches consistently fall short of addressing and meeting the needs of people with dementia, this book offers a proactive approach-one that challenges widely accepted dementia care practices and provides a compelling new framework for developing more effective dementia services. Through in-depth examinations of seven domains of well-being, readers will discover how current care practices erode them, and the transformative approaches that can restore them, plus: how to apply a well-being approach to the everyday care of people living with dementia a highly adaptable framework that can be adopted in any living environment valuable insight on overcoming physical and operational barriers to well-being a wealth of person-centered, strengths-based approaches to care Filled with true stories that demonstrate the power of a well-being approach to greatly improve the lives of people with dementia as well as those who care for them, this book presents methods that promise a new and hopeful vision for achieving the best possible outcomes for every person living with cognitive changes. Readers will be challenged, motivated, and profoundly inspired.

This book helps nursing and healthcare students to prepare for the challenges of working with the increasing number of patients requiring palliative care, so that they can work in partnership with patients and their carers, providing care that is compassionate, practical and backed up by the latest evidence. Delivering palliative care can be emotionally challenging and the book focuses on supporting healthcare staff, allowing them to provide the care that is needed. Key features include: * case studies in every chapter, helping students to practically work through difficult scenarios * reflective activities that assist readers in thinking critically about their care and how to improve it * a holistic approach to palliative care that includes family, carers and interprofessional work * up to date theory and policy. Palliative Care in Nursing and Healthcare is suitable for undergraduate nursing students and allied health students and practitioners. Michelle Brown is Senior Lecturer at the University of Derby.

Students and newly-qualified staff make up much of the workforce delivering end-of-life care but, because end-of- life care can be both technically challenging and emotionally demanding, it is an aspect of nursing that can cause considerable anxiety. This very accessible, straightforward book helps to allay those concerns and enables pre-registration students to prepare confidently for the challenges they will face when they are caring for dying patients and supporting their families. Each chapter is based on a different and realistic scenario - reflecting a range of circumstances - to demonstrate the essential generic knowledge and skills they need to develop, and draws out the important practical and theoretical issues students should consider and address if patients and their families are to receive the best possible care. Written by two experienced palliative care lecturer/practitioners, and mapping closely to the NMC's 2010 domains, the book is tailored to the needs of student nurses working with adult patients. It will explore the importance of their role in end-of-life care and how this interfaces with the roles of other multidisciplinary professionals involved in the care of their patients. It will also be helpful to students of other health care professions and support newly-qualified healthcare professionals working in adult health.

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.

Supportive Care for the Renal Patient Second Edition provides a comprehensive, evidence-based overview of supportive care for the nephrology patient. An international group of contributors emphasise the continuum of palliative care from the time of diagnosis through to end-of-life care and the issues surrounding withdrawal of dialysis. The book addresses the psychological impact of the disease, the importance of involving the patient in making decisions about their care, ethical considerations, the role of the family and the multidisciplinary team. This new edition includes two new chapters on conservative management of advanced kidney disease (AKD) and dialysis in the very elderly. The chapters covering non pain symptoms, advance care planning, quality of life, psychological and psychiatric consideration and end-of-life care have also be completely revised to include new evidence and current thinking. This book will be of particular interest to palliative care practitioners; nephrologists, who increasingly need to know more about palliative care; nurse practitioners, dialysis nurses, social workers, dieticians, and psychiatric consultants. ABOUT THE SUPPORTIVE CARE SERIES Supportive care is the multidisciplinary holistic care of patients with chronic and life-limiting illnesses and their families - from the time around diagnosis, through treatments aimed at cure or prolonging life, and into the phase currently acknowledged as palliative care. It involves recognising and caring for the side-effects of active therapies as well as patients' symptoms, co-morbidities, psychological, social and spiritual concerns. It also values the role of family carers and helps them in supporting the patient, as well as attending to their own special needs. Unlike traditional palliative care, which grew from the terminal care of cancer patients, supportive care is not restricted to dying patients nor to cancer. This series covers the support of patients with a variety of long-term conditions, who are currently largely managed by specialist medical teams in hospital and by primary care teams in community settings. Each volume therefore provides a practical guide to the supportive care of patients at all stages of illness. Series Editor: Sam H. Ahmedzai

The question of whether euthanasia and assisted suicide should be legalized is often treated, by judges and commentators alike, as a universal, ethical question, transcending national boundaries and diverse legal systems. By thinking of the issue in this way, the important context in which individual jurisdictions make decisions about assisted dying and the significance of the legal methods chosen to carry out those decisions is often lost. This book examines the impact of the choice of diverse legal routes towards legalization on the subsequent assisted dying regimes in operation. This examination suggests that greater caution is needed before relying on the experience of one jurisdiction when discussing proposals for regulation of assisted dying in others. The book seeks to demonstrate the need to explore the legal environment in which assisted dying is performed or proposed in order to evaluate the relevance of a particular legal experience to other jurisdictions. The book begins with an examination of the unsuccessful attempts to use constitutionally entrenched human rights claims to challenge criminal prohibitions on assisted suicide which reached the highest courts in the United States, Canada and Europe. Their failure makes legalization through a rights-based claim unlikely in any major common law or European jurisdiction. Alternative routes towards legalization are then discussed, including the defence of necessity, by which euthanasia was effectively legalized in the Netherlands and an approach based on compassion which has been proposed in France, as well as the legislative approaches which have been taken in Oregon, Belgium and the Northern Territory of Australia. All of these approaches are compared in detail, with particular attention paid to the effectiveness and transferability of the ubiquitous slippery slope arguments

