| Preface |
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xvii | |
| Acknowledgments |
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xix | |
| About the Authors |
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xxi | |
| Chapter 1 Palliative Care and Its Role in Suffering |
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1 | (12) |
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The Evolution of Palliative Care |
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2 | (1) |
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3 | (1) |
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4 | (3) |
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Physical Sources of Suffering |
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4 | (1) |
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Psychological Sources of Suffering |
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4 | (1) |
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Sociocultural Sources of Suffering |
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5 | (1) |
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Developmental Sources of Suffering |
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6 | (1) |
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Spiritual Sources of Suffering |
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7 | (1) |
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7 | (2) |
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7 | (1) |
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8 | (1) |
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Nurses as Collaborators in Palliative Care |
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8 | (1) |
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9 | (1) |
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10 | (1) |
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11 | (1) |
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11 | (1) |
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Questions for Reflection and Journaling |
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11 | (1) |
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11 | (2) |
| Chapter 2 Suffering and Palliative Care Across the Continuum |
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13 | (28) |
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14 | (1) |
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14 | (1) |
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Suffering in Various Cultures |
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15 | (4) |
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15 | (3) |
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18 | (1) |
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Suffering in Children and Families |
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19 | (8) |
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19 | (7) |
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26 | (1) |
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Suffering in Families and Patients Diagnosed with Mental Health Issues and Substance Abuse |
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27 | (4) |
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30 | (1) |
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30 | (1) |
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Suffering in Individuals Identifying as Lesbian, Gay, Bisexual, Transgender, or Queer and/or Questioning (LGBTQ+) |
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31 | (1) |
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Suffering in Individuals with Cognitive Deficits or Impairments |
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31 | (3) |
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32 | (1) |
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33 | (1) |
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Suffering in Student Nurses and Nurses |
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34 | (2) |
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Self-Transcending Through Suffering |
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36 | (1) |
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36 | (1) |
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36 | (1) |
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37 | (1) |
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37 | (4) |
| Chapter 3 Ethical Responsibilities and Issues in Palliative Care |
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41 | (36) |
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42 | (1) |
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Virtues of Nurses Providing Palliative Care |
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43 | (3) |
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43 | (1) |
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44 | (1) |
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45 | (1) |
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46 | (1) |
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46 | (2) |
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47 | (1) |
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47 | (1) |
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Approaches to Decision Making in Ethical Dilemmas |
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48 | (2) |
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What Information Should Be Considered When Making a Decision? |
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48 | (1) |
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Who Should Be Involved in Making the Decision? |
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48 | (1) |
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How Should One Make a Decision and Choose a Course of Action? |
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49 | (1) |
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What Follow-up Is Necessary After a Decision Is Made? |
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50 | (1) |
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Ethical Dilemmas Frequently Encountered by Nurses |
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50 | (9) |
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51 | (2) |
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Right to Choose or Decline Treatment at End of Life |
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53 | (2) |
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Dilemmas in Pain and Symptom Management |
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55 | (3) |
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Dilemmas Surrounding Nutrition and Hydration at the End of Life |
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58 | (1) |
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59 | (9) |
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Cardiopulmonary Resuscitation (CPR) and Do Not Resuscitate (DNR) Orders |
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60 | (1) |
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Withholding and Withdrawal of Life-Sustaining Technologies |
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61 | (1) |
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Active Assistance with Dying |
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62 | (6) |
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68 | (1) |
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69 | (1) |
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69 | (2) |
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Questions for Reflection and Journaling |
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71 | (1) |
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72 | (5) |
| Chapter 4 Advance Care Planning Responsibilities |
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77 | (26) |
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79 | (1) |
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Development of ADs: Legal/Ethical Underpinnings |
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79 | (4) |
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Differences Between Advance Care Planning and Advance Directives |
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80 | (1) |
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Types of Advance Directives |
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81 | (2) |
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Current Status of Patient Self-Determination |
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83 | (2) |
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Barriers to Advance Care Planning and Completion of Advance Directives |
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85 | (3) |
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HCPs Concerns About Initiating AD Conversations |
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85 | (1) |
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Sociocultural Barriers to Advanced Care Planning |
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86 | (2) |
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Misunderstandings About Outcomes of Treatment or Choices |
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88 | (1) |
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Advance Care Planning Strategies |
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88 | (4) |
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Beginning the Process: Start Early, Revisit Often |
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88 | (1) |
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Break the Ice for the Initial Discussion, Initiate the Discussion, and Obtain Permission |
