Fundamentals of Palliative Care for Student Nurses
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Fundamentals of Palliative Carefor Student Nurses is a thorough yet accessible introduction and overview of a key area of the nursing programme. This textbook clearly explains the palliation of symptoms and the social context of death and dying. Engaging with the latest guidelines and curriculum, it highlights the practical and communicative skills required for induction programmes and continuing professional development.


  • A full-colour, student-friendly, introduction to the essentials of palliative, or end of life care
  • A topical and timely subject area, explored clearly and concisely
  • Full of interactive pedagogy and features, including quizzes, multiple choice questions, vignettes/case studies and activities
  • Features a companion website with links to further reading, additional activities and resources, and self-testing interactive multiple choice questions

Fundamentals of Palliative Care for Student Nurses focuses on this area with expert knowledge and compassion, preparing students in order to help them provide the best possible care for their patients and their families.


Megan Rosser is Director for CPD/Non Professional Undergraduate Programmes at Swansea University. She is an established palliative care practitioner and educationalist, with previous oncology training and experience. She is experienced in the provision of palliative nursing care in primary and secondary health care settings.

Helen C. Walsh is Tutor in Nursing at Swansea University. This involves teaching and its associated activities for students on a range of levels from health care support workers, pre and post registration and Masters. The majority of her teaching relates to palliative care and its associated subjects.


About the series xi

The Authors xii

Acknowledgements xiii

Preface xiv

About the companion website xv

Section I The principles of palliative care 1

Chapter 1 The development of palliative care 3

Introduction 3

What is palliative care? 4

Where is palliative care provided? 8

Widening access 9

Influential documents and strategies 11

Conclusion 14

Chapter 2 Holistic care in palliative care 16

Introduction 16

Total pain 17

Holism 17

Holistic care 18

Spirituality 21

Quality of life 26

Conclusion 27

Chapter 3 Team working 31

Introduction 31

What is a team? 32

Why is interprofessional team work important in palliative care? 33

What makes a team work well? 41

What stops a team from working well? 44

Conclusion 46

Chapter 4 Legal principles in palliative care 48

Introduction 48

Identification of legal issues surrounding the provision of palliative care 49

Consent 50

Best interests 55

Withholding and withdrawing treatment 56

Do not resuscitate orders (DNR) 57

Euthanasia and assisted suicide 57

Verification of death 60

Conclusion 61

Chapter 5 Ethical principles in palliative care 63

Introduction 63

The meaning of ethics 64

Ethical theories 70

Euthanasia 75

Conclusion 76

Section II The practice of palliative care 79

Chapter 6 Communication in palliative care 81

Introduction 81

The importance of communication in palliative care 83

Communication theory 84

The importance of self-awareness in good communication 86

Key communication skills 87

Enablers of and barriers to good communication 91

Influencing factors 92

Communicating with groups who have particular needs 94

Conclusion 95

Chapter 7 Pain management and nursing care 98

Introduction 98

Pain 99

Pain assessment 101

Principles of pain management 106

Non-pharmacological approaches to pain relief 110

Conclusion 111

Chapter 8 Management and nursing care of gastro-intestinal symptoms 116

Introduction 116

Nausea and vomiting 117

Assessment 118

Management of nausea and vomiting 120

Nursing care 122

Malignant bowel obstruction 123

Constipation 124

Cachexia 126

Other gastrointestinal symptoms 127

Conclusion 128

Chapter 9 Management and nursing care of breathlessness and fatigue 133

Introduction 133

Breathlessness 134

Assessment of breathlessness 135

Pharmacological Management of breathlessness 135

Nursing management 137

Fatigue 138

Assessment 139

Management of fatigue 140

Nursing care 140

Conclusion 141

Chapter 10 Management and nursing care of psychological symptoms 145

Introduction 145

Psychological concerns 147

Depression and Anxiety 148

Management and treatment of anxiety and depression 153

Sexuality 154

Assessing sexuality 156

Psychological care 159

Conclusion 162

Chapter 11 Caring for the family 169

Introduction 169

Defining the family 170

Role of the family in care giving 172

Effects of caring on the family 173

The needs of carers 176

Communicating with the family 179

Conclusion 180

Chapter 12 Palliative care emergencies 184

Introduction 184

Palliative care emergencies 185

Spinal cord compression 185

Superior vena cava obstruction (SVCO) 188

Hypercalcaemia 189

Conclusion 191

Chapter 13 Nursing care at end of life 195

Introduction 195

Recognising that a patient is dying 196

End of life care 196

Physical nursing care for the dying patient 198

Bronchial secretions ( ‘death rattle’ ) 201

Terminal restlessness 201

The syringe driver 203

Being with a dying patient 204

Nurse’s role after death 205

Conclusion 207

Chapter 14 Loss grief and bereavement 212

Introduction 212

Coping With Loss 213

Common emotional responses to loss 215

Bereavement theories 216

Helping the bereaved 219

Conclusion 223

Section III Personal and professional development in palliative care 229

Chapter 15 Looking after yourself 231

Introduction 231

What is stress and why do we need to know about it? 232

Some of the reasons nursing is stressful 236

Effects of stress 237

Coping strategies 237

Managing your stress 241

Conclusion 244

Chapter 16 Professional support 247

Introduction 247

Key people 248

Clinical supervision 250

Conclusion 258

Chapter 17 Learning from your practice through reflection 261

Introduction 261

Types of reflection 263

Why use reflective practice? 265

Starting your reflective practice 266

Conclusion 272

Index 275