end of life nursing care

Resources for

Palliative & End-of-Life Care

Palliative care in acute & critical care settings.

The goal of palliative care is to address the impact of serious illness by managing symptoms, improving quality of life, providing emotional support and ensuring that the plan of care aligns with patient and family goals. Under usual circumstances, there is significant overlap between nursing basics — interaction between patient and disease — and palliative care.

AACN offers resources to support nurses as they care for patients with serious illnesses and those nearing the end of their lives, as well as education for staff members who don’t usually provide this kind of care. In addition, several respected organizations offer widely recognized resources on these topics, including the End-of-Life Nursing Education Consortium/ELNEC (palliative care training), Center to Advance Palliative Care (toolkits) and Vital Talk program (communication skills) .

Facts & Figures

Remember that (palliative care) can be offered simultaneously with curative, aggressive, lifesaving treatments. People do not have to wait. They do not have to choose. Clareen Wiencek, PhD, RN, ACHPN, ACNP, AACN past president

What’s the Difference?

There are sometimes subtle distinctions between palliative, end-of-life and hospice care, including patient prognosis, goals of care and insurance reimbursement.

Palliative Care

Palliative care is appropriate at any time in the trajectory of serious illness or injury and does not replace curative interventions.
Palliative care communication skills can be used to explain prognosis or uncertainty about prognosis and to elicit patient and family perspectives even if a change in the plan of care does not occur.
Insurance reimburses for specialty palliative care in the same way other consultative services are paid for and does not depend on a specific prognosis.
In some instances, palliative care is delivered by the primary care team instead of as an additional service. This is called primary palliative care.
Palliative care is given in many settings, including ICU, PCU, acute care or outpatient.

End-of-Life Care & Hospice

End-of-life care generally refers to patient care before death, either while undergoing curative treatment or after deciding to focus on comfort rather than cure.
With some serious illnesses, prognosis is uncertain and it is unclear if the care provided is end-of-life or life sustaining.
When patients have a prognosis of six months or less, they are eligible to enroll in hospice through their insurance coverage.
Hospice organizations provide a comprehensive set of services aimed at promoting comfort, and providing emotional support and education on what to expect during the dying process.
Hospice services can be delivered to patients at home, in a skilled nursing facility or in a hospital.

Key Resources

Communication skills and education can increase your confidence when discussing goals of care with patients and families. Keep up with the latest developments in palliative care with this selection of AACN resources, designed to help you deliver the best possible evidence-based care.

Palliative Care and Moral Distress: An institutional Survey of Critical Care Nurses

Do you or your colleagues experience moral distress providing curative treatment to patients with a poor prognosis? Read this journal article to learn about the association between palliative care skills and moral distress.

A Passion for Palliative Care

Palliative care nurse practitioner and AACN past president Clareen Wiencek answers common questions about the intersection of palliative and critical care in this Q&A article. Consider how her insights and expertise from four decades of nursing could apply to your practice.

Palliative Care in the ICU

Examine end-of-life patterns in chronically and critically ill patients, and identify the pharmacologic methods for providing comfort in this recorded session.

Providing Primary Palliative Care in the ICU

Learn key skills every critical care nurse should have to talk with patients about palliative care and collaborate with the team for family meetings.

Palliative Care in the ICU: Communication Skills in Practice

View videos demonstrating essential communication skills for providing primary palliative care in this interactive case-based webinar.

AACN Position Statement: Ethical Triage and End-of-Life Care

AACN’s position statement gives specific actions for nurses and organizations when triage guidelines apply to the allocation of scarce resource.

Additional Resources

Access AACN’s complete library of programs and publications on palliative and end-of-life care. This compilation of resources includes journal articles, webinars and CE activities to improve your understanding of palliative and end-of-life care, and enhance your practice.

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4 End-of-Life Care (Hospice Care) Nursing Care Plans

End-of-Life (Hospice) Care Nursing Care Plans and Nursing Diagnosis

Caring for a loved one at the end of their life can be a challenging and emotional experience. However, with the right nursing care plan in place, it can also be a time of peace, comfort, and dignity. In this article, we’ll explore the essential components of end-of-life care, including hospice care and nursing care plans .

What is end of life care, nursing problem priorities, nursing assessment, nursing diagnosis, nursing goals, 1. promoting effective coping abilities, 2. decreasing tolerance to activity, 3. providing emotional support and assisting in grieving, 4. managing pain, recommended resources.

End-of-life care is a specialized form of care that is provided to individuals who are near the end of their lives. This care is designed to manage physical, emotional, and spiritual symptoms and to improve the quality of life for both the patient and their loved ones. End of life care can be provided in a variety of settings, including at home, in a hospital, or in a hospice.

Nursing care involves the support of the general well-being of our patients, the provision of episodic acute care and rehabilitation, and when a return to health is not possible a peaceful death. Dying is a profound transition for the individual. As healthcare providers, we become skilled in nursing and medical science, but the care of the dying person encompasses much more. Certain aspects of this care are taking on more importance for patients, families, and healthcare providers.

Hospice care provides comprehensive physical, psychological, social, and spiritual care for terminally ill patients. Most hospice programs serve terminally ill patients from the comforts and relaxed surroundings of their own homes, although there are some located in inpatient settings. The goal of the hospice care team is to help the patient achieve as full life as possible, with minimal pain , discomfort, and restriction. It also emphasizes a coordinated team effort to help the patient and family members overcome the severe anxiety , fear , and depression that occur with a terminal illness. To that end, hospice staffs encourage family members to help and participate in patient care , thereby providing the patient with warmth and security and helping the family caregivers begin the grieving process even before the patient dies.

Everyone involved in this method of care must be committed to high-quality patient care , unafraid of emotional involvement, and comfortable with personal feelings about death and dying . Good hospice care also requires open communication among team members, not just for evaluating patient care but also for helping the staff cope with their own feelings.

Recent studies have identified barriers to end-of-life care including patient or family member’s avoidance of death, the influence of managed care on end-of-life care, and lack of continuity of care across settings. In addition, if the dying patient requires a lengthy period of care or complicated physical care, there is the likelihood of caregiver fatigue (psychological and physical) that can compromise the care provided.

The best opportunity for quality care occurs when patients facing death, and their families, have time to consider the meaning of their lives, make plans, and shape the course of their living while preparing for death.

Nursing Care Plans and Management

During end-of-life care, nursing care planning revolves around controlling pain , preventing or managing complications, maintaining the quality of life as possible, and planning in place to meet the patient’s and/or family’s last wishes.

The following are the nursing priorities for patients in hospice care:

Provide symptom management and comfort measures
Facilitate open and honest communication
Support decision-making and advance care planning
Coordinate interdisciplinary care
Offer emotional and spiritual support
Respect cultural and religious beliefs
Facilitate effective communication and support
Coordinate hospice or palliative care services
Provide bereavement support
Ensure patient and family-centered care

Assess for the following subjective and objective data :

Patient reports experiencing increased pain or discomfort.
Patient expresses feelings of sadness, anxiety , or fear.
Patient expresses a desire for emotional support or spiritual guidance.
Patient reports changes in appetite, sleep patterns, or energy levels.
Patient shares their wishes and preferences for end-of-life care.
Palliative symptoms such as pain , dyspnea , nausea , or vomiting .
Physical changes such as changes in skin color, coolness, or mottling.
Decreased responsiveness or level of consciousness.
Vital signs indicating impending death, such as weak or irregular pulse, decreased blood pressure , or altered respirations.
Family members or caregivers report observations of decreased eating, drinking, or engagement in daily activities.

After thorough assessment , nursing diagnoses are formulated to address the challenges of end-of-life care (hospice care), guided by the nurse ’s clinical judgment and understanding of the patient’s unique condition. While nursing diagnoses help organize care, their use may vary across clinical settings. Ultimately, the nurse’s expertise and judgment shape the care plan to prioritize each patient’s needs. Here are examples of nursing diagnoses that may be useful for common concerns associated with end-of-life care (hospice care):

Ineffective Coping related to emotional response to terminal illness, evidenced by statements of feeling overwhelmed, withdrawal from family interactions, and difficulty expressing feelings.
(Acute/Chronic) Pain related to disease progression, evidenced by verbal complaints of discomfort and nonverbal cues such as grimacing, restlessness, and guarding.
Impaired Comfort related to physical and emotional distress, evidenced by statements of feeling cold, anxious , and uncomfortable in their environment.
Readiness for Enhanced Coping as evidenced by patient and family verbalizing a desire for additional resources to manage stress and discussing end-of-life decisions more openly.
Hopelessness related to terminal illness, evidenced by expressions of feeling trapped, lack of interest in self-care , and statements like “there’s nothing left for me.”

