Palliative Practices From A-Z for the Bedside Clinician (Second Edition)

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Foreword
Kim K. Kuebler, MN, RN, APRN-BC

It is the clinician who walks along the path with the patient and his or her family when they receive the diagnosis of a life-limiting malignancy. It is the clinician who listens to the patient when he or she describes the intensity of symptoms and their effect upon the patient’s perceived quality of life. It is the clinician who acts as a patient advocate when reporting patient assessments to the healthcare team and ensuring that appropriate interventions will be initiated into the patient’s plan of care. It is the clinician who recognizes the value and importance of applying current evidence-based practice interventions into the management of advanced illness and influencing positive patient-centered outcomes.

Bedside clinicians who provide palliative care require the best evidence to support the skills and knowledge necessary to effectively manage multiple symptoms, address psychological and spiritual issues of patients and families, and help patients to make important healthcare decisions when facing advanced illness. Clinicians who apply the best evidence into clinical practice ensure optimal quality of life for the patient. When evidence-based assessments and interventions are considered thoughtfully by the clinician and combined with the goals of the patient and his or her family, clinical decision making should promote desired patient outcomes (Rutledge & Kuebler, 2005).

The lack of evidence-based care provided to patients with palliative care needs has been well documented over the past decade, and several initiatives have arisen from this burgeoning need. For the first time in history, Americans are living longer and, with a predicted increase in the number of malignancies, will require clinicians skilled in palliative management.

Use of psychometrically sound assessment tools to evaluate specific symptoms and the integration of selected interventions that have been trialed successfully and evaluated effectively promote positive patient outcomes. Understanding specific disease pathophysiology and ensuring the appropriate interventions are used to enable effective metabolism are key to optimal palliative symptom management.

Effective palliative management does not occur from a “cookbook” approach but rather from a patient-specific approach that requires ongoing evaluation of specific disease, concomitant diseases, organ function, metabolism capacity, substance history, psychosocial support systems, and patient participation in his or her plan of care. The clinician can facilitate the conduit of care between the healthcare system and the patient. The clinician is able to hold the lantern, casting light along the trajectory of disease that will allow the patient and family to “live until they die” (Saunders & Baines, 1984, p. 10).

The editors of this second edition have enlisted leaders and experts in the field of palliative care to provide the most current evidence to consider when integrating specific interventions into the patient’s plan of care. Understanding the evidence is always important, but more importantly, clinicians must recognize that each patient is unique and that not all interventions effectively work from one patient to another. Through sequential trials of interventions and dosing, the clinician, together with the healthcare team, will discover the best patient results.

References

Rutledge, D.N., & Kuebler, K.K. (2005). Applying evidence to palliative care. Seminars in Oncology Nursing, 21, 36–43.

Saunders, C., & Baines, M. (1984). Living with dying: The management of terminal disease. Oxford, UK: Oxford University Press.