Palliative care nursing: a continuum of practice from a generalized approach to a specialized disciplinePallative Care Nursing. A Guide to Practice, 2nd ed. Edited by Margaret O'Connor and Sanchia Aranda Published by Radcliffe Medical Press, Oxford, United Kingdom, 2003387 pages, $dollar;60 (soft cover)

Abstract

This palliative care nursing guide to practice is highly recommended, and will help any nurse caring for a patient with progressive debilitating disease to understand, individualize and provide the care that is needed. It is especially useful as an introductory text for those new to the field, but seasoned palliative care practitioners will also benefit from reading this text. Written in the main by nurses practicing in Australia and England, this book provides a broad framework for evidence-based palliative care nursing. This second edition has been expanded to include some international authors, although the practice models tend to be those of Australia and England. The nursing principles and practices described, however, have universal applicability. The text is rich with references and is of a size and format that makes it user friendly. Its organization rightly reflects the importance of communication skills, understanding nursing stressors in palliative care, as well as ethical decision-making and spirituality as a prelude to approaching other aspects of palliative care. The book is divided into 24 chapters, each of which starts with a brief introduction about the author and his/her clinical setting. This format is useful as it illustrates the wide arena within which palliative care is practiced. The chapters are organized into three main sections. The first section, “Framing Palliative Care,” includes chapters on the principles of evidence-based practice, communication skills in palliative care, occupational stress in palliative care, ethical decision-making, and spiritual care. The section on “Symptom Control” includes chapters on pain management, breathlessness, fatigue, constipation, nausea and vomiting, nutrition and hydration, malignant wounds, confusion and terminal restlessness, psychological and existential distress, sexuality and body image, and complementary therapies. The third section includes areas that are frequently lacking in palliative care texts, including chapters on working with families, bereavement, palliative care in chronic illness, aging, dementia and palliative care, caring for dying patients in critical care, and pediatric palliative care. The selective use of case studies in several of the chapters, a long nursing tradition, is a helpful way of illustrating key points. The case studies are particularly helpful in the chapters on ethical decision-making, spiritual care, and confusion and restlessness. Broad principles of nursing assessment and management underpin each of the chapters. Where pharmacotherapy is discussed, some chapters are quite specific regarding a step-by-step approach to symptom management (e.g., the management of constipation), while others are more general. For the more general chapters, the nurse will need to refer to other texts to get specifics on the “how to.” In each chapter, however, nursing care and the pivotal role of the nurse in facilitating palliative care for the patient, is strongly evident. This palliative care nursing guide to practice stands out in its recognition that nurses working with progressive, incurable illness and associated distressing symptom clusters need the tools to analyze and evaluate the literature and research that informs their clinical practice. The chapter on evidence-based practice provides both the insight and tools that make this possible. Lucid and practical checklists are provided for assessing the validity of both quantitative and qualitative research studies. This book beautifully illustrates the depth and rewards of palliative care nursing as a continuum of practice—from a generalized approach helpful to most patients to a specialized discipline in caring for the terminally ill.