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This chapter examines the issue of end of life care patients' ‘best interests’ in its various extended forms. It analyses the controversial view of specialist palliative care that the unit of care is the patient and relatives and that the best interests of the relatives must also be considered in making clinical decisions. Whole person or holistic care is acceptable as an aim of end of life care, but the term must be used with caution because a patient's wholeness extends well beyond anything that health care interventions at the end of life can encompass. The aims of end of life care should include the sensitive provision to patients of information about their illness in order to enable them to take part in decisions and lessen emotional distress.

This chapter considers the conceptual problem: how do we characterize the care that is due to people with dementia in such a way as to capture all its possible, desirable, and necessary aspects? It identifies the problems lying behind the conceptual question as being to do with the dichotomies and divisions inherent in the different approaches to dementia care. The conceptual conclusion has led in the direction of supportive care, which is a suitable way to characterize the nature of the care owing to people with dementia. Even at this preliminary stage, the supportive care model envisaged allows room for the full benefits of the palliative care approach and good quality end-of-life care to be harnessed, whilst still accommodating the biopsychosocial and spiritual dimensions of holistic care from the time of diagnosis.

This chapter begins by introducing the ethical concepts and principles that are used in contemporary discussions of health care. It then discusses the aims of palliative care, relating them to the general aims of health care, and finally puts the ethics and the aims together, showing how these are integrated. The chapter notes that to adopt the aims of palliative care is to adopt a moral standpoint. The intrinsic aim of palliative care, as part of health care, is the promotion of a medical good related to physical or mental illness. This professional treatment must be humane and show full appreciation of the meaning of the disease, suffering, and treatment for the particular patient, or of its place in the patient's conception of his total good.

This chapter examines resilience in the paediatric palliative care setting. Children facing life-threatening illness, whether in themselves or a close family member, and children experiencing loss, are made especially vulnerable by external factors and situations over which they have little or no control. Children's resilience can be developed or improved through skilled and compassionate holistic care, involving a multidisciplinary approach.

This chapter aims to summarize the positive suggestions discussed in the previous chapters. It also aims to develop some suggestions, to illustrate how palliative care can enhance and improve other specialties, and to suggest a short philosophy statement that can counter the weaknesses of the WHO statement. The chapter begins with a discussion on palliative care as a specialty. Other topics and issues discussed herein include: the Asklepian model of holistic care, Asklepian acceptance and spirituality, hope and truth-telling, patient–professional relationship, and professional development.

This chapter discusses a new direction in narrative and research, and considers how narrative might contribute to the evidence based in palliative care. It is argued in this chapter that palliative care's commitment to holistic and person-centre care demands multiple sources of evidence.

The crisis of an HIV or AIDS diagnosis for the men of the AIDS Generation is examined in relation to an Eriksonian frame and a disruption of the normal process of human development. The holistic approaches utilized by the men of the AIDS Generation to survive the epidemic are shared and considered with regard to the physical, psychological, and social domains of well-being. Early medical interventions and approaches are reviewed and described in the experiences of the men. The development of social networks and activist agencies are considered with regard to the development of social cohesion and capital. The enactment of personal relationships are considered with regard to emotional well-being. Strategies for survival that attend to the whole person are emphasized. An examination of spirit and will-to-live is described in relation to the narratives shared by the men of the AIDS Generation.

This chapter discusses the major psychological reactions to a chronic condition such as ESRD. It suggests an approach that would help provide optimum holistic patient care and provides a summary of treatment issues in the management of common co-morbid psychiatric disorders in patients with kidney disease. The chapter begins with a detailed case report before mentioning a number of co-morbid mental health issues and some patients' fears of sexual dysfunction.

Nursing is a distinct scientific field and an autonomous profession. Nurses follow a unique, holistic practice model that emphasizes preventive care and overall well-being. Virtually all US nurses are now educated at colleges by nursing scholars. Nurses report to senior nurses, not physicians. Today’s nurses practice in diverse settings, from major trauma centers to research institutions to rural clinics to disaster zones. These skilled professionals manage patient conditions, prevent deadly errors, teach and advocate for patients, and work for better health policies and systems. But patients die when nurses are understaffed or underempowered, and when nursing care is assigned to those who are not nurses, in order to cut costs. For many years the world has suffered from a deadly nursing shortage, both in terms of unfilled nursing positions and a failure to fund enough nursing positions. The current nursing shortage kills thousands, if not millions, of people every year.