Goals and expected outcomes may include:

The client will identify resources within themselves to deal with the situation.
The client will visit regularly and participate positively in the care of the patient, within the limits of their abilities.
The client will express a more realistic understanding and expectations of the patient.
The client will provide an opportunity for the patient to deal with the situation in own way.
The client will identify negative factors affecting performance and eliminate/reduce their effects when possible.
The client will adapt to his/her own lifestyle to energy level.
The client will verbalize understanding of the potential loss of ability in relation to the existing condition.
The client will maintain or achieve a slight increase in activity tolerance evidenced by an acceptable level of fatigue / weakness .
The client will identify and express feelings appropriately.
The client will continue normal life activities, looking toward/planning for the future, one day at a time.
The client will verbalize understanding of the dying process and feelings of being supported in grief work.
The client will experience personal empowerment in spiritual strength and resources to find meaning and purpose in grief and loss.
The client’s family will verbalize understanding of the stages of grief and loss, and ventilate conflicts and feelings related to illness and death.
The client will report pain is relieved/controlled.
The client will follow the prescribed pharmacological regimen.
The client will demonstrate the use of relaxation skills and diversional activities as indicated.
The client’s family will cooperate in the pain management program.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients in hospice care may include:

Family coping for patients in hospice care involves a range of emotional, psychological, and practical responses. Families may experience anticipatory grief, stress, and a need for support as they navigate the impending loss of their loved one. They may engage in various coping strategies, such as seeking emotional support from healthcare providers, connecting with support groups, or utilizing spiritual or cultural resources to find comfort and meaning during this challenging time.

Assess the level of anxiety present in the family and/or SO. Anxiety level needs to be dealt with before problem-solving can begin. Individuals may be so preoccupied with the client’s own reactions to situations that they are unable to respond to another’s needs.

Determine the level of impairment of perceptual, cognitive, and/or physical abilities. Evaluate illness and current behaviors that are interfering with the care of the patient. Information about family problems will be helpful in determining options and developing an appropriate plan of care.

Note the patient’s emotional and behavioral responses resulting from increasing weakness and dependency Approaching death is most stressful when patient and/or family coping responses are strained, resulting in increased frustration, guilt, and anguish.

Determine current knowledge and/or perception of the situation. Provides information on which to begin planning care and make informed decisions.

Assess the current actions of SO and how they are received by the patient. Lack of information or unrealistic perceptions can interfere with the caregiver’s and/or care receiver’s response to the illness situation.

Establish rapport and acknowledge the difficulty of the situation for the family. May assist SO to accept what is happening and be willing to share problems with staff.

Discuss underlying reasons for patient behaviors with family. When family members know why the patient is behaving differently, it may help them understand and accept or deal with unusual behaviors.

Assist family and patient to understand “who owns the problem” and who is responsible for resolution. Avoid placing blame or guilt. When these boundaries are defined, each individual can begin to take care of own self and stop taking care of others in inappropriate ways.

Involve SO in information giving, problem-solving, and care of patients as feasible. Instruct in medication administration techniques, and needed treatments, and ascertain adeptness with the required equipment. Significant others (SO) may be trying to be helpful, but actions are not perceived as being helpful by the patient. In addition, may be withdrawn or can be too protective.

Include all family members as appropriate in discussions. Provide and/or reinforce information about terminal illness and/or death and future family needs. Information can reduce feelings of helplessness and uselessness. Helping a patient or family find comfort is often more important than adhering to strict routines. However, family caregivers need to feel confident with specific care activities and equipment.

Tolerance to activity in patients in hospice care may vary based on their individual condition and prognosis. Some patients may have reduced physical stamina and may experience fatigue or shortness of breath even with minimal activity. It is important to assess their activity tolerance regularly, adjust activity levels accordingly, and provide support and assistance to help them maintain their desired level of activity while managing their symptoms and ensuring their comfort and safety.

Assess sleep patterns and note changes in thought processes and behaviors. Multiple factors can aggravate fatigue, including sleep deprivation, emotional distress, side effects of medication , and the progression of the disease process.

Document cardiopulmonary response to activity ( weakness , fatigue, dyspnea , arrhythmias, and diaphoresis). Can provide guidelines for participation in activities.

Monitor breath sounds. Note feelings of panic or air hunger. Hypoxemia increases the sense of fatigue and impairs the ability to function.

Recommend scheduling activities for periods when the patient has the most energy. Adjust activities as necessary, reducing intensity level and/or discontinuing activities as indicated. Prevents overexertion , and allows for some activity within the patient’s ability.

Encourage the patient to do whatever is possible: self-care , sitting in a chair, and visiting with family or friends. Provides a sense of control and a feeling of accomplishment.

Instruct patient, family, and/or caregiver in energy conservation techniques. Stress the necessity of allowing for frequent rest periods following activities. Enhances performance while conserving limited energy, preventing an increase in the level of fatigue.

Demonstrate the proper performance of ADLs, ambulation , or position changes. Identify safety issues: use of assistive devices, the temperature of bath water, keeping travel ways clear of furniture. Protects patient or caregiver from injury during activities.

Encourage nutritional intake and use of supplements as appropriate. Necessary to meet energy needs for activity.

Provide supplemental oxygen as indicated and monitor response. Increases oxygenation . Evaluates the effectiveness of therapy.

The process of grieving for patients in hospice care is a natural and individual experience that can vary in duration and intensity. It involves emotional, physical, and spiritual aspects as patients and their loved ones come to terms with the impending loss. Providing compassionate support, facilitating open communication, and offering resources for emotional and spiritual guidance can help patients and their families navigate the grieving process during this sensitive time.

Assess the patient and/or SO for the stage of grief currently being experienced. Explain the process as appropriate. Knowledge about the grieving process reinforces the normality of feelings and/or reactions being experienced and can help patients deal more effectively with them.

Monitor for signs of debilitating depression, statements of hopelessness, and desire to “end it now.” Ask the patient direct questions about the state of mind. The patient may feel vulnerable when recently diagnosed with an end-stage disease process and/or when discharged from the hospital. Fear of loss of control and/or concerns about managing pain effectively may cause the patient to consider suicide .

Investigate evidence of conflict; expressions of anger; and statements of despair, guilt, hopelessness, and inability to grieve. Interpersonal conflicts and/or angry behavior may be the patient’s or SO’s way of expressing or dealing with feelings of despair and/or spiritual distress, necessitating further evaluation and support.

Determine the way that the patient and/or SO understand and respond to death. Determine cultural expectations, learned behaviors, experience with death (close family members and/or friends), beliefs about life after death, and faith in Higher Power (God) . These factors affect how each individual faces death and influences how they may respond and interact.

Provide an open, nonjudgmental environment. Use therapeutic communication skills of active listening, affirmation, and so on. Promotes and encourages realistic dialogue about feelings and concerns.

Encourage verbalization of thoughts and/or concerns and accept expressions of sadness, anger, and rejection. Acknowledge the normality of these feelings. Patients may feel supported in the expression of feelings by the understanding that deep and often conflicting emotions are normal and experienced by others in this difficult situation.

Facilitate the development of a trusting relationship with the patient and/or family. Trust is necessary before the patient and/or family can feel free to open personal lines of communication with the hospice team and address sensitive issues.

Be aware of mood swings, hostility, and other acting-out behavior. Set limits on inappropriate behavior, and redirect negative thinking. Indicators of ineffective coping and need for additional interventions. Preventing destructive actions enables patients to maintain control and a sense of self- esteem .

