Palliative Care in Nursing and Healthcare


Michelle Brown

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    About the editor and contributors

    Michelle Brown currently works at the University of Derby as a senior lecturer. Her clinical practice has incorporated oncology and palliative care nursing. Before qualifying, she knew that caring for people with a life-limiting illness was what she wanted. Once qualified, after a small number of posts, she managed to attain a post on a gastrointestinal surgery ward. This often involved helping, supporting and caring for patients with a cancer diagnosis pre- and post-operatively. From there she spent a number of years in urology oncology research then working as a clinical nurse specialist. It was whilst working in this role, caring for individuals with a life-limiting illness, breaking bad news and liaising with palliative care specialists that she realised that she needed to be working in the palliative care field. She was fortunate enough to be able to undertake a Master’s degree in palliative care in the Trent Palliative Care Centre with the University of Sheffield. She felt inspired and applied for a hospice post. Although she was employed by the hospice, her role involved working in an acute Trust. This was demanding but rewarding. Referrals included cancer and non-cancer diagnoses but in addition there were a number of patients who were cancer survivors. Unfortunately there was little time for teaching other than ad-hoc, micro-teaching with nursing and medical staff. Michelle really wanted to improve the care that patients and their loved ones received, therefore, she made a very difficult decision and applied for a lecturing post. This post has given Michelle the flexibility to write, maintain clinical practice when she can, but also to try to inspire others as she had been during her Master’s degree. Michelle sincerely hopes that this book will help you understand her passion but also help you to develop your skills and knowledge in order to provide high-quality palliative and end of life care to those with a life-limiting illness.

    Martin Brock (MSc) is a Registered Mental Health Nurse and an accredited Cognitive Behavioural Psychotherapist with some 34 years clinical experience. He has trained clinically in Acceptance and Commitment Therapy, Compassion Focused Therapy and Mindfulness Based Cognitive Therapy and has a thriving private practice. Martin is a fellow of the Higher Education Academy in the UK and a Senior Lecturer at the University of Derby with a specific focus on teaching and researching compassionate practice in healthcare.

    Kersten Hardy works in the community as a Band 5 Staff Nurse, a post she has held since June 2014. Within this role, Kersten cares for many vulnerable and dependent patients in their own home that need the input of a registered nurse, but do not require admission into hospital. This role puts her in contact with many different health needs and disciplines, predominantly, and most importantly, patients who require palliative/supportive and end of life care, but wish to stay in their home environment. Kersten found palliative care almost by accident, starting work as a care assistant at a local hospice in 2001. In the first few weeks she feared this environment was not somewhere she could work and began to look for another job, but seven years later she was still working at the hospice and was extremely passionate about the care and service delivered to all that needed help. Kersten was encouraged and supported to train as a nurse, which she did, qualifying in May 2010 with an Advanced Diploma in Nursing Studies from the University of Derby. In September 2011 Kersten was lucky enough to secure a job back at her local hospice where it all began. She continued in her role but the more she thought about the role the more she wanted to focus on delivering palliative care to patients in their own homes, so she searched for an area of work that would enable her to do this, which brings her to where she is today. Kersten continued her education and topped her ADNS into a BSc, inclusive of a palliative care module and focusing her dissertation on ‘delirium at the end of life’, obtaining a first class honours. In the 14 years that Kersten has been in the palliative care environment she has seen many changes in the treatment and management of many life-limiting illnesses, as well as the positive impact of good palliative/supportive care and the areas that still need a lot of input. She hopes, in the future, to be able to contribute to the fast moving developments, but in the interim she will continue to do what she can, where she can, to ensure good patient care and will work towards starting and completing a MSc in Supportive and Palliative Care.

    About this book

    I would like to inspire and help all those interested in delivering the best care: this book encourages reflection around your own experiences but also introduces a number of case studies to help make sense of the theories, policies and guidance which support palliative and end of life care delivery. An international perspective is also provided, as the evidence suggests that there are issues surrounding care at the end of life globally. This book is suitable for undergraduate students and for postgraduate healthcare professionals who want a practical book to help them make sense of caring for an individual with a life-limiting illness.

    Chapter 1 examines palliative care from a historical perspective, and then goes on to look at the present and what the future holds. It examines some of the fundamental issues in palliative and supportive care.

    Chapter 2 discusses care and compassion for those with a life-limiting illness and addresses the needs of those with cancer and non-cancer diagnoses. It addresses quality in palliative care and how we can achieve it using a team approach.

    Chapter 3 examines holistic assessment and why this is paramount when caring for an individual with a life-limiting illness. A number of assessment tools are considered, as is the contribution that the interprofessional team can make to holistic care.

    Chapter 4 looks at planning care. It covers the why, what and how of care planning. Care planning will be discussed in general followed by an examination of care planning for those with a life-limiting illness and through to end of life care.

    Chapter 5 addresses carers’ needs. Caring has a significant impact on carers’ health and this will be discussed within the chapter. Suggestions will be made regarding how we can help carers continue to provide care.

    Chapter 6 discusses the interprofessional approach to care. It will explore team roles and how they may contribute to the delivery of high-quality palliative and end of life care. Some challenges to effective interprofessional working are also addressed.

    Chapter 7 examines communication in palliative and end of life care. It discusses the importance of communication when an individual is faced with their own mortality. The evidence surrounding what people want from healthcare professionals at the end of life will also be explored.

    Chapter 8 discusses some key ethical issues in palliative and end of life care. The role ethics plays in helping to make difficult decisions will be explored. A number of legal concerns will also be examined, e.g. the Mental Capacity Act.

    Chapter 9 addresses end of life care. Philosophies underpinning end of life care as well as some of the difficulties and challenges that face healthcare professionals, patients and carers when an individual is approaching end of life.

    Chapter 10 looks at death and dying. Establishing when time is short for your patient is often one of the key issues in end of life care. This will be addressed and the chapter explores a ‘good death’.

    Chapter 11, the final chapter, is a restorative chapter. It is there to ensure you have the ability to care for yourself. Palliative and end of life care can be challenging. What we need to ensure is that we have the ability to maintain a compassionate approach and to achieve this we need to be compassionate to ourselves. This chapter contains some useful advice and help. It suggests exercises to do in order to maintain your self-compassion and prevent the potential for emotional fatigue.

    How to use this book

    This book can be read from cover to cover during your studies, and you can also dip in and out of it once you qualify to help you reflect on particular issues or concerns you may come across during practice. There are useful reflective case studies to help make sense of the discussion and add some reality to the text. There is also some recommended reading which supports each specific chapter.

    The philosophy of this book is that it should be easy to read and engaging, but also should inspire you to make a difference by delivering high-quality palliative and end of life care with a little more confidence.

    And finally! High-quality palliative care is not just about doing your job well and making sure people are safe, it is about life and death. The experience touches a huge number of people’s lives. You can have a positive effect on not only the patients’ lives but also that of their carers’ and loved ones, and that memory will live on.

    Michelle Brown

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