NLE Oncology Nursing — Palliative, Hospice and End-of-Life CareConcept Map

Concept

Palliative Care Fundamentals

Sub Concepts

• Definition and scope (any stage, alongside curative treatment)
• Quality of life focus
• Symptom and pain relief
• Holistic care approach
• Team-based interdisciplinary model

Relationship To Central

Core foundation distinguishing palliative from curative and hospice approaches

Concept

Hospice Care Distinctions

Sub Concepts

• Terminal prognosis (6 months or less)
• Curative treatment cessation
• Comfort-focused care
• Family and bereavement support
• 24-hour care availability

Relationship To Central

Specialized form of palliative care for terminally ill patients

Concept

Pain and Symptom Management

Sub Concepts

• WHO Analgesic Ladder (Step 1, 2, 3)
• Around-the-clock scheduling
• Breakthrough dosing
• Adjuvant medications
• Opioid side effect management
• Non-pharmacological interventions

Relationship To Central

Essential clinical nursing priority in palliative and hospice care

Concept

Opioid Management

Sub Concepts

• No ceiling dose principle
• Addiction vs tolerance vs physical dependence
• Constipation prophylaxis (stimulant laxative + softener)
• Respiratory depression and naloxone
• Nausea and sedation management
• Ethical use and patient education

Relationship To Central

Critical medication knowledge for pain control in advanced cancer

Concept

Psychological and Spiritual Support

Sub Concepts

• Kübler-Ross five stages of grief
• Anticipatory grief
• Complicated grief recognition
• Therapeutic presence and communication
• Spiritual needs and clergy facilitation
• Existential support

Relationship To Central

Essential holistic dimensions of end-of-life care

Concept

The Dying Process

Sub Concepts

• Decreased consciousness
• Cheyne-Stokes respirations
• Cool, mottled extremities
• Decreased urine output
• Loss of sphincter control
• Sensory changes (hearing persists)
• Family preparation and presence

Relationship To Central

Recognition and nursing support for physiological changes at end of life

Concept

Ethical and Legal Framework

Sub Concepts

• Advance directives (living will, health care proxy)
• Do-Not-Resuscitate (DNR) orders
• Informed consent and autonomy
• RA 9173 - Philippine Nursing Practice Law
• Professional Code of Ethics
• Euthanasia vs palliative sedation
• Documentation and advocacy

Relationship To Central

Regulatory and professional obligations in end-of-life nursing

Concept

Philippine Cultural Considerations

Sub Concepts

• Family-centered decision-making
• Roman Catholic traditions (Anointing of the Sick)
• Home death preference and lamay (wake)
• Bahala na attitude and acceptance
• Protective truth-telling vs disclosure
• Multi-faith respect (Muslim, Evangelical)
• Post-mortem care rituals

Relationship To Central

Context-specific nursing approach in Filipino healthcare settings

Concept

Nursing Interventions and Management

Sub Concepts

• Comprehensive assessment (pain, symptoms, psychosocial)
• Comfort measures (mouth care, skin care, positioning)
• Family education and support
• Symptom control (dyspnea, nausea, secretions, anxiety)
• Care coordination and interdisciplinary collaboration
• Emotional presence and active listening
• Bereavement follow-up

Relationship To Central

Practical evidence-based nursing actions throughout palliative and hospice care

Concept

Patient and Family Education

Sub Concepts

• Pain control and opioid myths
• Bowel regimen adherence
• Signs of approaching death
• DNR order clarification
• Resource connection (hospice, spiritual, bereavement)
• Medication management at home

Relationship To Central

Knowledge transfer essential for informed participation in care

To

Hospice Care

From

Palliative Care

Strength

strong

Relationship

Hospice is a specialized form of palliative care for terminally ill patients; palliative can be provided at any stage alongside curative treatment

To

Pain and Symptom Management

From

WHO Analgesic Ladder

Strength

strong

Relationship

WHO ladder is the foundational framework for systematic pain management progression in palliative care

To

Pain and Symptom Management

From

Opioid Management

Strength

strong

Relationship

Opioids are Step 2 and Step 3 of the analgesic ladder; proper use and side effect management are critical to effective pain control

