"Peaceful Death" Monograph and 1998 Symposium on State-of-the-Art Nursing Care for Dying Patients

Monograph on Care of the Dying for Nurses

The University of North Carolina School of Nursing prepared a monograph on state-of-the-art nursing care of dying patients, and considered how to disseminate its ideas.

Key Results

  • Under the first grant, the researchers:

    • Created a monograph, "Notes on a Peaceful Death," building upon chapters on "Death and Dying" and "Pain" from a major earlier text (Virginia Henderson's "Principles and Practice of Nursing—6th Edition," 1978).
    • Hosted a meeting of 30 experts, including members of the clergy and the medical and pharmacy professions, December 2–4, 1998, in Chapel Hill, N.C., to review the monograph and to advise on its dissemination.
  • Under the second grant, which was intended to promote and disseminate the ideas generated at the meeting of experts, the researchers:

    • Worked with state nurses associations (in particular, North Carolina and Massachusetts) and the American Nurses Association, which ultimately endorsed the idea of pain as a fifth vital sign, and the concept of promoting pain assessment.
    • Conducted a survey of all health care facilities in North Carolina and identified six institutions as models for the routine assessment of patients' pain.
    • Established a closed listserv (a restricted email forum) for symposium participants to assist in promoting the monograph, "Notes on a Peaceful Death," and started a second closed listserv with a local (N.C.) end-of-life coalition group for discussion of end-of-life care, including promotion of a painless death.

Key Findings

  • There was an unmet need to address the great majority of nurses who only infrequently care for a dying patient (as opposed to nurses specializing in patients near the end of life). Subsequently, the project director revised the monograph for a general nurse readership based upon the input received during the meeting.

  • Participants addressed the idea of adding a fifth vital sign, pain assessment, to the set of vital signs (temperature, pulse, respiration and blood pressure) traditionally in use among nurses, agreeing to advance this idea within their organizations.

  • Participants unanimously endorsed the notion that nurses—because they are often the first to identify a patient as dying—have a special responsibility for instituting a plan of care in support of a peaceful death.

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