Chapter 13: Palliative and End-of-Life Care Guide

Palliative and End-of-Life Care Guide outlines various illness trajectories—such as sudden death, organ failure, and frailty—and describes diverse care settings ranging from acute hospital consultations and outpatient clinics to community-based home care. A major focus is placed on the National Consensus Project domains, emphasizing the interdisciplinary management of physical, psychological, social, and spiritual needs. The text details essential communication skills for nurses, utilizing frameworks to respond to emotion and facilitate difficult conversations regarding goals of care, while also explaining the legal and practical aspects of advance care planning, including advance directives, durable power of attorney, and Physician Orders for Life-Sustaining Treatment forms. Significant attention is given to the assessment and management of distressing symptoms at the end of life, specifically pain, dyspnea, anorexia-cachexia syndrome, delirium, and the management of terminal secretions often referred to as the death rattle. The physiologic changes associated with the active dying phase, such as mottling and altered vital signs, are described to prepare clinicians for the time of death and postmortem care. Furthermore, the chapter categorizes different types of loss, distinguishing between anticipatory, uncomplicated, disenfranchised, and prolonged or complicated grief, and introduces the Dual Process Model of bereavement. Finally, it addresses complex ethical dilemmas inherent in end-of-life practice, such as the withdrawal of artificial nutrition and hydration, the use of palliative sedation for intractable symptoms, and the distinctions between palliative care, euthanasia, and physician-assisted dying, while concluding with strategies to prevent professional burnout and foster nurse resilience.