I

t’s probably safe to say that end-of-life care is fresh in the minds of most Americans. Thanks to ’round-the-clock media coverage, the nation shared Terri Schiavo’s last few weeks of life. Terri’s case may have opened the eyes of many who were unaware of what occurs in that timeframe, but the extended care professional is all too familiar with death and the dying process. Coincidentally, the May issue of ECPN has a focus on palliative care. Here’s a glance at the articles on this timely topic.
       We begin our special focus on palliative care with our cover story, “The Aging of America,” by Judy Lentz, RN, MSN, NHA, and Paul O’Palka, Jr. Here, the authors define the objectives of palliative care as preventing and relieving suffering and supporting the best possible quality of life for patients and their families, regardless of the stage of disease. Palliative care is intended not just for the patient but also for the patient’s family and support group. Its delivery involves all care settings and employs a multidisciplinary team. In this article, the authors describe the “Clinical Practice Guidelines for Quality Palliative Care” set forth by the National Consensus Project (NCP). The intent of these guidelines is to provoke national dialogue among healthcare providers to establish or strengthen existing palliative care programs to improve quality, the efficiency of care delivery, and patient satisfaction. Some of the core elements of palliative care according to the NCP are the timing of palliative care, attention to relief of suffering, skill in care of the dying and the bereaved, continuity of care across settings, and quality improvement among others. Turn to page 18 to read more about the guidelines.
       In addition to our cover story, another feature and several departments discuss palliative care issues. In our nutrition department, Sharon Clewis, RD, LD/N; Chris Kallas, RD, LD/N; Diane Loechner, RD, LD/N; and Magda Segarra, RD, LD/N discuss the topic of diet liberalization. When the resident nears the end of life, foods the resident likes to eat may be more important than foods that are “good” for him or her or foods that have nutritive value. Congruent with the overall goal of palliative care, the goal of palliative nutritional care is to develop meal plans that provide optimal quality of life. Specifically, the authors review the American Dietetic Association’s position on diet restrictions for older residents with cardiac disease, hypertension, and diabetes.
       In this issue’s wound care department, Ben Peirce, BA, RN, CWOCN, discusses the goals of palliative care in relation to wound care. Here, the author focuses on the essential components of a complete wound assessment to determine if a wound is improving and the timeframes during which the clinician can expect to see a change.
       Cynthia Fleck, RN, BSN, MBA, ET/WOCN, CWS, DAPWCA, furthers our knowledge of palliative wound care in her article, “Ethical Wound Management for the Palliative Patient.” With the assistance of an illustrative case report, Ms. Fleck describes the shift in goals from healing to improved quality of life for the palliative patient with a wound. Protocols for palliative patients with nonhealing wounds stress symptom management, specifically pain and odor control, over wound closure. The author concludes with a wrap up of the case report.
       On behalf of the ECPN staff, I hope you enjoy this issue and find the content timely and informative. As always, I welcome your feedback.