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89 | (1) |
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90 | (1) |
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Ask About Preferences for Specific Types of Treatment and/or a Surrogate to Make Decisions |
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90 | (1) |
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91 | (1) |
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Review the Decisions Regularly |
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91 | (1) |
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Concerns That Arise During Implementation of Advance Directives |
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92 | (5) |
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Concern: Are Patients' Advance Care Decisions Stable? |
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92 | (1) |
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Concern: Advance Directives Are Often Unavailable When Needed |
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93 | (1) |
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Concern: Do Patients, Families, and Healthcare Providers Agree on How to Interpret an AD or POLST? |
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94 | (2) |
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Concern and Strategy: Misunderstandings About What an AD Is and What Will Occur |
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96 | (1) |
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Concern: Miscommunication |
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97 | (1) |
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97 | (1) |
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98 | (1) |
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Questions for Reflection and Journaling |
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99 | (1) |
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99 | (1) |
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100 | (3) |
| Chapter 5 Difficult Conversations |
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103 | (18) |
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106 | (1) |
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Which Conversations Are the Most Difficult? |
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106 | (1) |
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Communicating Clearly Matters: Benefits of Difficult Conversations |
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107 | (1) |
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Barriers to Effective Communication |
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107 | (1) |
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108 | (2) |
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110 | (1) |
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How to Begin the Conversation |
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110 | (1) |
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Setting the Stage for Difficult Conversations |
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110 | (1) |
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Becoming a Better Communicator |
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111 | (5) |
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116 | (1) |
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116 | (1) |
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116 | (3) |
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Questions for Reflection and Journaling |
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119 | (1) |
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119 | (2) |
| Chapter 6 Acute and Chronic Pain as Sources of Suffering |
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121 | (22) |
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Introduction-What Is Pain? |
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122 | (1) |
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122 | (1) |
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Acute Pain Versus Chronic Pain |
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122 | (1) |
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Nocioceptive Pain Versus Neuropathic Pain |
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123 | (1) |
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Cancer Pain and End-of-Life Pain Versus Chronic Nonmalignant Pain |
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123 | (1) |
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Scope of the Problem of Chronic Nonmalignant Pain |
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124 | (1) |
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Variables in Suffering with Pain |
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124 | (1) |
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124 | (2) |
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Pain and Suffering Intertwine with Trust and Frustration |
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126 | (1) |
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Pain and Suffering and Functional Limitations |
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126 | (1) |
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Pain and Suffering and Isolation |
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126 | (1) |
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The Emotional Burden of Pain and Suffering |
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127 | (1) |
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128 | (3) |
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Goals for People with Chronic Pain |
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131 | (1) |
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Questions for Reflection and Journaling |
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132 | (1) |
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Management of Chronic Pain and Suffering |
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132 | (6) |
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Barriers to Effective Management of Chronic Pain |
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132 | (1) |
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Options for Effective Management of Chronic Pain |
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132 | (1) |
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Physical and Behavioral Interventions |
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133 | (1) |
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Medications for Chronic Pain |
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134 | (4) |
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138 | (1) |
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138 | (1) |
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Exercise: One Day Spent Suffering with Chronic Pain |
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138 | (1) |
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139 | (4) |
| Chapter 7 Palliative Care for Patients with Serious Illness |
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143 | (26) |
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144 | (1) |
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Chronic Obstructive Pulmonary Disease |
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144 | (4) |
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145 | (1) |
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146 | (1) |
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Symptom Management in Advanced COPD |
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146 | (1) |
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147 | (1) |
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147 | (1) |
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148 | (3) |
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Treatment of Heart Failure |
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148 | (1) |
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Complications of Heart Failure |
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149 | (1) |
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Symptom Management in Advanced Heart Failure |
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149 | (1) |
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150 | (1) |
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151 | (1) |
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151 | (3) |
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Treatment of Alzheimer's Dementia |
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152 | (1) |
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Complications in Dementia |
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152 | (1) |
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Symptom Management in Dementia |
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153 | (1) |
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153 | (1) |
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153 | (1) |
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154 | (2) |
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154 | (1) |
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154 | (2) |
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156 | (1) |
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156 | (1) |
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Additional Progressive Diseases |
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156 | (6) |
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Idiopathic Pulmonary Fibrosis |
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156 | (1) |
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157 | (2) |
