Palliative, Hospice and End-of-Life Care - Concept Map
Palliative, Hospice and End-of-Life Care in Oncology Nursing
Related concepts
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
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
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
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
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
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
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
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
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
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
Concept connections
- Palliative CareHospice CareHospice is a specialized form of palliative care for terminally ill patients; palliative can be provided at any stage alongside curative treatment
- WHO Analgesic LadderPain and Symptom ManagementWHO ladder is the foundational framework for systematic pain management progression in palliative care
- Opioid ManagementPain and Symptom ManagementOpioids are Step 2 and Step 3 of the analgesic ladder; proper use and side effect management are critical to effective pain control
- Constipation ProphylaxisOpioid ManagementConstipation is the opioid side effect with NO tolerance development; prophylactic bowel regimen must begin immediately when opioid is started
- Kübler-Ross StagesPsychological and Spiritual SupportStages of grief are the framework for understanding and supporting patients and families through emotional responses to terminal diagnosis
- Anticipatory GriefPsychological and Spiritual SupportAnticipatory grief begins before death and requires nursing support and family education to normalize experience
- Physical Signs of Approaching DeathThe Dying ProcessRecognition of physical signs is essential for nurses to explain changes to family and provide appropriate comfort care
- Family PreparationThe Dying ProcessEducating family about dying process signs reduces fear, enables presence, and facilitates meaningful final time together
- Advance DirectivesEthical and Legal FrameworkAdvance directives are legal documents that protect patient autonomy and guide decision-making when patient cannot decide
- DNR OrdersEthical and Legal FrameworkDNR orders must be physician-ordered and documented based on patient wishes; apply only to CPR, not to comfort care
- RA 9173Ethical and Legal FrameworkPhilippine Nursing Practice Law defines nurse's role in advocating for patient rights and upholding advance directives
- Philippine Cultural ConsiderationsFamily-Centered CareFilipino culture emphasizes extended family involvement and collective decision-making; must be central to care planning
- Roman Catholic TraditionsPhilippine Cultural ConsiderationsAnointing of the Sick and priestly access are important rituals in largely Catholic Philippines; nurses must facilitate clergy visits
- Bahala Na AttitudePhilippine Cultural ConsiderationsCultural acceptance of God's will brings peace but may delay care-seeking; nurses approach with respect not judgment
- Home Death PreferencePhilippine Cultural ConsiderationsFilipino families prefer home death surrounded by family and lamay wake tradition; nurses should support home care when possible
- Patient EducationPain and Symptom ManagementPatients and families must understand that pain can be controlled, opioids don't cause addiction with real pain, and bowel regimen is essential
- Therapeutic PresenceNursing Interventions and ManagementActive listening, honest communication, and compassionate presence are foundational nursing interventions in end-of-life care
- Interdisciplinary TeamNursing Interventions and ManagementComprehensive palliative care requires collaboration among nurse, physician, social worker, chaplain, and volunteers
- Comfort MeasuresNursing Interventions and ManagementMouth care, skin care, positioning, and secretion management are meticulous nursing interventions that maintain dignity at end of life
- Bereavement SupportFamily SupportExtended support after death helps families process grief and move toward adaptation; core component of hospice care
- No Ceiling Dose PrincipleOpioid ManagementUnlike paracetamol and NSAIDs, opioids have no maximum dose ceiling in cancer pain; dose is titrated to relief
- Adjuvant MedicationsWHO Analgesic LadderCorticosteroids, anticonvulsants, and antidepressants enhance pain control at all steps of the ladder for specific pain types
- Naloxone UseOpioid ManagementNaloxone reverses opioid respiratory depression but used cautiously at end of life to avoid precipitating pain and withdrawal
- Complicated GriefGrief and LossUnresolved, prolonged grief requiring professional mental health intervention; distinct from normal grief trajectory
- Palliative SedationEthical and Legal FrameworkDistinct from euthanasia; ethically acceptable to relieve intractable suffering at end of life in Philippines
Diagrams
Palliative, Hospice and End-of-Life Care - Comprehensive Concept Hierarchy
Comprehensive hierarchical mind map showing all major concepts, subdomains, and relationships in palliative, hospice, and end-of-life care. Central theme branches into foundational concepts, clinical management strategies, grief/loss, dying process recognition, ethical-legal framework, Philippine cultural context, and practical nursing interventions.
WHO Analgesic Ladder - Pain Management Decision Tree
Step-by-step decision tree for the WHO Analgesic Ladder showing assessment, progression through three steps, adjuvant use, and side effect management. Emphasizes around-the-clock scheduling, breakthrough dosing, and no-ceiling-dose principle for strong opioids in cancer pain.
Kübler-Ross Stages of Grief - Non-Linear Progression
Non-linear representation of Kübler-Ross five stages showing they do not occur in fixed order and individuals may move back and forth. Emphasizes nursing approach of meeting patients where they are rather than pushing toward acceptance, with therapeutic interventions for each stage.
Opioid Side Effect Management - Prophylactic Nursing Care
Proactive nursing management of opioid side effects in palliative cancer care. Emphasizes prophylactic bowel regimen (the side effect with NO tolerance), monitoring for respiratory depression with judicious naloxone use, expectation that nausea and sedation usually resolve, and management of end-of-life symptoms like dyspnea, death rattle, and anxiety.
Advance Directives and DNR Orders - Documentation and Implementation
Documentation and implementation pathway for advance directives and DNR orders. Shows two-part advance directive structure (living will + health care proxy), clarifies that DNR applies only to CPR while all comfort care continues, and emphasizes nursing advocacy to honor patient autonomy and ensure wishes are implemented.
Signs of Approaching Death - Recognition and Family Preparation
Recognition and nursing response to physical signs of approaching death. Organizes signs into five categories: consciousness, circulation, respiration, elimination, and nutrition changes. Emphasizes that hearing persists (continue speaking to patient), explains changes to reduce family fear, and guides family preparation for meaningful time and peaceful death.
Philippine Cultural Context in End-of-Life Care
Framework for culturally competent end-of-life nursing care in the Philippine context. Addresses family-centered decision-making, Roman Catholic and other religious traditions, cultural attitudes like bahala na, preferences for home death and lamay, communication about prognosis, and respectful post-mortem care honoring Filipino customs.
Grief Trajectory - From Diagnosis to Bereavement
State diagram showing grief trajectory from diagnosis through bereavement. Illustrates anticipatory grief beginning with diagnosis, non-linear movement through Kübler-Ross stages, active dying phase, acute grief after death, divergence into normal vs complicated grief, and eventual adaptation or need for professional support.
Components of Comprehensive End-of-Life Care
Pie chart illustrating the proportional components of comprehensive palliative and end-of-life nursing care. Shows that while pain and symptom control are foundational 25%, significant emphasis must also be placed on psychological-spiritual support, family involvement, physical comfort measures, ethical advocacy, and post-death bereavement care for a truly holistic approach.