Chapter 10: Palliative & End-of-Life Nursing Care

Palliative care is presented as an active approach that focuses on relieving suffering, managing complex symptoms, and enhancing quality of life for patients and families, whether delivered alongside curative treatments or as the primary care model in hospice settings. The chapter delineates eight essential domains of quality palliative care, including structured care processes with interprofessional collaboration, comprehensive physical symptom management addressing pain and respiratory distress, psychological support for anxiety and depression, social care considerations involving environmental and economic factors, spiritual and existential care respecting diverse beliefs, culturally sensitive interventions, specialized care approaches as death approaches, and critical ethical-legal frameworks including advance directives and decision-making capacity assessments. Nurses learn to recognize physical manifestations of dying such as Cheyne-Stokes respirations, mottling, and decreased reflexes, while providing psychosocial support for fear, withdrawal, and existential concerns. The chapter thoroughly explores grief and bereavement as natural processes, distinguishing between anticipatory grief, adaptive mourning, and prolonged grief disorder, while presenting established grief models including phase-based approaches and the grief wheel concept. Practical nursing management strategies encompass comprehensive assessment focused on comfort, collaborative care planning involving patient preferences for place of death, evidence-based symptom management interventions, spiritual and psychological support techniques, family education and advocacy, and dignified postmortem care practices that honor cultural traditions and provide closure opportunities for bereaved families.