Compassionate Person Centered Care For The Dying

A milestone resource for palliative care nurses that facilitates evidence-based compassionate and humanistic care of the dying A valuable contribution to the evolving field of palliative nursing care. It is authored by a model for this field, Bonnie Freeman, and brings to the bedside what her practice embodies--evidence-based clinically expert care...The CARES tool is a long-needed resource and we are all grateful to the author for moving her passion to paper. It will touch the lives and deaths of patients, families, and the nurses who care for them. --Betty Ferrell, PhD, RN, MA, FAAN, FCPN, CHPN Professor and Director, Division of Nursing Research and Education City of Hope National Medical Center From the Foreword This groundbreaking reference for palliative care nurses is the first to provide realistic and achievable evidence-based methods for incorporating compassionate and humanistic care of the dying into current standards of practice. It builds on the author's research-based CARES tool; a reference that synthesizes five key elements demonstrated to enable a peaceful death, as free from suffering as possible: comfort, airway management, management of restlessness and delirium, emotional and spiritual support, and selfcare for nurses. The book describes, step by step, how nurses can easily implement the basic tenets of the CARES tool into their end-of-life practice. It provides a clearly defined plan that can be individualized for each patient and tailored to specific family needs, and facilitates caring for the dying in the most respectful and humane way possible. The book identifies the most common symptom management needs in dying patients and describes, in detail, the five components of the CARES paradigm and how to implement them to enable a peaceful death and minimize suffering. It includes palliative care prompts founded on 29 evidence-based recommendations and the National Consensus Project for Palliative Care Clinical Practice Guidelines. The resource also addresses the importance of the nurse to act as a patient advocate, how to achieve compassionate communication with the patient and family, and barriers and challenges to compassionate care. Case studies emphasize the importance of compassionate nursing care of the dying and how it can be effectively achieved. Key Features: Provides nurses with a clear understanding of the most common needs of the dying and supplies practical applications to facilitate and improve care Clarifies the current and often complex literature on care of the dying Includes case studies illustrating the most common needs of dying patients and how these are addressed effectively by the CARES tool Based on extensive evidence as well as on the National Consensus Project for Palliative Care Clinical Practice Guidelines Bonnie Freeman, DNP, ANP, RN, ACHPN, is an adult nurse practitioner in the Department of Supportive Care Medicine at the City of Hope National Medical Center in Duarte, California. She is involved with treating the symptom management needs of many chronically and terminally ill individuals diagnosed with various forms of cancer. Dr. Freeman trained at such excellent facilities as the in-patient units at San Diego Hospice and the Institute of Palliative Medicine in San Diego, California, and the home care hospice program in Owensboro, Kentucky. While in Kentucky, she completed her advanced practice clinical training for adult nurse practitioners with a specialty focus on palliative care through Vanderbilt University in Nashville, Tennessee. This program exposed Dr. Freeman to current concepts in caring for the dying, and enhanced her already significant clinical experience caring for dying individuals acquired from over 30 years working in critical care. Dr. Freeman obtained her MSN from Indiana Wesleyan University, and her DNP from Azusa Pacific University in Azusa, California. Contributors Tracey Das Gupta, MN, RN, CON, is director of Interprofessional Practice at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. She is also the colead of the Quality Dying Initiative with Dr. Jeff Myers. Tracey has been passionate about health care, quality of life, and leadership since becoming a nurse in 1991. Her decision to become a nurse was influenced by her father who lived with muscular dystrophy. Ms. Das Gupta has fulfilled various frontline nursing roles along the continuum of care and has had the opportunity to continue to grow in leadership roles such as educator, professional practice leader, and director of nursing practice. In her current role, she also provides leadership for the development and implementation of Sunnybrook's interprofessional care (IPC) strategy. Margaret Fitch, PhD, MScN, is a nurse researcher and holds an appointment at the Bloomberg Faculty of Nursing and School of Graduate Studies at the University of Toronto. She also serves as expert lead for cancer survivorship and patient experience for the Person-Centered Perspective Portfolio of the Canadian Partnership Against Cancer. She is also editor-in-chief for the Canadian Oncology Nursing Journal. Dr. Fitch has an extensive publication record based on her many years of research regarding patient perspectives, coping and adaptation with illness, and screening for psychosocial distress. She has particular expertise in measurement and evaluation, qualitative methods, and knowledge integration. During her career, she has held clinical and administrative positions and has maintained an ongoing role in education of both undergraduate and graduate students and health professionals in practice.

A milestone resource for palliative care nurses that facilitates evidence-based compassionate and humanistic care of the dying "A valuable contribution to the evolving field of palliative nursing care. It is authored by a model for this field, Bonnie Freeman, and brings to the bedside what her practice embodies--evidence-based clinically expert care...The CARES tool is a long-needed resource and we are all grateful to the author for moving her passion to paper. It will touch the lives and deaths of patients, families, and the nurses who care for them." --Betty Ferrell, PhD, RN, MA, FAAN, FCPN, CHPN Professor and Director, Division of Nursing Research and Education City of Hope National Medical Center From the Foreword This groundbreaking reference for palliative care nurses is the first to provide realistic and achievable evidence-based methods for incorporating compassionate and humanistic care of the dying into current standards of practice. It builds on the author's research-based CARES tool; a reference that synthesizes five key elements demonstrated to enable a peaceful death, as free from suffering as possible: comfort, airway management, management of restlessness and delirium, emotional and spiritual support, and selfcare for nurses. The book describes, step by step, how nurses can easily implement the basic tenets of the CARES tool into their end-of-life practice. It provides a clearly defined plan that can be individualized for each patient and tailored to specific family needs, and facilitates caring for the dying in the most respectful and humane way possible. The book identifies the most common symptom management needs in dying patients and describes, in detail, the five components of the CARES paradigm and how to implement them to enable a peaceful death and minimize suffering. It includes palliative care prompts founded on 29 evidence-based recommendations and the National Consensus Project for Palliative Care Clinical Practice Guidelines. The resource also addresses the importance of the nurse to act as a patient advocate, how to achieve compassionate communication with the patient and family, and barriers and challenges to compassionate care. Case studies emphasize the importance of compassionate nursing care of the dying and how it can be effectively achieved. Key Features: Provides nurses with a clear understanding of the most common needs of the dying and supplies practical applications to facilitate and improve care Clarifies the current and often complex literature on care of the dying Includes case studies illustrating the most common needs of dying patients and how these are addressed effectively by the CARES tool Based on extensive evidence as well as on the National Consensus Project for Palliative Care Clinical Practice Guidelines