Reinforce teaching regarding disease processes and treatments and provide information as requested or appropriate about dying. Be honest; do not give false hope while providing emotional support. Patient and/or SO benefit from factual information. Individuals may ask direct questions about death, and honest answers promote trust and provide reassurance that correct information will be given.

Review past life experiences, role changes, sexuality concerns, and coping skills. Promote an environment conducive to talking about things that interest the patient. Opportunity to identify skills that may help individuals cope with the grief of current situation more effectively. Issues of sexuality remain important at this stage: feelings of masculinity or femininity, giving up a role within the family, and the ability to maintain sexual activity (if desired).

Assist patient/SO to identify strengths in self or situation and support systems. Recognizing these resources provides an opportunity to work through feelings of grief.

Be aware of the client’s feelings about death. Accept whatever methods patients/SO has chosen to help each other through the process. The caregiver’s anxiety and unwillingness to accept the reality of the possibility of the client’s death may block the ability to be helpful to the patient/SO, necessitating enlisting the aid of others to provide needed support.

Provide an open environment for discussion with patient/SO (when appropriate) about desires and/or plans pertaining to death; e.g., making a will, burial arrangements, tissue donation, death benefits, insurance, time for family gatherings, and how to spend the remaining time. If patients/SO are mutually aware of impending death, they may more easily deal with unfinished business or desired activities. Having a part in problem-solving or planning can provide a sense of control over anticipated events.

Encourage participation in care and treatment decisions. Allows patients to retain some control over life.

Visit frequently and provide physical contact as appropriate or desired, or provide frequent phone support as appropriate for the setting. Arrange for a care provider and/or support person to stay with the patient as needed. Helps reduce feelings of isolation and abandonment.

Provide time for acceptance, final farewell, and arrangements for memorial or funeral service according to individual spiritual, cultural, and ethnic needs. Accommodation of personal and family wishes helps reduce anxiety and may promote a sense of peace.

Identify the need for appropriate timing of antidepressants and/or anxiety medications. May alleviate distress, and enhance coping, especially for patients not requiring analgesics.

Determine spiritual needs or conflicts and refer to appropriate team members including clergy and/or spiritual advisor. Providing for spiritual needs, forgiveness, prayer, devotional materials, or sacraments as requested can relieve spiritual pain and provide a sense of peace.

Refer to an appropriate counselor as needed (psychiatric clinical nurse specialist, social worker, psychologist, pastoral support) Compassion and support can help alleviate distress or palliate feelings of grief to facilitate coping and foster growth.

Refer to visiting nurse, home health agency as needed, or hospice team, when appropriate. Provides support in meeting the physical and emotional needs of the patient and/or SO, and can supplement the care family and friends are able to give.

Managing pain for patients in hospice care is one aspect of providing comfort and maintaining the quality of life. It involves regular assessment of pain intensity and characteristics, utilizing appropriate pain management strategies such as pharmacological interventions, non-pharmacological techniques, and complementary therapies.

Perform a comprehensive pain evaluation, including location, characteristics, onset, duration, frequency, quality, severity (e.g., 0–10 scale), and precipitating or aggravating factors. Note cultural issues impacting reporting and expression of pain. Determine the patient’s acceptable level of pain. Provides baseline information from which a realistic plan can be developed, keeping in mind that verbal/behavioral cues may have a little direct relationship to the degree of pain perceived. Often the patient does not feel the need to be completely pain-free but is able to be more functional when pain is at a lower level on the pain scale.

Determine possible pathophysiological and/or psychological causes of pain Pain is associated with many factors that may be interactive and increase the degree of pain experienced.

Assess the patient’s perception of pain, along with behavioral and psychological responses. Determine the patient’s attitude toward and/or use of pain medications and locus of control (internal and/or external). Helps identify patients’ needs and pain control methods found to be helpful or not helpful in the past. Individuals with an external locus of control may take little or no responsibility for pain management .

Assess the degree of personal adjustment to diagnosis, such as anger, irritability, withdrawal, and acceptance. These factors are variable and often affect the perception of pain and the ability to cope and the need for pain management .

Identify specific signs and symptoms and changes in pain requiring notification of healthcare provider and medical intervention. Unrelieved pain may be associated with the progression of a terminal disease process, or be associated with complications that require medical management.

Verify current and past analgesic and narcotic drug use (including alcohol). May provide insight into what has or has not worked in the past or may impact the therapy plan.

Monitor for/discuss the possibility of changes in mental status, agitation, confusion , and restlessness. Although causes of deterioration are numerous in terminal stages, early recognition and management of the psychological component is an integral part of pain management.

Encourage the patient and family to express feelings or concerns about narcotic use. Inaccurate information regarding drug use or fear of addiction or oversedation may impair pain control efforts.

Discuss with SO(s) ways in which they can assist patients and reduce precipitating factors. Promotes involvement in care and belief that there are things they can do to help.

Involve caregivers in identifying effective comfort measures for patients: use of non-acidic fluids, oral swabs, lip salve, skin and/or perineal care , and enema. Instruct in the use of oxygen and/or suction equipment as appropriate. Managing troubling symptoms such as nausea, dry mouth , dyspnea , and constipation can reduce patients’ suffering and family anxiety, improving quality of life and allowing the patient/family to focus on other issues.

Demonstrate and encourage the use of relaxation techniques, guided imagery, and meditation. May reduce the need for/can supplement analgesic therapy, especially during periods when the patient desires to minimize the sedative effects of medication .

Establish a pain management plan with the patient, family, and healthcare provider, including options for the management of breakthrough pain. Inadequate pain management remains one of the most significant deficiencies in the care of the dying patient. A plan developed in advance increases the patient’s level of trust that comfort will be maintained, reducing anxiety.

Schedule and administer analgesics as indicated to maximal dosage . Notify the physician if the regimen is inadequate to meet the pain control goal. Helps maintain an “acceptable” level of pain. Modifications of drug dosage or combinations may be required.

Instruct the patient, family, or caregiver in the use of an IV pump (PCA) for pain control. When the patient controls the dosage and administration of medication , pain relief is enhanced and quality of life is improved.

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Other recommended site resources for this nursing care plan:

Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ! Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

More care plans related to basic nursing concepts:

Cancer (Oncology Nursing) | 12 Care Plans
End-of-Life Care (Hospice Care or Palliative) | 4 Care Plans
Geriatric Nursing (Older Adult) | 11 Care Plans
Prolonged Bed Rest | 8 Care Plans
Surgery (Perioperative Client) | 13 Care Plans
Systemic Lupus Erythematosus | 4 Care Plans
Total Parenteral Nutrition | 4 Care Plans

3 thoughts on “4 End-of-Life Care (Hospice Care) Nursing Care Plans”

This helps a lot. Thanks for sharing. I use it as a tool guide to make NCP’s.

As an experienced RN X 34 years in more varied clinical and off-site not hands on clinical workflows, I am now finding this wonderful role of Hospice Nursing and really love what I am doing now with my career!!

This information you shared is a great network builder in how I address these very different methods with my patents, families, caregivers…to be all in the most solid headspace as possible with caring for, AND understanding there loved one, who may look and appear very different to them.

I have a previous high functioning mother, also retired RN, who know has late onset Alzheimer’s and she is taking it pretty hard. Your content within your course will definitely help me in my work role; but nearly as/more important, will help me keep everything in perspective as I walk this path with my mama, and help my other family members who just simply don’t grasp the changes and why they are occurring….(ie. the anger outburst,, for one example).

Thank you for a well presented topic with many great take-away tools.

Terri Smith RN CM

Hi Terri. Hope you are in good health. I am impressed by the vast knowledge and skill you have acquired through the years in your career. I am a retired registered general nurse I was working in one of the best private hospitals in my country. I am currently looking after my mother who has Alzheimer’s I am interested in starting a hospice or a nursing home in my hometown as I have noticed that the is a high demand for such facilities in my country. having said that I was wondering if could join hands with me in this endeavor

Nursing Care at the End of Life: What Every Clinician Should Know

(16 reviews)

Susan E. Lowey, SUNY, Brockport

ISBN 13: 9781942341192

Publisher: Open SUNY

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Katrina Stowers, Assistant Professor, Marian University on 10/25/24

Nursing Care at the End of LIfe is easy to understand and offers a very organized flow of content. read more

Comprehensiveness rating: 4 see less

Nursing Care at the End of LIfe is easy to understand and offers a very organized flow of content.

