Chapter 11: End-of-Life and Palliative Care
End-of-life care (EOL care) is the term currently used to describe issues related to dying and
EOL care focuses on the physical and psychosocial needs of the patients and their families at the
end of life.
Death is the irreversible cessation of circulatory and respiratory function or the irreversible
cessation of all functions of the entire brain, including the brainstem.
Bereavement is an individual’s emotional response to the loss of a significant person.
Grief develops from bereavement and is a dynamic psychologic and physiologic response
following the loss.
Assessment of spiritual needs in EOL care is a key consideration.
Family involvement is integral to providing culturally competent EOL care.
Persons who are legally competent may choose organ donation.
Advance care planning is focused on anticipated challenges that the patient and family will face
because of illness, medical treatment, and other concerns.
The nurse needs to be aware of legal issues and the wishes of the patient.
Advance directives and organ donor information should be located in the medical record and
identified on the patient’s record and/or the nursing care plan.
Palliative care is the active total care of patients whose disease is not responsive to curative
treatment. Palliative care focuses on controlling pain and other symptoms, as well as reducing
psychologic, social, and spiritual distress for the patient and the family. Palliative care is the framework for hospice care. Palliative care can start much earlier in a
disease process, whereas hospice traditionally is limited to the projected last 6 months of life.
Admission to a hospice program has two criteria: (1) the patient must desire the services; and
(2) a physician must certify that the patient has 6 months or less to live.
The objective of a bereavement program is to provide support and to assist survivors in the
transition to a life without the deceased person.
The physical assessment is abbreviated in EOL care and focuses on changes that accompany
terminal illness and the specific disease process.