This open access book aims to provide a comprehensive but practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture. It considers this from the perspectives of all of the settings in which this group of patients receive nursing care. Globally, a fragility fracture is estimated to occur every 3 seconds. This amounts to 25 000 fractures per day or 9 million per year. The financial costs are reported to be: 32 billion EUR per year in Europe and 20 billon USD in the United States. As the population of China ages, the cost of hip fracture care there is likely to reach 1.25 billion USD by 2020 and 265 billion by 2050 (International Osteoporosis Foundation 2016). Consequently, the need for nursing for patients with fragility fracture across the world is immense. Fragility fracture is one of the foremost challenges for health care providers, and the impact of each one of those expected 9 million hip fractures is significant pain, disability, reduced quality of life, loss of independence and decreased life expectancy. There is a need for coordinated, multi-disciplinary models of care for secondary fracture prevention based on the increasing evidence that such models make a difference. There is also a need to promote and facilitate high quality, evidence-based effective care to those who suffer a fragility fracture with a focus on the best outcomes for recovery, rehabilitation and secondary prevention of further fracture. The care community has to understand better the experience of fragility fracture from the perspective of the patient so that direct improvements in care can be based on the perspectives of the users. This book supports these needs by providing a comprehensive approach to nursing practice in fragility fracture care.

This book identifies key treatment challenges and unique care considerations in patients with head and neck cancers, providing a comprehensive guide to patient management that illustrates the critical importance of a multidisciplinary approach in achieving optimal oncological, functional, and survival outcomes. It covers all relevant specialties, including dental and oral medicine, medical oncology, radiation oncology, surgical oncology, and reconstructive surgery. It highlights the vital role played by ancillary head and neck cancer services, such as speech and swallowing therapy, occupational and physical therapy, and nutritional therapy in offering essential physical and psychological support from the time of diagnosis onward. The closing chapters address post-treatment issues, including those relating to survivorship, surveillance, and end-of-life care. Multidisciplinary care is perhaps even more important for patients with head and neck cancers than for other cancer patients, and in addressing all its aspects this book is invaluable for a wide range of practitioners.

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.

Working as an emergency room nurse, Margaret Coberly came in contact with death on a daily basis. However, it wasn't until her own brother was diagnosed with terminal cancer that she realized she understood very little about the emotional and spiritual aspects of caring for the terminally ill. To fill this gap she turned to the unique wisdom on death and dying found in Tibetan Buddhism. In this book Coberly offers sound, practical advice on meeting the essential needs of the dying, integrating stories from her long career in nursing with useful insights from the Tibetan Buddhist teachings. In the West, death is viewed as a tragic and horrible event. Coberly shows us how this view generates fear and denial, which harm the dying by adding unnecessary loneliness, confusion, and mental anguish to the dying process. Tibetan Buddhism focuses on the nature of death and how to face it with honesty, openness, and courage. In this view, death is not a failure, but a natural part of life that, if properly understood and appreciated, can offer the dying and their loved ones an opportunity to gain valuable insight and wisdom. Coberly argues that the Tibetan Buddhist outlook can be a useful antidote to the culture of fear and denial that surrounds death in the West and can help caregivers become more fully present, fearless, honest, and compassionate. Sacred Passage highlights two very practical teachings on death and dying from the Tibetan Buddhist tradition and presents them in clear, nontechnical language. Readers learn about the "eight stages of dissolution leading to death," a detailed roadmap of the dying process that describes the sequence of physical, psychological, and spiritual changes that occur as we die. Coberly also presents the "death meditation," a contemplative exercise for developing a new relationship to death—and life. The book also includes a lengthy, annotated list of recommended readings for added guidance and inspiration. Topics include: • How the terminally ill can experience emotional and spiritual healing even when they can't be cured • Why Western medicine's relentless focus on curing disease has led to inadequate care for the dying • What to expect during the dying process • How our fear and denial of death harm the dying • Techniques to help caregivers promote a peaceful environment for the dying and their loved ones • How to meet the changing physical and emotional needs of the dying • Helpful advice on what to say and how to behave around the terminally ill Registered nurses can earn Continuing Education Units (CEUs) by passing a written test based on this book. For more information, see http://www.shambhala.com/sacredpassage.

This important book outlines how, despite varying levels of global socio-economic development, governments around the world can guarantee their citizens’ fundamental right to basic healthcare. Grounded in the philosophical position that healthcare is an essential element to human dignity, the book moves beyond this theoretical principle to offer policy-makers a basis for health policies based on public accountability and social responsiveness. Also emphasizing the importance of global co-operation, particularly in the area of health promotion and communication, it addresses, too, the issue of financial sustainability, suggesting robust mechanisms of economic and social regulation. New opportunities created by e-health, evidence-based data and artificial intelligence are all highlighted and discussed, as is the issue of patient rights. Students and researchers across bioethics, public health and medical sociology will find this book fascinating reading, as will policy-makers in the field.