Content Accuracy rating: 4

Content is accurate and does a great job providing a discussion on the stages of grief.

Relevance/Longevity rating: 3

The book's content remains relevant, as the stages of grief continue to the same. However, there are sources used that are great than 5 years, which can be an issue. We ask our students to use relevant and current sources of <5 years. Also current trends provides a list of leading causes of death based on the CDC 2011 stats, which would not be the most current. There is a lag time, but not 13 years. This would need to be addressed.

Clarity rating: 4

Terms are clear, lucid, and written in concise language, I found it not to wordy and actually an interesting read.

Consistency rating: 4

There is a decent amount of consistency in the terminology used.

Modularity rating: 4

The organization and flow of content is easy to follow and can be divided into assigned readings, offering a less intimidating reading assignment.

Organization/Structure/Flow rating: 5

The topics are presented in an organized and logical flow, building upon eachother.

Interface rating: 5

No image distortions observed that would confused readers.

Grammatical Errors rating: 4

Found no grammatical errors.

Cultural Relevance rating: 5

Great discussion on the importance of cultural competence, suggesting nurses must make an effort to understand the culture of their patients.

This book is particularly valuable for nurses, but it is also relevant for other healthcare providers involved in end-of-life care. Its clear, compassionate, and comprehensive approach makes it a go-to resource for improving the quality of care for patients in their final days, while also supporting clinicians in navigating the emotional complexities of this type of caregiving. In summary, Nursing Care at the End of Life is an insightful and practical resource, offering crucial guidance for clinicians committed to providing empathetic and effective care to patients during one of the most important phases of life.

Reviewed by Marty (Martha) Fabian-Krause, RNBS, Adjunct Clinical Instructor, Rogue Community College on 11/29/22

From history, definitions, trajectories, stages of death, hospice and palliative care , interpersonal communication nurse to patient, symptom management, bereavement, this text is very thorough and progressive. read more

Comprehensiveness rating: 5 see less

Content Accuracy rating: 5

No issues encountered.

Relevance/Longevity rating: 5

Totally current in time and cultural relevance for today’s healthcare.

Clarity rating: 5

Written clearly with current accepted terminology.

Consistency rating: 5

This text follows a progressive style with each section building upon the next. The topics can be used independently also.

Modularity rating: 5

Can be easily assigned in smaller sections or changed in order depending on the class structure.

This text is well organized with an opening introduction, the body of work, and an easily to understand closing.

The grafts and charts are relevant and easy to comprehend. They are included in most sections.

Grammatical Errors rating: 5

No grammatical errors noted.

The writing style includes a wide population base with some detail to further research with reference to particular cultural groups available.

Important material about medical ethics, withholding, withdrawing medical care discussed and clarified in closing content. Very relevant for healthcare practitioners. Special consideration to grief and loss and the work of Dr Elisabeth Kubler Ross.

Reviewed by Nicole Trainer, Assistant Clinical Professor of Nursing, The George Washington University on 1/31/22

The book is very comprehensive and provides all details a novice nurse needs to know without overcomplicating the clinical situation. read more

The book is very comprehensive and provides all details a novice nurse needs to know without overcomplicating the clinical situation.

The book is accurate and provides evidence-based interventions for nursing practice within the hospital and community settings.

This book is extremely relevant to nursing practice. It makes a great point that only 2% of nursing curriculum focuses on end of life however, the vast majority of nurses will need to know how to care for the dying patient and family.

The book is clearly written and provides clear guidance to care for patients and families at the end of life.

The book is consistent in terms of terminology and framework. The afterward provides a real-life interview of the author that addresses the great need for resiliency in nursing practice relating to death and dying. The final chapter provides resources.

I really appreciated the division of reading with "Anticipation", "In the moment", and "Afterwards". These sections make a lot of sense when you are working with dying patients. The anticipation section prepares students for the in-the-moment part which would be the most anxiety-approaching aspect of dying.

The book's organization is clear and logical.

The text was easy to navigate and broken into chapters that were placed in logical sections.

No grammatical errors were found.

Cultural Relevance rating: 4

The book references different spiritual and cultural beliefs but does not detail specific races, ethnicities, and backgrounds. There are no cultural insensitivities noted and the book is in no way offense.

This textbook is exceptional and the content should be integrated into the curriculum of all nursing schools. The writing is concise, meaningful, and approaches a difficult topic in a positive way. Communicating healthcare wishes in a careful manner during the dying process is explained thoroughly.

Reviewed by Laura Mallett, Assistant Director of Nursing, Neosho County Community College on 6/3/21

The book covers all areas of the End of LIfe that a clinician should be aware of. The information would be good for novice nurses. read more

The book covers all areas of the End of LIfe that a clinician should be aware of. The information would be good for novice nurses.

We do a Death and Dying course as an elective in the program and use the online course. Comparing the two I would say this covers information well and actually goes presents it in more detail.

Very relevant to nursing education.

Written very well.

Consistent with the resources and best practices that I could see.

The book can be divided into modules easily.

The organization of the book is sequential and makes sense.

I think it is well written and no distractions noted

None that I saw in the review process.

I did not see anything that would alert me to cultural insensitivity.

I feel this would be a good resource or even book to use within the curriculum for nursing programs

Reviewed by Linda Mollino, Director of CTE Program, Oregon Coast Community College on 1/11/21

Overall, this book provided a comprehensive look at the role of nursing care in end-of-life care. Much of the content is presented in a detailed format and presented at a level that an undergraduate nursing student would understand and apply the content into their clinical practice. However, I would have liked to see additional information on the non-pharmacological approaches to pain and symptom management.

No errors were noted with regard to content, but it does present content from a single clinicians' point of view. The references do back-up the content.

Content is current and will stand-up to time. it is important for the reader to understand that laws could affect the approaches to care such as the use of marijuana based on state and federal laws and new approaches to pain and symptom management.

Very readable for an undergraduate nursing student. The charts presented were good but the use of tables and charts whenever possible to keep the student engaged in the topic is very important. So additional resources would have assisted in solidifying the content for the reader. The use of outcomes at the beginning each chapter and focus statements at the end of the chapter is very effective for solidifying the chapter content for the reader.

The information presented was consistent, through this probably is due to the fact that it was presented with one author's voice. However, there were no inconsistencies noted in the information presented.

The way the text is outlined, it can easily be broken up into smaller modules. This would be very effective for the instructor in dividing up content lessons. The book would totally support this approach. Example: historical approach vs. symptom management.

Organization/Structure/Flow rating: 4

The information was presented in a very organized matter, bringing in an historical perspective, and moving through the important topics such as palliative care vs. hospice care, on to pain management and the emotional/spiritual aspects of care at the end-of-life. One element that would have added to the flow of the content is case presentations and/or scenarios.

There were no interface issues. The book flows well in a number of interface programs. The charts are readable, pages remain consistent with the table of contents and the reference links are accessed in new tabs thereby locking the content and allowing the readers to maintain where they were within the book.

No errors were noted. Again, the flow of the book makes it readable for an under-graduate nursing student.

Although the chapter on "Diversity in Dying" is done well, it would have been more effective if some of this content was included throughout the book such as in the chapter "Initiating Conversations about Goals of Care.

Overall, this book is effective in presenting the concept of end-of-life care. Case studies would have brought the information home to the reader. However, the last part of the book that focuses on "lessons learned" does solidify the information presented. The hope is that book will engage the reader, encouraging them to look at other resources in the care of patients at the end of their lives.

Reviewed by Thomas Dombrowsky, Clinical Assistant Professor, University of Texas at Arlington on 2/19/20

The book addresses all the major areas of end of life care. I would have liked to see more specifics about symptom relief and about non-pharmaceutical methods for addressing pain. read more

Comprehensiveness rating: 3 see less

The book addresses all the major areas of end of life care. I would have liked to see more specifics about symptom relief and about non-pharmaceutical methods for addressing pain.

No errors of fact were detected. The content was presented from the perspective of the author's experience, but due to the nature of the case that is what one would expect.

