To Comfort Always: A Nurse's Guide to End-Of-Life Care

209 Pages·2014·0.93 MB·English

by  Linda Norlander

Praise for To Comfort Always
“Linda Norlander has leveraged her many years of direct patient care, teaching,
and research experience to simplify the critical elements of hospice and palliative
care. For nursing professionals who are new to the field, this valuable resource
presents a practical way to assess, advocate for, and guide patients and their
families through the end-of-life care process.”
–Barry K. Baines, MD
Medical Director, Sholom-Johnson Hospice
Associate Medical Director, Hospice of the Twin Cities
“Care of seriously ill and dying patients and their families is essential work of
nurses across all settings of care. This book is a primer that should be essential
reading for all nurses. Using a paradigm of nurses as clinicians, advocates, and
guides, this book is both a ‘nuts and bolts’ toolkit of knowledge to guide care but
also an eloquent statement of the spiritual nature of this work we are privileged to
provide as nurses.”
–Betty R. Ferrell, PhD, RN, MA, FAAN, FPCN, CHPN
Director and Professor, Department of Nursing Research and Education
City of Hope National Medical Center
“Linda Norlander remembers her own early experiences of feeling unprepared to
meet the needs of people approaching the end of life, and these people have framed
and guided her career. She is passionate about supporting nurses in providing
competent, compassionate care for terminally ill and dying patients and their
families, no matter what the setting. Norlander understands that not all nurses
who care for dying patients do so in the context of hospice, and this book is a quick,
accessible resource to help them in this work.”
–Kerstin Lappen, MS, RN, ACNS-BC, ACHPN
Palliative Care Consultant
Abbott Northwestern Hospital
“Linda Norlander has captured the essence of what nurses do best in end-of-life
caregiving. Essential knowledge and skills for nurses who are present with dying
patients and their families are highlighted in examples, tools, and tips for best
practice.”
–Marjorie A. Schaffer, PhD, RN
Professor of Nursing, Bethel University
“Norlander provides a guide that is gentle, practical, and down to earth for
nurses caring for palliative and hospice patients. The common concerns and fears
of nurses are gently addressed with practical clinical suggestions. The real-life
experiences assure the reader that indeed there is always something more that we
can do for our patients and families. The book is a gold mine for the nurse in her
role as advocate, guide, and clinician.”
–Joan “Jody” Chrastek, DNP, RN, CHPN
Pediatric Advanced Complex Care Coordinator
University of Minnesota/ Fairview Home Care and Hospice
Linda Norlander, MS, BSN, RN
To
Comfort
Always
SECOND EDITION
A Nurse’s Guide to
End-of-Life Care
Copyright © 2014 by Sigma Theta Tau International
All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval
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use here does not imply that you may use them for similar or any other purpose.
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whose mission is to support the learning, knowledge, and professional development of nurses committed
to making a difference in health worldwide. Founded in 1922, members include practicing nurses,
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ISBN: 9781938835506
EPUB ISBN: 9781938835513
PDF ISBN: 9781938835520
MOBI ISBN: 9781938835537
____________________________________________________________________________________
Library of Congress Cataloging-in-Publication Data
Norlander, Linda, 1949- author.
To comfort always : a nurse's guide to end-of-life care / Linda Norlander. -- Second edition.
p. ; cm.
Preceded by: To comfort always : a nurse's guide to end-of-life care / Linda Norlander. c2008.
Includes bibliographical references.
ISBN 978-1-938835-50-6 (book : alk. paper)
I. Sigma Theta Tau International, issuing body. II. Title.
[DNLM: 1. Nursing Care. 2. Terminal Care. 3. Advance Care Planning. WY 152.3]
RT87.T45
616'.029--dc23
2014014363
____________________________________________________________________________________
First Printing, 2014
Publisher: Renee Wilmeth Principal Book Editor: Carla Hall
Acquisitions Editor: Emily Hatch Development and Project Editor: Tonya Maddox Cupp
Editorial Coordinator: Paula Jeffers Copy Editor: Kevin Kent
Cover Designer: Kim Scott Proofreader: Erin Geile
Interior Design/ Indexer: Jane Palmer
Page Layout: Rebecca Batchelor
Dedication
This book is written for all the nurses who have the courage
and willingness to walk with patients on their final journeys. It is my hope
that when you do this, you will be a full witness to the fundamental
richness and grace of the human spirit.
Acknowledgments
I want to express my thanks and gratitude to the following professionals for
sharing their expertise, passion, and stories to enrich this book: Jody Chrastek,
RN, DNS, CHPN; Angela Lee, RN, BSN; Ruth Gregersen, PhD, RN; Greg
Holmquist, PharmD; Kerstin McSteen, RN, MS; Maureen McDonald, RN,
MSN, CWCN; Susan Powell, MSW, LICSW; Mary Jo Tornberg, RN, MN;
and Angela Ward, BA.
About the Author
Linda Norlander, MS, BSN, RN, is Director of Clinical Services for the
Franciscan Hospice in Tacoma, Washington. She has written numerous journal
articles on advance care planning, suffering at the end of life, and other hospice
and end-of-life topics. Besides To Comfort Always, she co-wrote with Marjorie
Schaffer, Being Present: A Nurse’s Resource for End-of-Life Communication.
Linda has presented nationally on these topics. She has also conducted
writing workshops for nurses. She is a recipient of a Robert Wood Johnson
Foundation Executive Nurse Fellowship.

Table of Contents
About the Author . . . . . . . . . . . . . . . . . . . . . vii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . x
Introduction . . . . . . . . . . . . . . . . . . . . . . . . xii
Chapter 1 Beginning . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2 Advance Care Planning . . . . . . . . . . . . . . . . . 13
Chapter 3 Chronic Illness and End of Life . . . . . . . . . . 27
Chapter 4 Dementia and End of Life . . . . . . . . . . . . . . 39
Chapter 5 Pain Management:
It’s More Than Knowing the Meds . . . . . . . . 49
Chapter 6 Physical Symptom Management . . . . . . . . . . 65
Chapter 7 Suffering: It’s Not Just the Pain . . . . . . . . . . 83
Chapter 8 Active Dying: The Final Days and Hours . . . 97
Chapter 9 After the Death: The Long Journey
to the Car . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Chapter 10 Pediatric End of Life: When a Child
Is Dying . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Chapter 11 Cultural Sensitivity: Looking Through
Different Eyes . . . . . . . . . . . . . . . . . . . . . . 137
Chapter 12 Hospice: The Gold Standard for
End-of-Life Care . . . . . . . . . . . . . . . . . . . . 147
Chapter 13 Ethical Issues in End-of-Life Care . . . . . . . . 155
Chapter 14 A Final Note: Taking Care . . . . . . . . . . . . . 165
Appendix Suggested Resources . . . . . . . . . . . . . . . . . 171
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175