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Advanced Chronic Liver Disease |
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159 | (1) |
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159 | (1) |
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Amyotrophic Lateral Sclerosis |
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160 | (1) |
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161 | (1) |
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162 | (1) |
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163 | (1) |
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Questions for Reflection and Journaling |
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164 | (1) |
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164 | (5) |
| Chapter 8 Suffering and Palliative Care at the End of Life |
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169 | (32) |
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170 | (1) |
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Sources of Suffering at the End of Life |
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171 | (4) |
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Physical Suffering of the Person |
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171 | (1) |
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Emotional Suffering of the Person |
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172 | (2) |
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Spiritual Suffering of the Person |
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174 | (1) |
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Emotional Suffering of the Family |
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174 | (1) |
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Physical Suffering of Family |
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175 | (1) |
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Interventions to Assist with Persons Suffering at End of Life |
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175 | (3) |
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Prevalence of Symptoms at the End of Life |
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178 | (1) |
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179 | (1) |
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179 | (4) |
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Assessment of Pain at the End of Life |
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179 | (1) |
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Pharmacologic Relief of Pain at the End of Life |
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180 | (3) |
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Breathlessness or Dyspnea |
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183 | (6) |
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Pharmacologic Interventions for Dyspnea |
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183 | (1) |
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Nonpharmacological Interventions for Dyspnea |
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184 | (1) |
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Management of Oral Secretions |
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185 | (1) |
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186 | (2) |
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188 | (1) |
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189 | (1) |
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Interventions to Assist the Family of a Person Near the End of Life |
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189 | (5) |
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192 | (1) |
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192 | (2) |
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194 | (1) |
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194 | (1) |
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Visualization Exercise for End-of-Life Care |
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195 | (1) |
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Questions for Reflection and Journaling |
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196 | (1) |
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197 | (4) |
| Chapter 9 Grieving and Suffering |
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201 | (26) |
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203 | (1) |
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Interweaving of Suffering and Grieving |
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203 | (2) |
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Traditional and Newer Models of Loss and Grieving |
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205 | (3) |
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205 | (2) |
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207 | (1) |
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208 | (2) |
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210 | (1) |
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210 | (1) |
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210 | (4) |
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212 | (1) |
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212 | (1) |
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213 | (1) |
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Adolescence to Young Adulthood |
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213 | (1) |
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Middle-Aged and Older Adults |
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214 | (1) |
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Cultural Considerations Related to Loss and Grieving |
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214 | (1) |
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215 | (1) |
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215 | (2) |
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217 | (1) |
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Communication and the Role of Nursing |
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217 | (3) |
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With Patients and Families |
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217 | (1) |
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218 | (1) |
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219 | (1) |
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What to Say to a Grieving Person |
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219 | (1) |
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220 | (1) |
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221 | (1) |
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221 | (1) |
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222 | (5) |
| Chapter 10 Spirituality and Suffering |
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227 | (26) |
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228 | (1) |
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229 | (4) |
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229 | (1) |
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230 | (1) |
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231 | (1) |
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Spirit-Mind-Body Connection |
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231 | (1) |
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Connectedness Between Religion, Faith, and Spirituality |
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232 | (1) |
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The Relationship Between Spirituality and Suffering |
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233 | (1) |
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234 | (5) |
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234 | (1) |
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235 | (1) |
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236 | (1) |
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Nurses Sharing Feelings and/or Crying |
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236 | (1) |
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237 | (2) |
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Assessment of Patient's Spirituality and Religion |
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239 | (1) |
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Alleviating Spiritual Suffering Within the Nurse |
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240 | (1) |
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241 | (6) |
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242 | (1) |
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242 | (2) |
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244 | (1) |
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245 | (1) |
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245 | (1) |
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246 | (1) |
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Nursing Interventions That Promote Spiritual Care and Alleviate Suffering |
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247 | (1) |
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248 | (1) |
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249 | (1) |
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249 | (1) |
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249 | (4) |
| Chapter 11 The Search for Meaning in Suffering |
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253 | (24) |
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256 | (1) |
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Shattering of Global Meaning |
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257 | (1) |
