3  .Using the American nurses association position statement,  r

3  .Using the American nurses association position statement,  recommendations for improvement in end of life management focuses on  practice, education, research and administration. Listed below are steps  that nurses can take to overcome barriers in healthcare practice. Practice  1.  Strive to attain a standard of primary palliative care so that all  health care providers have basic knowledge of palliative nursing to  improve the care of patients and families.  2.  All nurses will have basic skills in recognizing and managing symptoms,  including pain, dyspnea, nausea, constipation, and others.  3.  Nurses will be comfortable having discussions about death, and will  collaborate with the care teams to ensure that patients and families  have current and accurate information about the possibility or  probability of a patient’s impending death.  4.  Encourage patient and family participation in health care  decision-making, including the use of advance directives in which both  patient preferences and surrogates are identified.  Education  1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.  2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.  3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.  4.  Advocate for additional education in academic programs and work  settings related to palliative care, including symptom management,  supported decision-making, and end-of-life care, focusing on patients  and families.  Research  1. Increase the integration of evidence-based care across the dimensions of end-of-life care.  2.  Develop best practices for quality care across the dimensions of  end-of-life care, including the physical, psychological, spiritual, and  interpersonal.  3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.  4.  Develop best practices to measure the quality and effectiveness of the  counseling and interdisciplinary care patients and families receive  regarding end-of-life decision-making and treatments.  5.  Support research that examines the relationship of patient and family  satisfaction and their utilization of health care resources in  end-of-life care choices.  Administration  1.  Promote work environments in which the standards for excellent care  extend through the patient’s death and into post-death care for  families.  2.  Encourage facilities and institutions to support the clinical  competence and professional development that will help nurses provide  excellent, dignified, and compassionate end-of-life care.  3.  Work toward a standard of palliative care available to patients and  families from the time of diagnosis of a serious illness or an injury.  4. Support the development and integration of palliative care services for all in- and outpatients and their families.  Discussion Board Question 2: End of Life Care. Choose  1 focal point from each subcategory of practice, education, research  and administration and describe how the APRN can provide effective care  in end of life management. .

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