Palliative Care: An Integrated Approach

Jenny Buckley is Head of Education at St Wilfrid's Hospice.

• Foreword xContributors’ biographies xiiAcknowledgements xvDedications xvi1 Historical and cultural perspectives on the evolution of palliative care 1Key points 1Introduction 2Death in society 2Dame Cicely Saunders and the origins of contemporary palliative care 3An international perspective 6Defi nitions 8End-of-life care national programme 12Culture 15Service user involvement 18Conclusion 19Main implications for practice 19Suggested further reading 192 Facing progressive disease and death 21Key points 21Psychosocial care 22Partnership – maintaining the balance 23Approaches to care 24Giving the bad news 26Denial/avoidance 29Anger 32Anxiety 33Depression 33Social pain 35Conclusion 35Main implications for practice 36Suggested further reading 363 Communication skills 37Key points 37The impact of good communication 38The impetus to teach communication skills 38Facilitative styles 40What Howard taught me about nursing dying people 45Helpful strategies 46Communicating with people with dementia 56Conclusion 57Main implications for practice 57Suggested further reading 584 Self-awareness and self-care 59Key points 59Saving a life versus stealing a death 60Facing death 62Making space for decision-making 64Self-awareness 66How much did Nicky impact on my life? 68Self-care 69Main implications for practice 72Suggested further reading 725 The sick role and partnership working 73Key points 73Introduction 73Partnership care – what does it mean? 75The sick role 76Face-to-face partnership: attention to information giving 78Written information 81Decision aids 82Special needs 83Conclusion 83Main implications for practice 83Suggested further reading 846 Hope and spirituality 85Key points 85Introduction 86Hope research 86Spirituality 94Religious practices concerned with death 100Conclusion 104Main implications for practice 104Suggested further reading 1057 Finding resilience together 106Key points 106Resilience in health care 107Patient groups 108Psychoneuroimmunology 108The expert patient 111Conclusion 114Main implications for practice 115Suggested further reading 1158 Living with dying 116Key points 116Introduction 117Social death 118Vulnerable groups 119Informational needs 121Being heard and feeling supported 122Companionship 123Intimacy and caring 125Health needs 125Diffi cult thoughts and letting go 127Conclusion 128Main implications for practice 128Suggested further reading 1299 Bereavement 130Key points 130Defi nitions 131Untimely deaths 131Bereavement and health 132Grief theorists 134Mourning practices in different cultures 141Bereaved children 143Old age 143Bereavement and dementia 143Solitary grief 144Bereavement services 145Conclusion 148Main implications for practice 149Suggested further reading 14910 Pain and other major symptoms: an integrated approach 150Key points 150Pain theories 152Psychological approaches 154Physical approaches 158Complementary therapies 163Creative therapies 170Conclusion 172Main implications for practice 172Suggested further reading 17211 The history of the use of strong opioids for cancer pain 173Key points 173Studies and narratives 174WHO analgesia ladder 177Side effects 182Alternative routes for administration of strong opioids 184Conclusion 187Main implications for practice 188Suggested further reading 18812 Concordance and advance care planning 189Key points 189Patient-centred care: concordance 190Advance care planning 192The Mental Capacity Act 2005 196Main implications for practice 196Suggested further reading 19713 Eleven prevalent symptoms 198Key points 198History 198Pain 199Nausea and vomiting 206Constipation 212Diarrhoea 216Anorexia 218Fatigue 223Breathlessness 227Confusion 232Insomnia 236Anxiety 238Depression 240Conclusion 244Main implications for practice 244Suggested further reading 245Addendum: Doloplus 2 Scale 24514 Palliative issues in some common diseases 248Key points 248Gold standard for all 248Doing the right thing at the right time 249Conclusion 280Main implications for practice 280Suggested further reading 280Contents ix15 Palliative emergencies 282Key points 282Palliative emergencies 282Other symptoms 286Main implications for practice 287Suggested further reading 287References 288Index 315

“However, I have found myself referring to this book in recent months far more than some of the bigger, more established, textbooks – and if the measure of a good book is how well-thumbed the pages become, then the author is on to a winner.  (European Journal of Palliative Care, 2010)"The author's warmth, enthusiasm and concern for patients, their families and the professionals who care for them, combined with her scholarship, shine throughout this book. I recommend it to anyone with an interest in the care of people approaching the end of their lives in any setting." (Palliative Medicine, 2009) "This book will be a very welcome addition to the undergraduate curriculum for clinicians seeking to specialize in palliative care." (International Journal of Palliative Nursing, 2009)"There is a wealth of knowledge and experience for nursing students and newly qualified nurses seeking direction.... I would recommend this for reference on general medical wards and units where patients are receiving end of life care." (Nursing Standard, April 2009)