To

Opioid Management

From

Constipation Prophylaxis

Strength

strong

Relationship

Constipation is the opioid side effect with NO tolerance development; prophylactic bowel regimen must begin immediately when opioid is started

To

Psychological and Spiritual Support

From

Kübler-Ross Stages

Strength

strong

Relationship

Stages of grief are the framework for understanding and supporting patients and families through emotional responses to terminal diagnosis

To

Psychological and Spiritual Support

From

Anticipatory Grief

Strength

moderate

Relationship

Anticipatory grief begins before death and requires nursing support and family education to normalize experience

To

The Dying Process

From

Physical Signs of Approaching Death

Strength

strong

Relationship

Recognition of physical signs is essential for nurses to explain changes to family and provide appropriate comfort care

To

The Dying Process

From

Family Preparation

Strength

strong

Relationship

Educating family about dying process signs reduces fear, enables presence, and facilitates meaningful final time together

To

Ethical and Legal Framework

From

Advance Directives

Strength

strong

Relationship

Advance directives are legal documents that protect patient autonomy and guide decision-making when patient cannot decide

To

Ethical and Legal Framework

From

DNR Orders

Strength

strong

Relationship

DNR orders must be physician-ordered and documented based on patient wishes; apply only to CPR, not to comfort care

To

Ethical and Legal Framework

From

RA 9173

Strength

strong

Relationship

Philippine Nursing Practice Law defines nurse's role in advocating for patient rights and upholding advance directives

To

Family-Centered Care

From

Philippine Cultural Considerations

Strength

strong

Relationship

Filipino culture emphasizes extended family involvement and collective decision-making; must be central to care planning

To

Philippine Cultural Considerations

From

Roman Catholic Traditions

Strength

strong

Relationship

Anointing of the Sick and priestly access are important rituals in largely Catholic Philippines; nurses must facilitate clergy visits

To

Philippine Cultural Considerations

From

Bahala Na Attitude

Strength

moderate

Relationship

Cultural acceptance of God's will brings peace but may delay care-seeking; nurses approach with respect not judgment

To

Philippine Cultural Considerations

From

Home Death Preference

Strength

strong

Relationship

Filipino families prefer home death surrounded by family and lamay wake tradition; nurses should support home care when possible

To

Pain and Symptom Management

From

Patient Education

Strength

strong

Relationship

Patients and families must understand that pain can be controlled, opioids don't cause addiction with real pain, and bowel regimen is essential

To

Nursing Interventions and Management

From

Therapeutic Presence

Strength

strong

Relationship

Active listening, honest communication, and compassionate presence are foundational nursing interventions in end-of-life care

To

Nursing Interventions and Management

From

Interdisciplinary Team

Strength

moderate

Relationship

Comprehensive palliative care requires collaboration among nurse, physician, social worker, chaplain, and volunteers

To

Nursing Interventions and Management

From

Comfort Measures

Strength

strong

Relationship

Mouth care, skin care, positioning, and secretion management are meticulous nursing interventions that maintain dignity at end of life

To

Family Support

From

Bereavement Support

Strength

strong

Relationship

Extended support after death helps families process grief and move toward adaptation; core component of hospice care

To

Opioid Management

From

No Ceiling Dose Principle

Strength

strong

Relationship

Unlike paracetamol and NSAIDs, opioids have no maximum dose ceiling in cancer pain; dose is titrated to relief

To

WHO Analgesic Ladder

From

Adjuvant Medications

Strength

moderate

Relationship

Corticosteroids, anticonvulsants, and antidepressants enhance pain control at all steps of the ladder for specific pain types

To

Opioid Management

From

Naloxone Use

Strength

moderate

Relationship

Naloxone reverses opioid respiratory depression but used cautiously at end of life to avoid precipitating pain and withdrawal

To

Grief and Loss

From

Complicated Grief

Strength

moderate

Relationship

Unresolved, prolonged grief requiring professional mental health intervention; distinct from normal grief trajectory

To

Ethical and Legal Framework

From

Palliative Sedation

Strength

moderate

Relationship

Distinct from euthanasia; ethically acceptable to relieve intractable suffering at end of life in Philippines