Relevance/Longevity rating: 4

The content is up to date. However, state laws regarding end of life care are rapidly evolving. This is especially true in the area of assisted suicide. The book mentions states that currently allow physician assisted euthanasia but does not acknowledge that this is an area where law and societal norms are rapidly changing.

The text is quite readable. Technical terms are explained as soon as they are introduced. The objectives for each chapter give a clear idea of what to expect, and content is appropriately summarized at the end.

There is only one author, so the style is highly consistent.

Each chapter stands on its own. Chapters could be assigned individually or used along side content from other sources.

The organization is logical and clear. Content could easily be used in order in a course focusing on end of life.

Interface rating: 4

The interface is clean. Appropriate tables are used. There is a lack of diagrams or pictures, but diagrams and pictures would not necessarily be helpful.

Grammatical Errors rating: 3

The author uses gender inclusive pronouns but there are some inconsistencies in their use that are a little distracting.

The text is inclusive and no insensitivity was detected. However the content was quite specific to US law and customs, so it might be less useful in an international educational setting.

I was disappointed by the section on pain control. The author led with pharmaceutical interventions. This is of course what is usually done, but I would have liked to see an emphasis on non-pharmaceutical interventions. Actually little was said about non-pharmaceutical interventions, and practical suggestions along this line were not offered. Most patients do indeed need medications, but too often the non-pharmaceutical interventions are an afterthought when medications are not effective rather than leading with the non-pharmaceutical interventions and including medications as well in a comprehensive plan of care. The section could be strengthened by adding content on the physiology and psychology of pain transmission and how pain control methods work. The chapters on emotional and spiritual distress and on communication were excellent.

Reviewed by Lisa Kuppler-Lee, Nursing Faculty, Radford University Carilion on 2/14/20

The on-line book is very informative on most aspects of "end-of-life-care" (ELOC). Unfortunately, it provides minimal information regarding Advanced Directives and Healthcare Power of Attorney. These two issues are becoming more of a problem in the hospital setting. Patients and/or family members are asked if an Advanced Directive or Power of Attorney is available on admission.

EOLC is so important. This text is error-free. The author provided unbiased information based on the different professional journals and books cited and referenced. The publications are well-known medical and nursing journals.

The book was up-to-date when it was published and EOLC will never become obsolete. In fact, its relevance increases as our life expectancy increases. Based on how the author arranged the text, the updates would be easily implemented.

Although the text is written primarily for healthcare professionals, an educated layperson could easily understand the book.

The material presented followed a consistent understandable format. At the end of each chapter was a section titled "What you would know". This provided highlights of the chapter in a few sentences.

The modular design of the various chapters make a strong pulling point for this book. Each chapter can stand alone by itself or have the flexibility to be part of a module. You can assign a few chapters as a module to be part of their current assignment. The book can be used as reference material for an assignment.

The book is very well organized. Its starts with history of EOLC and ends with breavement.

I used the PDF version. The text was easy to read and the various charts were significant to the chapter. The charts were clean without any distortion.

No grammatical errors were noted.

The book was not insensitive or offensive. The book only provided a chart on the different cultural/religious beliefs pertaining to care of the patient after death. Many of the different cultures/religious have rituals taking care of the patient prior to death. More in-depth information needs to be provided about the different cultures/religious groups.

Reviewed by Laurie Schroder, Program Coordinator & Assistant Professor, East Tennessee State University on 10/6/19

The text is comprehensive in its scope but only touches on many topics which would benefit from more depth, such as ancillary pain treatments and assessment tools utilized with patients. While the author is obviously knowledgeable about the topics introduced, many may be unfamiliar to readers and a list of additional reading or references for those interested in pursuing more information might be helpful. It is understood that many of these topics are beyond the scope of this text, which makes this text both more readable, and slightly less comprehensive.

Overall, the text is accurate and material presented is supported with current research. Occasionally, an inaccuracy occurs, such as a statement on page 69 that seems to indicate that physical tolerance of a medication is analogous to withdrawal, but this seems to be the result of an editing error more than one of inaccurate facts.

The content is up-to-date and relevant, and is unlikely to become obsolete quickly as it does not serve primarily as a scientific text. Although some statistics are included, they are not terribly important in terms of bolstering any textual arguments.

The text is clear and accessible, with very little in the way of professional jargon. The author generally makes her point and provides sufficient anecdotal or research support for it. In some cases, the writing style is almost too informal, and weaves back and forth between present and future perfect progressive tense, or between addressing the reader directly as "you" and more formal technical-style writing.

The text is generally internally consistent. Those minor inconsistencies that exist (e.g. a suggestion that patients be included in meals and encouraged to eat their favorite foods, vs. a later suggestion that patients be given bland, cool foods to eat) are easily sorted out by individuals with a healthcare background, and could be readily explained by a knowledgeable instructor. The text is generally informal and written to relate the author's extensive personal experience with the dying and their families, and reads as a personal communique with some current evidence-based information and medical background added in as support. If intended for that use, the book would serve well; if intended to provide a thorough presentation of the pharmacologic, therapeutic, rehabilitative, etc. framework for death and dying, there is insufficient breadth and depth present.

This text would lend itself easily to being divided into easily read and digested units for a course. Although perhaps not entirely comprehensive, it would serve as a good jumping-off point for material that permitted students to self-assess their own biases related to death and dying, palliative care, and grief.

This text is well-organized, beginning with a historical (if purely Westernized) view of end-of-life care and ending with a chapter on bereavement, and includes chapters that cover illness trajectories, frameworks of death and dying, palliative and hospice care, and an in-depth section related to the relationship, both professional and personal, that exists between the nursing caregiver and the dying patient.

I elected to review the pdf version of the text, which downloaded without difficulty, was easy to navigate, presented with no interface errors, and with which I was able to use the search tool.

Although the text does not contain notable, consistent grammatical errors, it is written in the style of a thesis paper, and at a relatively basic reading level. Some stylistic elements may grate on the college-level reader, such as references to inanimate systems that "grow and develop", "less" and "fewer" being used interchangeably, references that are unclear (e.g. "those diseases"), and other word and phrase choices that would be well-served by some revision. Additionally, the author tends to move freely among tenses within any given paragraph, which slows reading and comprehension. Clunky sentences, such as, "While there are certain things that are not warranted in a nurse's role to talk about, such as delivering bad news or a terminal prognosis, there are plenty of other informative things that can be discussed with the patient.", may cause the reader to pause unnecessarily. The occasional missing apostrophe, misused term, and redundancy ("also", "as well", "in addition" - more than one present in one sentence) would also have been eliminated by a good editor. Finally, as a note regarding writing style, moving from an informal manner similar to direct discussion with the reader ("So now you have a basic understanding about illness trajectory") to a formal style, adds an additional obstacle to making this text easy to read.

Cultural Relevance rating: 2

Although the text includes a chapter on "Diversity in Dying: Death across Cultures", it only serves to outline traditional American death and burial traditions and to provide a table of abbreviated beliefs from different religious traditions. The text does urge individuals working with patients and families from different cultures to be intentional about learning more about their values and traditions.

This book is an easy read, and while it has some stylistic issues, these are minor. It does a very good job of presenting a realistic personal perspective, from an experienced nurse, of the many facets included in the work (and calling) of providing care to patients and families during a difficulty period in their lives.

Reviewed by Monica Schibig, Associate Clinical Professor, University of Missouri on 1/15/19

This text does a respectable job of including all the key elements for one's understanding of end of life care (EOLC) issues. Some information on the basics of the legal side of EOLC would be helpful. Part of the discussion surrounding EOLC is to assist the patient in understanding the various components of written documentation of their wishes, such as advanced directives and power of attorney.

I did not notice any errors in the book, but this is a topic where the statistics supporting the information can easily change over the course of a couple years, so one needs to take into account he authoring year.

Relevance is one of the book's strengths. It is a fairly easy read which should increase the likelihood that the student or healthcare professional will read the entire book. future updates seem quite manageable.

The author did a great job of writing for a broad audience. It is not overly "medical" and presents the information in such a a manner that most lay individuals could comprehend the book's material.

