Palliative Care Nursing: Principles and Evidence for Practice

Sheila Payne, Jane Seymour and Christine Ingleton

Fifty-six million people die in the world each year (World Health Organization 2002). Some infants may die after just a few hours or days of life, while other people die many decades after birth in late old age (Nuland 1994). Death may come in many different ways, such as after an acute illness, as a result of a sudden violent road accident, on the battlefield, following a chronic illness or after a prolonged decline in physical fitness in late old age. While all of us will die, most of us cannot determine the manner of our dying. According to the World Health Organization (2002), approximately 40 per cent of deaths worldwide are related to 11 risks: being underweight (especially for women and children), unsafe sexual behaviour, hypertension, tobacco use, alcohol consumption, unsafe water, lack of sanitation, high cholesterol, indoor smoke from cooking and heating fires, iron deficiency anaemia and obesity. There are stark contrasts between causes of death in different parts of the world, and in overall life expectancy and in healthy life expectancy. In the developed world, death is no longer common in infants and young people, but it is most frequently associated with chronic illness and occurs in later life. It has been estimated that approximately 60 per cent of all deaths worldwide could be amenable to palliative care interventions. However, health care agendas, the organization and funding of health care services, and resources for health and social care are remarkably variable throughout the world (Sepulveda et al. 2002). So the majority of dying people do not benefit from supportive and palliative care or even have sufficient access to medication to relieve suffering.

This book is about the care of people facing death, both those who will die and those who accompany them – families, friends, community supporters, volunteer workers, health and social care workers. In particular, the book focuses on the role of nurses in providing care during the trajectory of advanced illness, through the process of dying and in the respectful care of the dead person. Nurses generally work closely with family members, supporting them through the process of illness and bereavement. We have focused attention on those who die as adults rather than those who die as babies and young children. Paediatric palliative nursing care is an important topic but requires the attention of a different book. However, dying adults are often in relationships with children as parents, grandparents or guardians, so to ensure the needs of children are not overlooked a chapter about services for bereaved children has been included.

The palliation of distressing symptoms, the care of patients approaching death, the laying out of the body and the care of newly bereaved relatives have long formed an important part of nursing work. In the latter part of the twentieth century, the emergence of the modern hospice movement has provided an impetus to reconceptualizing the delivery of some aspects of

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