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257 | (2) |
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258 | (1) |
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Attributes of Holocaust Survivors |
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258 | (1) |
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Illness as a Source of Suffering |
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259 | (7) |
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Logotherapy in the Search for Meaning in Illness |
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259 | (1) |
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Learning the Meaning of the Illness to the Patient |
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260 | (1) |
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260 | (1) |
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261 | (1) |
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261 | (1) |
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Value of Stories/Narratives |
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262 | (2) |
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264 | (2) |
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266 | (7) |
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266 | (1) |
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Do We Contribute to Suffering? |
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267 | (1) |
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267 | (6) |
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273 | (1) |
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273 | (1) |
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273 | (1) |
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Questions for Reflection and Journaling |
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274 | (1) |
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274 | (3) |
| Chapter 12 The Nurse as Witness to Suffering |
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277 | (28) |
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278 | (1) |
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Bearing Witness/Not Bearing Witness |
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278 | (5) |
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Ethical Aspects of Bearing Witness |
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279 | (1) |
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280 | (1) |
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Communication Strategies Nurses Use With Suffering Patients |
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281 | (2) |
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Morse's Model of Patient Suffering |
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283 | (5) |
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284 | (3) |
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287 | (1) |
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What Do Nurses Do With the Suffering They Have Witnessed? |
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288 | (12) |
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Findings From Nurses Working With AIDS Patients |
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288 | (1) |
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289 | (3) |
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Nurses' Narratives About Patient Suffering |
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292 | (1) |
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Compassion Fatigue and Burnout |
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293 | (3) |
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Summary of Nurses' Responses to Suffering |
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296 | (1) |
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Student Nurses' Responses to Patient Suffering |
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296 | (1) |
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Student Nurses' Experiences of Bearing Witness |
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296 | (1) |
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Faculty Responses to Student Suffering |
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297 | (3) |
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300 | (1) |
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300 | (1) |
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Exercise: Witness to Suffering |
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301 | (1) |
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Questions for Reflection and Journaling |
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301 | (1) |
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301 | (4) |
| Chapter 13 The Role of Healing and Holistic Nursing |
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305 | (20) |
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306 | (1) |
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307 | (1) |
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307 | (4) |
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Definition of Holistic Nursing |
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308 | (1) |
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Holistic Nursing Theories |
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308 | (1) |
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Comparison and Contrast of Allopathic and Holistic Models of Care |
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309 | (2) |
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311 | (1) |
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The Science of Psychoneuroimmunology |
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311 | (1) |
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Implications of Mind-Body Interactions |
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312 | (7) |
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313 | (1) |
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Complementary/Alternative/Integrative Therapies |
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314 | (5) |
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Tending to the Nurses' Spirit |
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319 | (1) |
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320 | (1) |
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321 | (1) |
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322 | (1) |
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Questions for Reflection and Journaling |
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322 | (1) |
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322 | (3) |
| Chapter 14 Conveying Comfort |
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325 | (24) |
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326 | (1) |
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Why Should Nurses Focus on Providing Comfort? |
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327 | (2) |
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Assessment of Patient Comfort |
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329 | (1) |
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330 | (3) |
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331 | (1) |
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Meeting Patient Expectations for Care and Comfort |
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331 | (2) |
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333 | (7) |
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Characteristics of Comfort Strategies |
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333 | (1) |
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Dependence of Comfort Strategies on Patient Suffering State |
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334 | (6) |
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Comforting Interaction as a Model of Nurse-Patient Relationship |
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340 | (3) |
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Development of Nurse-Patient Relationship |
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340 | (1) |
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Dynamic Nature of Nurse-Patient Relationship |
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340 | (3) |
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343 | (1) |
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343 | (1) |
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Exercise: A Comfort Shawl Project |
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344 | (1) |
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Questions for Reflection and Journaling |
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345 | (1) |
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346 | (3) |
| Chapter 15 Inspiring Hope |
|
349 | (18) |
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351 | (1) |
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352 | (1) |
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352 | (1) |
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353 | (1) |
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Hope, False Hope, and Suffering |
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354 | (1) |
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355 | (1) |
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355 | (2) |
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357 | (1) |
|
Including Hope in Nursing Practice |
|
|
358 | (1) |
|
|
|
358 | (4) |
|
|
|
362 | (1) |
|
|
|
363 | (1) |
|
Question for Reflection and Journaling |
|
|
363 | (1) |
|
|
|
363 | (1) |
|
|
|
363 | (4) |
| Index |
|
367 | |