The consistency throughout the book is one of the main reasons that a lay individual could easily absorb the content of this book.

Modularity is another strength of this book. Not only could an instructor assign the various chapters to coincide with a student's progressive matriculation through a program, but each section can stand on it's own and is not dependent on previous content. This lends nicely for faculty that may only want to emphasize certain sections of the book.

I believe the organization of this book is excellent, with one exception. In the last section, "Afterword Evaluation of Self: Lessons Learned", the first objective is "Evaluate one's own attitudes and beliefs about death and dying". The author goes on to focus mostly on caregivers that work in hospice, which leaves a gap for many other healthcare professionals, such as those that work in ICU's and ER's. Additionally, I think devoting some time to processing one's own feelings about dying could be beneficial in the beginning of the book.

There are many tables and charts that contribute significantly to the readers understanding of the content, such as the cultural differences (pg. 113-114).

Lack of perceived cultural sensitivity in healthcare is one reason many patients do not seek care, especially in the end of life stage. This book does an excellent job of bringing that to the forefront and arming the reader with knowledge and examples to feel confident in caring for a variety of patients who culture may differ from their own.

I enjoyed reading this book and look forward to incorporating the content in my own classes.

Reviewed by Patricia Drees, Assistant Professor, Fort Hays State University on 11/29/18

There is no index at the end of the work. There is a list of websites that can be used as resources for further reading. The topic is covered logically and groups the subtopic by when these topics occur in the life and death experience. read more

It is accurate and evidence based. Pain management and ethics are objectively discussed. Pain management is an area of nursing that tends to bring out opinions more than evidence to guide care. This warns against that.

This is relevant to nursing as it expands the topics: 1.fear of death 2.fear of pain in dying 3.accurate information on death process (physiological processes) 4.accurate information on pain medications 5.grief and hope 6.spiritual distress 7.application of ethical principles as related to death and dying

Accepted and appropriate terms are used. Written in standard American English.

The educator could easily ask the student to read a section to expand upon what is being taught in class.

It flows sequentially using a timeline or several timelines to capture the death and dying process.

Being an online book requires a different sort of navigation. It may require conversion to a format where the student can search out specific parts. I was unable to sign in. I downloaded a PDF. Perhaps, the other format had this feature.

If grammatical errors occur, they did not hamper my understanding of the content.

It is based on the American death and dying experience. It has a section on cultural care. It is brief and not the most comprehensive resource on that, however, it would not lead the nurse astray if this is the only source of cultural information. It has brief examples of religious and ethnic variations in beliefs and customs.

If I were teaching health and illness, it would be an adjunct source on pain medications and dying. As a mental health instructor, I could pick out different sections to supplement and expand topics. The spiritual distress section would be useful. This resource is good to look at the family dynamics of death and dying. I do not have a nursing book in the curriculum that this could 100% replace. The citations after each chapter alone would be a goldmine for students trying to learn more about the topic.

Reviewed by Sandra S. Lee, PhD, RN, CNE, Assistant Clinical Professor of Nursing, University of Houston on 5/21/18

The book addresses all areas of end-of-life care, starting with history, frameworks, and models of care. The middle section sufficiently covers the symptoms and corresponding interventions that a hospice nurse would most commonly encounter in the illness trajectory. Although there is not an index or glossary, the table of contents is clear enough to quickly identify and find topics of particular interest.

The content is accurate and reflects current knowledge and science around end-of-life care.

The content is up-to-date and utilizes reputable sources throughout. A resource list at the end of the text gives the reader links to online sources which are not likely to change, such as the American Geriatrics Society and the American Medical Association, Institute of Medicine, etc.

The text is refreshing to read. It challenges the reader with expanding knowledge and points of critical discussion and handles a weighty topic in a way that is easy to think about and digest. The narrative is clear and easy to understand yet obviously scholarly and well supported by the current research and literature in end of life care.

The text is clear and consistent with its terminology and approach.

What really stands out is the large-font chapter titles, a poignant quote at the beginning of chapters to introduce the reader to the topic, and the learning objectives clearly indicated in a black and white box. The "What You Should Know" key points are easily identified at the end of each chapter by a green box, highlighting the most important take-aways from each chapter. References follow each chapter.

Each chapter begins with large-font chapter titles and a poignant quote at the beginning of chapters to introduce the reader to the topic. The learning objectives are clearly indicated in a black and white box. The "What You Should Know" key points are easily identified at the end of each chapter by a green box, highlighting the most important take-aways from each chapter. Each chapter is organized in the same way, so the reader knows what to expect while progressing through the text.

The interface is excellent. The no-frills approach in a PDF allows easy download and storage onto multiple device. I enjoyed reading the book on my iPhone. The reader won't find complicated graphics, images, or interactive activities in the text. Instead, Dr. Lowey opted for a simple, streamlined approach that I found aesthetically pleasing and easy to navigate between chapters. Charts and graphics are carefully selected and strategically placed wtih full explanations.

No grammatical or formatting errors were noted. The text is easy to read yet employs professional language and terminology.

The book approaches the subject of end of life care with sensitivity, knowing that many nurses are not comfortable with the topic or their ability to provice sufficient care. Dr. Lowey assures readers of all experience levels that the nursing hesitancy and limited of knowledge in end of life care is widespread. She empowers the reader that our presence and voice is our greatest and most effective intervention during end of life care. A specific chapter addresses the diversity and death practices across cultures and summarizes the religious beliefs for each of the world's major religions. No book or chapter could possibily comprehensively consider all cultural beliefs around death, dying, and funerals, but Dr. Lowey gives us a good starting point.

Nursing Care at the End of Life: What Every Clinician Should Know is a real gem for nursing students, experienced clinicians, and those new to hospice care. Having such an outstanding resource in the Open Textbook Library is a gift to the nursing profession, and to our patients. The text gives a practical, relevant, well-written, and comprehensive resource to draw upon when caring for patients in the palliation/hospice trajectory. The very best chapter is the last one in which Dr. Lowey reflects on what it's like to be a hospice nurse, how she copes with her own sadness when patients die, and other common questions that hospice nurses are often asks. If a nurse is thinking about becoming a hospice nurse and reading this book to get information, the last chapter will clearly help guide the decision. Several chapters could stand alone as reading assignments in other courses such as medical-surgical nursing or psychiatric care, or a course addressing cultural aspects of care. Whether used in its entirety, in part, as required or optional, this text is a must have in every nursing education program. I definitely plan to use this text in my classes for both required and optional reading assignments. Great job and outstanding work, Dr. Lowey!

Reviewed by Nancyruth Leibold, Associate Professor, Southwest Minnesota State University on 2/1/18

Nursing Care at the End of Life: What Every Clinician Should Know is a comprehensive book about caring for patients and families at the end of life. All areas and ideas related to nursing care at the end of life are included. A Table of Contents... read more

The textbook includes accurate information about end of life care that is supported with evidence from the literature. The content is free of errors and unbiased

Nursing Care at the End of Life: What Every Clinician Should Know is relevant information as information about End-of-Life case is important for health care professionals to know and apply when caring for patients and their families at end-of-life. The content will not be quickly outdated, which is a major concern in nursing topics.

Nursing Care at the End of Life: What Every Clinician Should Know is clear and easy to read. The book includes professional vocabulary, but defines the terms used.

Consistent terms and frameworks are used throughout the book.

Nursing Care at the End of Life: What Every Clinician Should Know is presented in smaller reading sections with headings and subheadings to divide up the chunks of content. The book is not overly self-referential. Dr. Lowey cites her work in this area, but it is not overdone.

Nursing Care at the End of Life: What Every Clinician Should Know is well organized and flows well. There are 12 chapters in the text. Each chapter includes learning objectives, content, a “What You Should Know” section, and references. The major sub-topics for end of life care are included. And Afterword and End of Life Care Resources section is included. The tables and figures are helpful and point out the key ideas.

When I read the book in the online format, the font changed to difficult to read fonts and also changed to italic for some chapters. I found this difficult to read. The figures and tables were not impacted. I recommend using the PDF format of the book for this reason as it was consistent and easier to read. This may have been some odd technical aberration, but did happen to me at several different checks on different days. However, I mention in case you have similar issues so you can try the PDF as another option. Being able to download the PDF is an awesome plus!

