Pain Management and Palliative Pharmacology

The essence of nursing care continually exposes nurses to suffering. Although they bear witness to the suffering of others, their own suffering is less frequently exposed. This book attempts to give voice to the suffering that nurses witness in patients, families, colleagues, and themselves. By making this suffering visible, the book aims both to honor and help solve the problem. The book offers nurses' colleagues in other professions — social workers, psychologists, chaplains, ethicists, and physicians — a window onto what it means to practice nursing.

In most patients, pain medication, along with physical therapy and supportive counselling, adequately controls the pain of terminal disease, but in some cases pain medication fails or produces unacceptable side effects, and other more invasive interventions may be used. This book provides guidelines on nerve blocking and neuromodulation techniques to help patients and professionals make choices in pain management. Patient selection and appropriate referral are discussed as well as ethical issues and consent. The book outlines the full range of techniques considered to provide excellent care for patients with pain that is difficult to manage and will be a source of information for a variety of professionals working with patients with advanced disease, including palliative care doctors and specialist nurses.

Consultants and nurses in palliative medicine who do not have a background in oncology need to know about the different types of cancer to be able to deal with palliation in these patients. The new edition of this book continues to provide comprehensive coverage of cancer management aimed at palliative care professionals. To aid understanding in the specialty, the format of the book has been thoroughly revised to include numerous tables, figures, algorithms, case histories, and key points to ensure that it will prove an invaluable, practical guide to oncology for all health care professionals involved in the care of patients with malignant disease. It provides a comprehensive overview of the management of malignant disease from the perspective of palliative medicine. The pathology, diagnosis, and management of individual tumour sites are described, with an emphasis on the symptoms produced in advanced disease and the place of oncological treatment in their management. Introductory chapters present the principles of oncological management, and later chapters address specific symptoms from the viewpoint of their pathophysiology and management. Each chapter is enhanced by typical case histories and patient journeys.

Lesions of the oral cavity have an enormous impact on the quality of life of patients with advanced disease. They cause considerable morbidity and diminish a patient's physical and psychological well being. Oral complications impair oral nutrition and can cause a variety of problems including malnutrition, anorexia, and cachexia. Psychological problems relate to the role that the oral cavity plays in communication and social life. This book provides comprehensive, clinically relevant, evidence-based guidelines on oral problems to ensure first-rate care. The scientific foundations and research base for their management underpin the discussion throughout. A multi-disciplinary group of contributors provide authoritative guidelines on clinical features, investigations, and pharmacological and non-pharmacological treatment, as well as complementary therapies. Chapters cover oral assessment, hygiene, domiciliary dental care, infections, taste disturbance, pain, HIV infection and AIDS, neurological diseases, and paediatric problems.

Hospital palliative care teams have been established in rapidly increasing numbers over the last twenty, as it has been recognised that hospices can never transfer the philosophy and practice of palliative care into the acute sector by simply existing; they often work as ‘stand alone units’ and remain outside mainstream medicine. However it has become apparent that improving access to palliative care for patients in acute hospitals is not as easy as employing external palliative care specialists as consultants. Even setting up a team of professionals who work solely in a hospital will often not improve the care of the great majority of patients being treated there. Based on the experience and knowledge of three clinicians in the area who have developed palliative care services in acute settings, this book provides those facing the same challenges with guidance and advice on a range of problems they might encounter. Using a problem focused and practical approach, this guide is filled with case-based problems to help with the identification of realistic, usable, everyday solutions. It also covers the skills and knowledge needed to help teams make progress in the hospital as well as outlining the best training to help professionals continue to flourish.

Most people with far-advanced illness wish to be cared for at home for as long as possible. The challenge of providing good palliative care at home is therefore of major importance for family doctors, nurses, and all those committed to maintaining the highest possible quality of life for the dying person. As modern specialist palliative care has raised both standards of care and also public expectations of family doctors and community nurses, this book helps to place specialist care in context. As palliative care is a major responsibility for teams providing care at home, the book provides a definitive guide on how to provide effective care for people with far-advanced disease. It has been written by two palliative specialists, both of whom have been family doctors. The book deals with all the physical, emotional, spiritual, and social problems that will be encountered by family doctors and community nurses caring for patients and relatives in a home setting. It deals in detail with emergencies, communications, and ethical issues, and emphasises throughout the importance of team work.

Drawing from his extensive clinical experience and many years of teaching, the author of this book has written a guide to palliative care for clinicians. The topics addressed range from an overview of death and dying to specific approaches to symptom management. As an introduction to both the art and science of palliative care, the book reflects the perspectives of one physician who has dedicated his career to this rapidly evolving field. It links real stories of illness with practical advice, thereby delineating clinical practice in a way that reflects the daily concerns of clinicians.

Day care for people with advanced diseases is one of the most rapidly expanding components of palliative care in the UK, and is increasingly a focus of new-service development throughout the world. Many benefits, in terms of quality of life, holistic care for the patient and family and increased time at home are claimed by day care. This book provides a comprehensive overview of the current philosophy, patterns, and policies of palliative day care. It places emphasis on the need to evaluate performance in palliative day care and describes in detail aspects such as audit, health economics, and research, and their associated problems and pitfalls. For readers new to the field it aims to survey the broad concepts and components of palliative day care and the philosophies and practical issues that relate to them. For those more experienced in the field, it seeks to highlight some of the questions, challenges, and dilemmas that palliative day care services face and which will need to be addressed in the years ahead.

Supportive care can be thought of as an extension of palliative care so that the person with dementia receives good quality, holistic care that makes no distinctions between the dichotomies of care and cure from the time of diagnosis until, and beyond, death. It recognizes the need for an inter-disciplinary approach and for continuity of care. Supportive care in dementia must, therefore, be broad in its scope and application. This book provides such a perspective, drawing upon the experience and expertise of a wide range of internationally-based professionals to outline a model of supportive care that will provide good quality and holistic care for people with dementia. Making use of real-life reports from both patients and carers to help readers fully understand the reality of dementia, the book examines the key principles that guide the practice of supportive care. It looks at how supportive care can be used, and specific benefits a care model of this type can bring to the complex problems that are frequently encountered when treating this condition.

This book provides an evidence-based overview of supportive care for the nephrology patient. An international group of contributors emphasize the continuum of palliative care from the time of diagnosis through to end-of-life care and the issues surrounding withdrawal of dialysis. The book addresses the psychological impact of the disease, the importance of involving the patient in making decisions about their care, ethical considerations, the role of the family and the multidisciplinary team. This second edition includes two new chapters on conservative management of advanced kidney disease (AKD) and dialysis in the very elderly. The chapters covering non pain symptoms, advance care planning, quality of life, psychological and psychiatric consideration, and end-of-life care have also be completely revised to include new evidence and current thinking.