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Fundamental Aspects of Palliative Care Nursing, 2nd Edition
Quay books, Feb 2010, Pages: 370
It is now five years since the first edition of this book was published and whilst the core skills and behaviours required to care for the dying in multiple environments have remained constant, the knowledge base to support this care has developed and changed in some important areas. It is appropriate therefore that this second edition takes a fresh look at the new evidence- and practice-based experience that has become available to inform care in this dynamic area.
The primary focus of the book is now on student nurses, who have many competing demands during their education, but are consistently exposed to palliative care scenarios throughout their three-year training and find such care emotionally exhausting and academically challenging. They care very much about getting it right, and whilst there are numerous high-quality books on the market that are available to support academic study in this area, this book is currently the only one specifically designed for their learning needs in everyday clinical practice.
Rather than providing a detailed meta-analysis of theoretical and research-based concepts, the emphasis in the text is on dealing with practice-based situations in a sensitive and informed way. This second edition is therefore designed to be a compact, learning-oriented, evidence-based handbook which offers comprehensive, practice guidelines across the spectrum of palliative/end of life care scenarios to provide a trigger and opportunity for reflection and learning.
The authors have taken the opportunity to redesign the layout of the chapters to make them more structured and user friendly by the use of symbols to help the reader easily locate the relevant information they need. It also includes some educationally important elements, such as learning outcomes at the outset of each chapter to guide the reader, reflective points and activities to help with professional development, and self-assessment multiple choice tests at the conclusion of each chapter to consolidate learning. There is even a true or false quiz offered for those who would like to test their knowledge before or after their studies. The short clinical anecdotes at the outset of each chapter which served well to set the scene in the first edition have been retained and changed only where necessary.
Several new chapters have also been added to help readers make sense of the range of new initiatives that have come to the fore in palliative care in the last five years. Even the language has changed and we now hear the term ‘end of life care’ used in many contexts where ‘palliative’ was used before. Essentially they are one and the same, but government strategy and policy documents have introduced this phrase for a good reason. The term ‘palliative’, whilst generic in its meaning and intent, has nevertheless become synonymous with hospices, specialisation and above all cancer. There is a real need to find a term that is clearly understood by the general public and embraces caring for the dying of whatever diagnosis in whatever environment. ‘End of life care’ does just that and signals an intent to meet everyone’s needs.
Overall, the integrity of the text remains fundamentally the same. It was the intention with the first edition to produce a book that was very much an evidence-based ‘how to do it’ text, and feedback from many sources (including the formal reviews), confirmed that this was a successful and much appreciated approach. It is with this in mind that the focus was moved towards student nurses and their learning needs. Post-registration learning opportunities in palliative care abound in the UK for qualified nurses, with a proliferation of study courses available in both the higher education sector and local hospices. Some are tied to academic pathways, while others offer a more flexible online or distance learning approach. Each has its merits and the growth of such educational opportunity has undoubtedly contributed greatly to the high degree of skills employed by nurses in many sectors of healthcare where end of life issues are of importance.
Pre-registration nursing curricula are constantly developing alongside service developments to reflect the need for nurses to be well prepared for the demands of clinical practice in many environments. The learning needs in a palliative context of the next generation of nurses have, however, been systematically ignored by successive statutory bodies. There remains to this day no formal imperative to include any specific end of life care content in the preregistration nursing curricula on any part of the nursing register. Consequently, provision ranges from the fully integrated and structured module through to the odd lecture given by a local clinical nurse specialist if they can spare the time and have the skills. This is simply not good enough. As any competent educator will confirm, if you can inform, inspire and shape attitudes, skills and behaviours at the outset of a career, then nurses will carry this learning with them throughout their working lives. The potential therefore to empower the role models of the future is enormous, and whilst crowded curricula and complex politics may preclude more formal inclusion of palliative care knowledge in the short term, it is hoped that in some small way this text will fill a much needed gap in the market and provide students of nursing with a user-friendly but challenging reference book that will help them in both their studies and – more importantly – at the bedside of those who die in multiple environments across the healthcare system.
The Nursing and Midwifery Council of the UK published a new edition of their Code of Professional Conduct in 2008, so the links to appropriate clauses that are relevant to chapter content have been updated accordingly. It is now more important than ever for nurses to be able to utilise the code to support care, so that they can assure themselves of delivering best practice at all times.
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