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When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily. While an "overtreated" dying is feared, untreated pain or emotional abandonment are equally frightening. Approaching Death reflects a wide-ranging effort to understand what we know about care at the end of life, what we have yet to learn, and what we know but do not adequately apply. It seeks to build understanding of what constitutes good care for the dying and offers recommendations to decisionmakers that address specific barriers to achieving good care. This volume offers a profile of when, where, and how Americans die. It examines the dimensions of caring at the end of life: Determining diagnosis and prognosis and communicating these to patient and family. Establishing clinical and personal goals. Matching physical, psychological, spiritual, and practical care strategies to the patient's values and circumstances. Approaching Death considers the dying experience in hospitals, nursing homes, and other settings and the role of interdisciplinary teams and managed care. It offers perspectives on quality measurement and improvement, the role of practice guidelines, cost concerns, and legal issues such as assisted suicide. The book proposes how health professionals can become better prepared to care well for those who are dying and to understand that these are not patients for whom "nothing can be done."
Originally published as a series of articles in Missouri medicine.
Revised edition of the best-selling memoir that has been read by over a million people worldwide with translations in 29 languages. After too many years of unfulfilling work, Bronnie Ware began searching for a job with heart. Despite having no formal qualifications or previous experience in the field, she found herself working in palliative care. During the time she spent tending to those who were dying, Bronnie's life was transformed. Later, she wrote an Internet blog post, outlining the most common regrets that the people she had cared for had expressed. The post gained so much momentum that it was viewed by more than three million readers worldwide in its first year. At the request of many, Bronnie subsequently wrote a book, The Top Five Regrets of the Dying, to share her story. Bronnie has had a colourful and diverse life. By applying the lessons of those nearing their death to her own life, she developed an understanding that it is possible for everyone, if we make the right choices, to die with peace of mind. In this revised edition of the best-selling memoir that has been read by over a million people worldwide, with translations in 29 languages, Bronnie expresses how significant these regrets are and how we can positively address these issues while we still have the time. The Top Five Regrets of the Dying gives hope for a better world. It is a courageous, life-changing book that will leave you feeling more compassionate and inspired to live the life you are truly here to live.
A Field Manual for Palliative Care in Humanitarian Crises represents the first-ever effort at educating and providing guidance for clinicians not formally trained in palliative care in how to incorporate its principles into their work in crisis situations. A Field Manual for Palliative Care in Humanitarian Crises represents the first-ever effort at educating and providing guidance for clinicians not formally trained in palliative care in how to incorporate its principles into their work in crisis situations.
For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.
Taking as its focus a highly emotive area of study, The Dying Process draws on the experiences of daycare and hospice patients to provide a forceful new analysis of the period of decline prior to death. Placing the bodily realities of dying very firmly centre stage and questioning the ideology central to the modern hospice movement of enabling patients to 'live until they die', Julia Lawton shows how our concept of a 'good death' is open to interpretation. Her study examines the non-negotiable effects of a patient's bodily deterioration on their sense of self and, in so doing, offers a powerful new perspective in embodiment and emotion in death and dying. A detailed and subtle ethnographic study, The Dying Process engages with a range of deeply complex and ethically contentious issues surrounding the care of dying patients in hospices and elsewhere.
Practicing nurse and New York Times columnist Theresa Brown invites us to experience not just a day in the life of a nurse but all the life that happens in just one day on a busy teaching hospital’s cancer ward. In the span of twelve hours, lives can be lost, life-altering treatment decisions made, and dreams fulfilled or irrevocably stolen. Unfolding in real time--under the watchful eyes of this dedicated professional and insightful chronicler of events--The Shift gives an unprecedented view into the individual struggles as well as the larger truths about medicine in this country. By shift’s end, we have witnessed something profound about hope and humanity.
This second edition provides the most up-to-date information on all aspects of palliative care including recent developments (including COVID-19), global policies, service provision, symptom management, professional aspects, organization of services, palliative care for specific populations, palliative care emergencies, ethical issues in palliative care, research in palliative care, public health approaches and financial aspects of care. This new Textbook of Palliative Care remains a unique, comprehensive, clinically relevant and state-of-the art book, aimed at advancing palliative care as a science, a clinical practice and as an art. Palliative care has been part of healthcare for over fifty years but we still needs to be explained. Healthcare education and training has been slow to recognize the vital importance of ensuring that all practitioners have a good understanding of what is involved in the care of people with serious or advanced illnesses and theirfamilies. However, the science of palliative care is advancing and this new edition will contribute to a better understanding of this specialty. This new edition offers 20 new chapters out of over 120, written by experts in their given fields provide up-to-date information on a wide range of topics of relevance to those providing care towards the end of life no matter what the disease may be. We present a global perspective on contemporary and classic issues in palliative care with authors from a wide range of disciplines involved in this essential aspect of care. The Textbook includes sections addressing aspects such as symptom management and care provision, organization of care in different settings, care in specific disease groups, palliative care emergencies, ethics, public health approaches and research in palliative care. This new Textbook will be of value to practitioners in all disciplines and professions where the care of people approaching death is important, specialists as well as non-specialists, in any setting where people with serious advanced illnesses are residing. It is also an important resource for researchers, policy-and decision-makers at national or regional levels. Neither the science nor the art of palliative care will stand still so the Editors and contributors from all over the world aim to keep this Textbook updated so that the reader can find new evidence and approaches to care.
Changes in health care have dramatically altered the experience of dying in America. At the turn of the twentieth century, medicine’s imperative to cure disease increasingly took priority over the demand to relieve pain and suffering at the end of life. Filled with heartbreaking stories, The Inevitable Hour demonstrates that professional attention and resources gradually were diverted from dying patients. Emily K. Abel challenges three myths about health care and dying in America. First, that medicine has always sought authority over death and dying; second, that medicine superseded the role of families and spirituality at the end of life; and finally, that only with the advent of the high-tech hospital did an institutional death become dehumanized. Abel shows that hospitals resisted accepting dying patients and often worked hard to move them elsewhere. Poor, terminally ill patients, for example, were shipped from Bellevue Hospital in open boats across the East River to Blackwell’s Island, where they died in hovels, mostly without medical care. Some terminal patients were not forced to leave, yet long before the advent of feeding tubes and respirators, dying in a hospital was a profoundly dehumanizing experience. With technological advances, passage of the Social Security Act, and enactment of Medicare and Medicaid, almshouses slowly disappeared and conditions for dying patients improved—though, as Abel argues, the prejudices and approaches of the past are still with us. The problems that plagued nineteenth-century almshouses can be found in many nursing homes today, where residents often receive substandard treatment. A frank portrayal of the medical care of dying people past and present, The Inevitable Hour helps to explain why a movement to restore dignity to the dying arose in the early 1970s and why its goals have been so difficult to achieve.
The second edition of a succinct and portable text reviewing the clinical approach to emergency medicine and critical care.