`There is much to learn about easing suffering from John's reflective narrative. The journal is both evocative and illuminating. The attention given to individuals patients experiences and to the manner in which practitioners can help to relieve suffering is the main strength of the book' -Journal of Advanced Nursing `Christopher Johns has written an exquisite book detailing the experience of being a palliative care nurse. He has taken a unique approach in chronicling his practice through a journal, which serves a model for the reader on reflective practice. Johns' book is insightful on several levels. He offers a poignant book about the practice of palliative care, which will certainly evoke deep feelings and memories for many who have cared for dying patients. The narrative serves a model for reflective practice for students and practitioners alike who wish to explore this method of research and self-inquiry. John also, as the postscript writer describe, addresses some of the lessons that can be learned in palliative care work, the importance of living in the moment, and acknowledgement of the constantly changing nature of life.' - Mary L. Wilby, MSN, CRNP, La Salle University School of Nursing `Chris Johns has produced a book that is, I believe, unique in the field of nursing practice. In his personal and philosophical reflections on palliative care he pin-points...the very essence of nursing practice... This text should be at the heart not only of nursing but also the way in which we should live our lives.' - Denise Rankin-Box, Editor in Chief, Complementary Therapies in Nursing and Midwifery Written by an experienced palliative care nurse, trainer, and complementary therapist, Being Mindful, Easing Suffering is an essential resource for professionals working with the seriously ill and the dying. Chris Johns describes how he has combined traditional medical, and more reflective models in his palliative practice, enabling him to work mindfully to alleviate physical and non-physical pain and suffering throughout the health-illness cycle. With reference to ideas from Buddhist philosophy around compassion and reflective knowing, this important book shows how the core task of those working in palliative care is to nurture the spiritual growth and development of their patients and, in turn, themselves.

In Caring for Patients at the End of Life: Facing an Uncertain Future Together, Dr. Quill uses his wide range of clinical experience caring for severely ill patients and their families to illustrate the challenges and potential of end-of-life care. Section one utilizes the near death experiences of two patients to explore values underlying medical humanism, and then presents the case of "Diane" to explore the fundamental clinical commitments of partnership and non-abandonment. Section two explores, illustrates, and provides practical guidance for clinicians, patients, and families about critical communication issues including delivering bad news, discussing palliative care, and exploring the wish to die. In section three, difficult ethical and policy challenges inherent in hospice work, including the rule of double effect, terminal sedation, and physician-assisted suicide, are explored using a mix of real cases and an analysis of underlying clinical, ethical, and policy issues. In a final chapter, Dr. Quill discusses the tragic death of his brother which occurred as this book was being completed, and how his family made the most emotionally challenging decisions of their lives.

Dr. Quill exposes readers to an internally consistent and practical way of thinking by simultaneously embracing the potential of palliative care, and also acknowledging that it has limitations. His philosophy of offering forthright discussions with patient and family, mutual decision-making, ensuring medical and palliative care expertise and of committing to see the dying process through to the patient's death is vividly illustrated

Palliative care is a rapidly evolving field focused on the management of problems that undermine the quality of life of patients with progressive incurable medical disorders. It is fundamentally concerned with all factors- physical, psychological, social, and spiritual- that contribute to suffering, and prevent a death with comfort and dignity. Palliative care is a fundamental aspect to good clinical practice, the "parallel universe" to therapies directed at cure or prolongation of life. All clinicians who treat patients with chronic life-threatening diseases are engaged in providing palliative care, continually attempting to manage complex symptomatology and functional disturbances.
The scholarly foundation of palliative care is advancing, and resources are needed to highlight the findings of empirical research. TOPICS IN PALLIATIVE CARE has been designed to meet the need for enhanced communication in this field. To highlight the diversity of concerns in palliative care, each volume of the TOPICS IN PALLIATIVE CARE Series is divided into sections that address a range of salient issues: symptom control, psychosocial functioning, spiritual or existential concerns, and ethics. The authors present and evaluate existing data, provide a context drawn from both the clinical and research settings, and integrate knowledge in a manner that is both practical and readable. The specific topics in this volume are: Pediatric Palliative Care, Management of Bone Pain, Psychopathology in Patients with Cancer, and Skin Disorders and their Management.

The rapidly evolving field of Palliative Care focuses on the management of phenomena that produce discomfort and that undermine the quality of life of patients with incurable medical disorders. The interdisciplinary clinical purview includes those factors - physical, psychological, social, and spiritual - that contribute to suffering, undermine quality of life, and prevent a death with comfort and dignity. Palliative Care is a fundamental part of clinical practice, the "parallel universe" to therapies directed at cure or prolongation of life. All clinicians who treat patients with chronic life-threatening diseases are ingaged in palliative care, continually attempting to manage complex symptomatology and functional disturbances.
The scientific foundation of palliative care is advancing, and similarly, methods are needed to highlight, for practitioners at the bedside, the findings of empirical research. TOPICS IN PALLIATIVE CARE has been designed to meet the need for enhanced communication in this field.
To highlight the diversity of concerns in palliative care, each volume of the TOPICS IN PALLIATIVE CARE Series is divided into sections that address a range of issues. Addressing aspects of symptom control, psychosocial functioning, spiritual or existential concerns, ethics, and other topics, the chapters in each section review the given area and focus on a small number of salient issues to analysis. The authors present and evaluate existing data, provide a context drawn from both the clinical and research settings, and integrate knowledge in a manner that is both practical and readable. The specific topics covered in Volume 2 are Neuropathic Pain, Cachexia/Anorexia, Asthenia, and Psychological Issues in the Caregiver.