German hospice care developed as a civil society movement in which volunteers were essential from the beginning. Palliative care was, however, led by a few pioneer physicians and started independently from hospices. This separate development is still visible with a clear distinction between palliative care units and inpatient hospices. Over the last two decades these two areas of care have moved more into the regular health care service. As a result volunteer services are increasingly subject to regulations. This also means that there is an increasing amount of competition and economic pressure. Developing trust and high transparency in the local and regional palliative care networks, and open and bilateral collaboration of specialist services with general practitioners (GPs) and other health care providers on the basic palliative care level are prerequisites of integrated palliative care. Ongoing development leads to changes in the patient groups that receive palliative care.

The chapter first explores the issues involved in how and why mental health nurses come to learn about the decisions that they need to take in clinical practice, and why these are crucial to the establishment and maintenance of therapeutic relationships. It must be noted that various terms will be used throughout this chapter that refer to individuals requiring care and support from nurses—that is, ‘patients’, ‘service users’, and ‘clients’. We will also explore some of the challenges and tensions that can arise when there is a difference between what the professional and the service user might feel is the right decision. Reference is made to the prevailing mental health legislation in the United Kingdom and, in particular, the legislation around care being provided possibly against an individual’s wishes and while he or she is living in the community. If you are not living or studying in the UK, you should seek out the relevant legislation that applies to your country. You might want to see where the similarities and differences are between that and the UK legislation. The chapter concludes with a discussion of how the mental health nurse can ensure that inclusive and informed decision making leads to safe, secure, and effective mental health care. By means of the case studies and the discussion, it will enable you, as the student nurse, to learn how different kinds of decision making can influence outcomes of care, and it will also help you to work towards achieving the Nursing and Midwifery Council (NMC) competencies as they relate to decision making in nursing practice. Note that while the case studies are based on real-life examples of decision-making situations, all names in the case studies have been changed, in keeping with The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives (NMC 2008). Mental health nurse education, practice, and research have long championed innovative approaches to improving our understanding of the impact, on individuals, the communities in which they live, and wider society, of the decisions and actions taken in the name of therapeutic endeavour.

By now, you have read lots of information on the principles of decision making and why this is so important for you in your nursing practice. It will be invaluable to you as you progress in your nursing career to know how to make decisions in and about nursing practice, including knowing: ● when to make these decisions; ● when decisive action is required; ● when to call a doctor; ● when to withhold a particular medication; and ● when to recommend an alternative nursing intervention. It is equally imperative that you understand why you are making the decisions that you are making and where you might go to find the information that you need to underpin these decisions. The Nursing and Midwifery Council (NMC), in its Standards for Pre-Registration Nurse Education (2010), specifies clearly the competencies that are required upon completion of a nursing programme for entry to the NMC professional register. In its competency framework, four key areas (‘domains’) are identified, one of which is ‘Nursing practice and decision making’, demonstrating unequivocally the emphasis and importance that the NMC places on the role of the qualified nurse in decision making. This domain statement is presented in Box 3.1. Specific requirements relating to this domain can be found in Parts 2 and 3 of this book. In addition, the NMC stipulates, in relation to specific knowledge and skills, that ‘all nurses must apply knowledge and skills based on the best available evidence indicative of safe nursing practice’ (NMC 2010). It also offers guidance to programme providers on the ‘Essential Skills Clusters’ (NMC 2010)—that is, additional sets of skills (‘clusters’ of skills set around specific areas of nursing practice) required to be attained by student nurses at specific points during their programme. The Essential Skills Cluster that is relevant to the use of evidence to underpin practice decisions is the ‘Organisational aspects of care’. Within this cluster, there are a number of descriptors listed that are related to this area, as listed in Table 3.1.