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Nearing the End of Life Dare to Care by Nancy Joyner

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Outline:

  • An Inexact Art & Science
    • Illness and dying trajectories
    • Frailty
    • Dementia
    • Prognostication and prognostic scales
    • When to refer to palliative care or hospice (disease specific)
  • Essentials of Care: Comfort, Communication, Choices, Control
    • Comfort Always
      • Morphine: Still the gold standard?
      • Pain during the final hours of life
      • Drug misuse: How to avoid it
      • Opioids for dyspnea
      • Thirst vs. xerostomia
      • Medical marijuana
    • Complementary and alternative therapies
      • Emotional distress interventions
      • The role of spirituality
      • Palliative sedation
      • Communication: Everyone is Involved
      • Advance care planning: More than just a form
      • The terminology matters
      • Your role in these critical conversations
      • How much can we share?
      • Truth vs. hope
      • Code status discussions
      • DNR does not mean do not treat
      • Addressing concerns and needs of the family
      • Thanatophobia: Is it fear of dying or fear of death?
      • Premortem surge
      • Near death awareness
      • The dying process
    • Choices: Shared Decision-Making
      • Nutrition & hydration choices
      • Voluntarily Stopping Eating and Drinking (VSED): Benefits & burdens
      • Life-sustaining treatment
      • Non-beneficial treatment choices
      • Faith-based influences
      • Ventilator support
      • Dialysis or renal palliative care
      • Devices to extend life
      • Hastened death request: Why not humanely euthanize?
    • Allowing Control: Patient-Centered Care
      • Reframing hope
      • What do family members want you to consider
      • Who makes the decision
      • What about family dysfunction…
      • Is the focus quality or quantity?
      • Decision to withhold or withdraw care
      • Challenging decisions: Honoring patients’ wishes
    • Cultivating Moral Resiliency
      • Moral resilience–preserving/restoring integrity
      • Personal vs. professional grieving
      • Enabling character and honorable action
      • Ethical Competency