Palliative Practices: An Interdisciplinary Approach

Abstract

Kim K. Kuebler, Mellar P. Davis, Crystal Dea Moore. St. Louis, MI: Elsevier Mosby; 2005. Softcover, 491 pages. ISBN 0-323-02821-7.The provision of healthcare to patients requires a delicate balance between doing good and doing no harm. This is especially true in critical care units in which the technologic therapies used to “rescue” acutely and critically ill patients are often painful and undignified. The concept of relieving pain and suffering for those at end of life—palliative care—now has been expanded to include approaches that address the quality of life for those facing life-threatening illnesses.1 This broadened definition has placed palliative care into the domain of critical care practitioners as a necessary skill, not only during curative therapy, but also comfort-care only treatment at end of life. Palliative Practices was written by experts in palliative care with the expressed purpose to be a reference for healthcare providers and a study guide for palliative care certification.The text is organized into 3 sections that address palliative care issues; disease-specific issues; and grief, bereavement, and the dying process. Each chapter begins with objectives and ends with practice questions. The appendices include medications by disorders, medication routes and metabolism, palliative care assessment tools, and Web sites for further referencing.The first section, Issues Specific to Palliative Care, provides an introduction to the concepts of palliation and hospice and supportive care. This section includes a discussion of Medicare and hospice benefits. The chapter on advanced care planning is well written and provides an in-depth discussion of end-of-life conversations and communication strategies, an area that research has shown critical care practitioners have difficulty with. There is an interesting chapter on sleep that includes its physiology, pathophysiologic disorders, and interventions that is relevant to critical care settings. The last 2 chapters in this section are good reviews of evidence-based practice issues and pharmacology (dynamics and kinetics).Section 2 of the book is devoted to discussing the incidence, patho-physiology, and care strategies of the chronic and advanced diseases of heart failure, renal disease, chronic obstructive pulmonary disease, asthma, emphysema, acute lateral sclerosis, and Huntington disease. Each chapter provides concise information that includes symptomology, prognostic tables, pharmacologic and nonpharmacologic interventions, and outcome assessments.There is a comprehensive chapter on oncology that includes the previously mentioned information of common cancers and also malignancy-related disorders such as syndrome of inappropriate anti-diuretic hormone, hypercalcemia, spinal cord compression, superior vena cava syndrome, tumor lysis syndrome, neutropenia, and increased intracranial pressure. This chapter is particularly informative as oncology patients most often are admitted to the intensive care unit (ICU) with these crisis syndromes. The chapter discussing cancer pain provides useful information that can be used for all types of pain and includes assessment tools and pharmacotherapeutics (narcotics and adjunct therapies).The third section of the book is devoted to grief, bereavement, and the dying process. This section is especially relevant to critical care and includes ICU issues. The ethics chapter has sections discussing the ethics of advanced directives, decision making, and terminal weaning. The authors even illustrate an ethical situation by discussing the ICU nurse who had “No CPR” tattooed on her chest (yes—there really is an ICU nurse out there with that tattooed!). It is apparent that the authors appreciate the murkiness of end-of-life decision making in critical care as they discuss the doctrine of double effect and the choice between the lesser evils in withdrawing life support.The authors also demonstrate insight into the critical care world when they discuss the barriers to providing a “good death” in the ICU setting as technology is blurring the line between living and dying. By identifying issues such as conflicts between physicians and nurses and the healthcare team and families, lack of privacy, social services, and spiritual care, solutions can be facilitated.The chapter on cultural and spiritual issues contains succinct and useful information concerning religious and cultural practices and beliefs. In addition, this chapter includes Web references for 19 religions and discusses Muslim, Hispanic, Native American, African American, and Asian American end-of-life considerations.This book is useful as a study guide for palliative care certification. It includes case studies and practice test questions with rationales for correct answers; its references are multidisciplinary and relevant; and it is comprehensive in scope and certainly requires the reader to digest a great deal of information. Palliative Practices is organized in a manner that allows readers to reference specifics related to patient diseases and interventions. It also allows for immersion into the specialty of palliative care to see the gestalt of it. In reviewing its value as a reference for critical care practitioners, the reader can extrapolate from the general information as needed and use the critical care–specific information in everyday practice. This book is an important addition to a critical care unit’s reference library if only to serve as a reminder that palliative care must be incorporated into our everyday practice.To access previous book reviews that have been published in Critical Care Nurse, go to our Web site, http://ccn.aacnjournals.org, and type in “book reviews” in the keyword search field.