The book is free of grammar and spelling errors.

This book includes a chapter about Diversity in Dying. The chapter outlines various religious beliefs and practices related to death and dying. Nurses are told to become familiar with the death and dying practices of the family. This is appropriate because families will have their own cultural practices that may or may not be used by everyone of their culture or religious affiliation.

Nursing Care at the End of Life: What Every Clinician Should Know is a well written book with outstanding content and organization. Thanks to Dr. Lowey for this open educational resource!

Reviewed by Dawn Cullison, Assistant Professor, Reynolds Community College Richmond, Virginia on 2/8/17

This book is very comprehensive and the author's scaffolding of foundational to more complex concepts yields a very thorough and yet concise understanding of the content. read more

This book is very comprehensive and the author's scaffolding of foundational to more complex concepts yields a very thorough and yet concise understanding of the content.

This book contains very well researched, current, and unbiased information, allowing the reader to glean an understanding of the various theories of death and dying and the myriad of approaches to the care of the dying patient.

The content of this text is current, relevant, and most essential in the training of nursing students and is written in such a manner as to not require frequent updates. The content is applicable to all facets of nursing as death and dying are encountered in any given specialty within the nursing profession. This text serves to fill in the gaps of coverage of death and dying in many nursing programs and would also be of benefit to the practicing nurse who desires to pursue additional independent learning opportunities.

The text is written in a manner consistent with educational resources aimed at the target population of nursing students, however, even one not familiar with nursing jargon/technical terminology would benefit from reading and be able to understand the overall intent of the text.

This text is divided into very concise chapters and utilizes a consistent framework throughout, which allows the reader to quickly identify the author's given style of writing, yielding an ease of comprehension and expeditious sense of familiarity and understanding.

This text is written in a format of very concise, modular sections which could easily be dissected and read in part, but also as a whole. The text references multiple sources of a wide range of expertise, offering the reader many opportunities to explore a particular topic of interest in greater depth.

The topics are presented in a clear, logical, and systematic manner, allowing the reader to either review or learn afresh the foundational principles and then move deeper into the more complex and finely tuned content.

This text is free of any significant interface issues, and no distortions of content, images, or charts is noted. The text was downloaded without difficulty and the formatting is clear, consistent, and reader-friendly.

The text contains no grammatical errors.

This text is culturally sensitive and addresses the unique differences in terms of cultural or religious views of death and dying while avoiding generalizations. The text seeks to educate the reader on the wide range of patient, family, and health care professional responses to death and dying while also avoiding generalization. This facet allows the reader to glean insights without forming potentially inappropriate or inaccurate presuppositions when faced with other cultures or religions in practice.

This book is an invaluable resource to all nursing students and practicing nurses as it very concisely articulates the unique complexities encountered in the care of the dying patient and the dying patient's family. This book accurately asserts that the content explored in this text is often covered minimally in the traditional nursing curriculum, leaving many nurses feeling inadequate, unprepared, and less than confident when caring for the dying patient in practice. This book more than adequately fills the void and I will be utilizing this resource in the future. Thank you for compiling and sharing this information.

Reviewed by Cindy Yascavage, Instructor, Temple University on 8/21/16

The text is comprehensive and appropriately provides a basic understanding of terms of a difficult topic for care givers. read more

The text is comprehensive and appropriately provides a basic understanding of terms of a difficult topic for care givers.

The book's content is accurate and supported appropriately with relevant references.

Even though some of the material seemed old, it is the gold standard. The content is up to date, and somewhat ageless. Medications for pain may change, however, learning how to manage palliative care clients remains difficult for many.

There text is not written with techinical terminology such as medical procedures, however, to a nonmedical person, there might be some terminology they are unfamiliar with.

The text is consistent in terminology and framework throughout the text. For example each chapter begins with learning objectives.

The text is easily divided into smaller section that are managable for assignments.

The text is organized and presented in a logical and clear fashion.

The text is free of significant interface issues. There were not any navigation or chart distortion issues on computer or phone display access.

The text was written without any noticeable grammatical errors. It was written at a level that a nurse could share the text with a family member and they could understand the information.

The text touches on a cultural diversity and end-of-life care in a very non-offensive way.

This text is a great addition to any course that discusses end of life. It touches on hospice and palliative care, as well as pain control when dying, all in one text. Many texts are lacking this combination.

Reviewed by Michael Torguson, MS, MA, Bioethicist; Past Chair for Education & Policy - Ethics Committee, Rogue Valley Medical Center (Medford, Oregon) on 8/21/16

Health Care is - by definition - a profession that is focused on preventing the end of life. This text aims to guide health care providers through the inevitable process that all patients will experience, divided into stages of care: Anticipation,... read more

Content is presented in as unbiased a manner as is possible with such a high-emotion subject.

Content is very timely and up to date. There are some references that are older (greater than 10 years), but they are included in such a way that the age of the study does not detract from the predominant thesis in each chapter.

Updating the work to include the latest trends in best clinical practices should not be difficult, as the compartmentalization of the information - while building on previous learning - is not so interwoven as to substantially detract from the flow of the narrative.

Written in such a way as to be accessible to a layperson not clinically trained, but also not too basic for the healthcare provider, the text is clear, concise, and accessible to the reader. When complex clinical information is presented, it is not dumped on the reader; rather there is a "ramp up" feel to the content.

There is good consistency in the book, as well as mercifully few "callback" references to earlier chapters.

The three main content areas (Units?) work well to guide the clinician through the process of learning about the end of life process. Within each of these units, however, the individual chapters - upon first reading - seem to require the healthcare provider to take each chapter in order. Once read and when the content is familiar, however, the chapters are useful as stand-alone references.

Highest marks for the organization and flow of the book. Leading the clinician through the death and dying process in a chronological "presentation of symptoms" order makes the text exceptionally well suited for this subject. Again, once the healthcare provider is familiar with the text, then accessing specific information in non-sequential chapters is not only possible, but easy.

This reviewer experienced no problems with the format of the text.

No errors in grammar, punctuation, or sentence structure/mechanics.

No text can be all things to all people. This text manages to hit the "middle of the bell-shaped curve" in that it is applicable to most people under most circumstances, most of the time. The Ethics chapter will be the most "controversial," as Ethics is - by definition - a morality based, Right-And-Wrong subject. Further, there is no overtly judgmental language when dealing with controversial topics (withdrawing/withholding care, assisted dying, etc.). Being from Oregon, I would have personally liked to see more than one paragraph on assisted suicide, but the author's treatment of the subject is satsifactory.

The layout of each chapter is especially useful. Starting with learning objectives bullet points, the author guides the reader through the content, then wraps up each chapter with three main bullet point "Things You Should Know." The text lends itself to note taking and information retention. Overall, a good text that will be useful to clinicians working with end of life patients, as well as a helpful adjunct for those in the healthcare realm (long term care, acute care, ethics committee, etc.) to supplement their understanding of the issues.

Reviewed by Tina Davis, Health Faculty, Lane Community College on 8/21/16

This book is very comprehensive in its coverage of the topics of nursing at the end of life. And although the book does not include a separate index or glossary, it does provide plenty of terms and definitions within the text in a thoughtful and... read more

I found the accuracy of this book to be excellent. With the exception of one small error of two words joined together, I found no other errors. And the inclusion of various perspectives provides an unbiased view of nursing in this context.

The relevance to today's nursing field and hospice care is extremely up-to-date. Having experienced my mother's and father's hospice care at different times within the last six years, I found the advice and information affirming and relevent. Obsolescence is easily avoided with supplementing information when it is necessary. The personal experiences and examples are timeless.

The terms were clearly defined and the examples provided the helpful context. The prose was very accessible and easy to follow and enjoyable to read without being too wordy or technical. For example, p. 60 clearly gives a thorough description of the classifications of pain and differentiating between the mechanisms and temporal patterns.

Each chapter is nicely framed, beginning with the objectives and moving to an introduction and the main ideas, then finishing with "what you should know." This framework provided an easy-to-follow pattern.

