The Nursing clinics of North America
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Palliative sedation has become a standard practice to treat refractory symptoms at end-of-life. Dyspnea and delirium are the two most commonly treated symptoms. The medications used in palliative sedation are usually benzodiazepines, barbiturates, antipsychotics, and/or anesthetics. Some ethical considerations remain, especially surrounding the use of palliative sedation in psychological distress and existential suffering.
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Nurs. Clin. North Am. · Sep 2016
Review Case ReportsPain Management in the Individual with Serious Illness and Comorbid Substance Use Disorder.
Pain is a common occurrence in individuals with serious illnesses. Effective pain management can be complicated when the individual has a comorbid substance use disorder. Comprehensive pain assessment includes opioid risk screening to provide safe and effective pain management. An appropriate, safe treatment plan includes the use of "universal precautions" commonly used in managing chronic pain.
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Nurs. Clin. North Am. · Sep 2016
ReviewPain Assessment in Noncommunicative Adult Palliative Care Patients.
Palliative care patients who have pain are often unable to self-report their pain, placing them at increased risk for underrecognized and undertreated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for noncommunicative adult patients.
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Nurs. Clin. North Am. · Sep 2016
Review Case ReportsSeeing the Light: End-of-Life Experiences-Visions, Energy Surges, and Other Death Bed Phenomena.
Spiritual care is an integral part of multidimensional palliative care and a major domain of care identified in definitions and guidelines. Death bed phenomena include visions, dreams, hallucinations, and premortem energy surges, which can be deeply spiritual experiences. ⋯ The last hours of life are sacred; as holistic, multidimensional practitioners, nurses should remain open to experiences not easily explained within a traditional medical model. As the most consistent caregivers, nurses assess, recognize, and validate such experiences to assist patients in finding meaning, comfort, and a peaceful end-of-life.
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Understanding the significance of rituals at the end-of-life enables health care professionals to offer meaningful and compassionate interventions that enhance quality of life and support those dying and those who grieve. Rituals contribute to the strength, capacity, and health of providers who cope with death events. Rituals help the living create continuing bonds with those dying, help with coping skills, and allow healthy growth through opportunities for naming, honoring, and memorializing. The display of respect and a nonjudgmental attitude create a space for support, trust, sharing of emotion, empowerment, and quality of care during end-of-life events.