Megan Rosser is Director for CPD/Non Professional Undergraduate Programmes at Swansea University. She is an established palliative care practitioner and educationalist, with previous oncology training and experience. She is experienced in the provision of palliative nursing care in primary and secondary health care settings.Helen C. Walsh is Tutor in Nursing at Swansea University. This involves teaching and its associated activities for students on a range of levels from health care support workers, pre and post registration and Masters. The majority of her teaching relates to palliative care and its associated subjects.

• About the series xiThe Authors xiiAcknowledgements xiiiPreface xivAbout the companion website xvSection I The principles of palliative care 1Chapter 1 The development of palliative care 3Introduction 3What is palliative care? 4Where is palliative care provided? 8Widening access 9Influential documents and strategies 11Conclusion 14Chapter 2 Holistic care in palliative care 16Introduction 16Total pain 17Holism 17Holistic care 18Spirituality 21Quality of life 26Conclusion 27Chapter 3 Team working 31Introduction 31What is a team? 32Why is interprofessional team work important in palliative care? 33What makes a team work well? 41What stops a team from working well? 44Conclusion 46Chapter 4 Legal principles in palliative care 48Introduction 48Identification of legal issues surrounding the provision of palliative care 49Consent 50Best interests 55Withholding and withdrawing treatment 56Do not resuscitate orders (DNR) 57Euthanasia and assisted suicide 57Verification of death 60Conclusion 61Chapter 5 Ethical principles in palliative care 63Introduction 63The meaning of ethics 64Ethical theories 70Euthanasia 75Conclusion 76Section II The practice of palliative care 79Chapter 6 Communication in palliative care 81Introduction 81The importance of communication in palliative care 83Communication theory 84The importance of self-awareness in good communication 86Key communication skills 87Enablers of and barriers to good communication 91Influencing factors 92Communicating with groups who have particular needs 94Conclusion 95Chapter 7 Pain management and nursing care 98Introduction 98Pain 99Pain assessment 101Principles of pain management 106Non-pharmacological approaches to pain relief 110Conclusion 111Chapter 8 Management and nursing care of gastro-intestinal symptoms 116Introduction 116Nausea and vomiting 117Assessment 118Management of nausea and vomiting 120Nursing care 122Malignant bowel obstruction 123Constipation 124Cachexia 126Other gastrointestinal symptoms 127Conclusion 128Chapter 9 Management and nursing care of breathlessness and fatigue 133Introduction 133Breathlessness 134Assessment of breathlessness 135Pharmacological Management of breathlessness 135Nursing management 137Fatigue 138Assessment 139Management of fatigue 140Nursing care 140Conclusion 141Chapter 10 Management and nursing care of psychological symptoms 145Introduction 145Psychological concerns 147Depression and Anxiety 148Management and treatment of anxiety and depression 153Sexuality 154Assessing sexuality 156Psychological care 159Conclusion 162Chapter 11 Caring for the family 169Introduction 169Defining the family 170Role of the family in care giving 172Effects of caring on the family 173The needs of carers 176Communicating with the family 179Conclusion 180Chapter 12 Palliative care emergencies 184Introduction 184Palliative care emergencies 185Spinal cord compression 185Superior vena cava obstruction (SVCO) 188Hypercalcaemia 189Conclusion 191Chapter 13 Nursing care at end of life 195Introduction 195Recognising that a patient is dying 196End of life care 196Physical nursing care for the dying patient 198Bronchial secretions (‘death rattle’) 201Terminal restlessness 201The syringe driver 203Being with a dying patient 204Nurse’s role after death 205Conclusion 207Chapter 14 Loss grief and bereavement 212Introduction 212Coping With Loss 213Common emotional responses to loss 215Bereavement theories 216Helping the bereaved 219Conclusion 223Section III Personal and professional development in palliative care 229Chapter 15 Looking after yourself 231Introduction 231What is stress and why do we need to know about it? 232Some of the reasons nursing is stressful 236Effects of stress 237Coping strategies 237Managing your stress 241Conclusion 244Chapter 16 Professional support 247Introduction 247Key people 248Clinical supervision 250Conclusion 258Chapter 17 Learning from your practice through reflection 261Introduction 261Types of reflection 263Why use reflective practice? 265Starting your reflective practice 266Conclusion 272Index 275