The book's modularity is wonderful. The three main parts I. Anticipation II. In The Moment and III. Afterwards provides structure of the individual chapters and their focus. This allows instructors to easily assign readings in individual sections. And the subheadings within the chapters are very useful.

The organization of the book showed topics divided into a simple sequence related to the care of the patient. The three major sections clearly follow the sequence related to the care of the patient. The chapters within the sections are logically divided and clearly presented. The subheadings within the chapters also makes it easy to find individual topics. And even though this book may target nurses, it is organized in a useful fashion for the patient and family member as well.

The figures and tables are nicely formatted and easy-to-read. The Models of Care (p. 39) figures were a bit confusing at first but the explanation in the text following the figures was provided and made it more clear. The tables provided easy-to-reference guides for such areas of questions to ask the patient as well as religious beliefs about death and dying.

I found no grammar errors and the language used corresponded to the nursing field but also provided concrete examples for the lay person.

The book mentioned consideration of different groups of people with its definition of 'diversity' on p. 109. It also provided different religious perspectives of death and dying in the chapter on Diversity and Dying. But more importantly the language and style of the book continually used phrasing of 'inclusiveness' and repeatedly cautioned the nurse to be aware of the care and communication with the patient and family so as not to offend or exclude anyone based on different cultural or ethnic backgrounds.

This book is a valuable resource for anyone, not just a nurse or caregiver, patient or family member of a patient. Its comprehensiveness and validity can be summed up with Susan Lowey's reminder about the importance of care a dying patient receives and how it may not be remembered by the nurse, but it will surely be remembered by the patient's family (p.94).

Part I. Anticipation

1. A Historical Overview of End-of-Life Care
2. Types and Variability within Illness Trajectories
3. Conceptual Frameworks Guiding Death & Dying
4. Models of Organized End-of-Life Care: Palliative Care vs. Hospice
5. Initiating Conversations about Goals of Care

Part II. In the Moment

6. Management of Pain and Physical Symptoms
7. Management of Emotional and Spiritual Distress
8. Ethical Concerns in End-of-Life Care
9. Care at the Time of Death
10. Nurse–Patient–Family Communication

Part III. Afterwards

11. Diversity in Dying: Death across Cultures
12. Grief and Bereavement

Ancillary Material

About the book.

Nursing Care at the End of Life: What Every Clinician Should Know should be an essential component of basic educational preparation for the professional registered nurse student. Recent studies show that only one in four nurses feel confident in caring for dying patients and their families and less than 2% of overall content in nursing textbooks is related to end-of-life care, despite the tremendous growth in palliative and end-of-life care programs across the country. The purpose of this textbook is to provide an indepth look at death and dying in this country, including the vital role of the nurse in assisting patients and families along the journey towards the end of life. There is an emphasis throughout the book on the simple, yet understated value of effective interpersonal communication between the patient and clinician. The text provides a basic foundation of understanding death and dying, including a brief historical examination of some main conceptual models associated with how patients cope with impending loss. An overview of illness trajectories and models of care, such as hospice and palliative care are discussed. Lastly, the latest evidence-based approaches for pain and symptom management, ethical concerns, cultural considerations, care at the time of death, and grief/bereavement are examined. The goal of this text is to foster the necessary skills for nurses to provide compassionate care to individuals who are nearing the end of life and their families. Every chapter contains a “What You Should Know” section which highlights and reinforces foundational concepts.

About the Contributors

Dr. Susan Lowey works with both juniors and seniors in the traditional Nursing program, teaching Community Health Nursing and Nursing Research at SUNY, Brockport. She earned her PhD in Health Practice Research from the University of Rochester and was awarded a Claire M. Fagin Fellowship from the Building Academic Geriatric Nursing Capacity Program for her post-doctoral work. Improving care at the end of life, with a particular focus on symptom management, is the focus of Dr. Lowey’s research. The majority of her clinical practice has been as a community health hospice nurse providing care for dying patients and their loved ones.

Dr. Lowey holds national certification as a board certified hospice and palliative care nurse (CHPN) through the National Board for Certification of Hospice and Palliative Nurses. In addition, she is a certified ELNEC (End-of-Life Nursing Education Consortium) trainer (Core and Geriatric). She is also an appointed member of the National Board for Certification of Hospice and Palliative Nurses Registered Nurse Examination Development Committee and holds another appointment as the ESPO Representative on the Membership Executive Committee through the Gerontological Society of America. Dr. Lowey also serves as one of the faculty representatives for Omicron Beta, Brockport’s Chapter of Sigma Theta Tau International Honor Society.

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IMAGES

What does an end-of-life care team do? [infographic]
Stages Of End Of Life Care
End-of-life Care
End of Life Nursing Diagnosis and Nursing Care Plan
End-of-life care in nursing and care homes
End of life care

VIDEO

English for Social Care: End of life Care
Quality of Life in the Long Term Care Setting
Empowering Palliative Nurses with the AdKinPal Program
Finding Time Alone as a Quadriplegic
@ashadkhanvlogs3987 the nursing life// nursing education Ashad khan vlogs // #shortsvideo #shorts
End-of-Life Care for People with Dementia with Barbara Karnes RN

COMMENTS

Care and Comfort at the End of Life">Providing Care and Comfort at the End of Life
Providing comfort and care for someone at the end of life can be physically and emotionally exhausting. If you are a primary caregiver, ask for help when you need it and accept help when it's offered.
Nursing Roles & Responsibilities - End of Life Care | ANA">Nursing Roles & Responsibilities - End of Life Care | ANA
Nurses are obliged to provide comprehensive and compassionate end-of-life care. This includes recognizing when death is near and conveying that information to families, surrogates, or health care agents.
Palliative & End-of-Life Care - AACN">Palliative & End-of-Life Care - AACN
End-of-life care generally refers to patient care before death, either while undergoing curative treatment or after deciding to focus on comfort rather than cure. With some serious illnesses, prognosis is uncertain and it is unclear if the care provided is end-of-life or life sustaining.
Nurses’ Roles and Responsibilities in - ANA Enterprise
Nurses will advocate for additional education in academic programs and work settings related to ethics education and palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients, families, surrogates, and health care agents.
End-of-Life (Hospice Care): Nursing Diagnoses & Care Plans">End-of-Life (Hospice Care): Nursing Diagnoses & Care Plans
End-of-life care focuses on the patient’s and family’s psychosocial and physical needs. Nursing care for end of life aims to provide support and comfort during the dying process, help ensure a dignified death, improve the quality of the patient’s life, and provide emotional support for the family.
End-of-Life Care (Hospice Care) Nursing Care Plans">4 End-of-Life Care (Hospice Care) Nursing Care Plans
Caring for a loved one at the end of their life can be a challenging and emotional experience. However, with the right nursing care plan in place, it can also be a time of peace, comfort, and dignity. In this article, we’ll explore the essential components of end-of-life care, including hospice care and nursing care plans. Table of Contents
Care and Hospice Care? - National Institute on Aging">What Are Palliative Care and Hospice Care? - National Institute...
Palliative care can start as early as a person’s diagnosis or not until later in their illness, and it can occur alongside other types of treatment for the disease. This form of care includes, but is not limited to, advance care planning, end-of-life care, hospice care, and bereavement support.
Nursing Care at the End of Life: What Every Clinician Should Know">Nursing Care at the End of Life: What Every Clinician Should Know
Nursing Care at the End of Life: What Every Clinician Should Know is a comprehensive book about caring for patients and families at the end of life. All areas and ideas related to nursing care at the end of life are included.
Life to Death: The Need for Honest, Compassionate, and ...">Bringing Life to Death: The Need for Honest, Compassionate, and...
•. Patients are interested in discussing their goals of care and end-of-life wishes. •. Education is generally lacking in end-of-life communication but can be improved upon. •. Care providers experience barriers to serious conversations at many levels. •. Communication skills can be honed with guided courses online and in person. •.
Managing care at the end of life : Nursing Management - LWW">Managing care at the end of life : Nursing Management - LWW
Nursing care is crucial for creating a peaceful end-of-life experience. Family—a term that includes all significant others—is an important part of end-of-life care. The goal isn't to optimize care by using the most cutting-edge, advanced treatment because this frequently results in overtreatment.