xvi Essentials in Hospice and Palliative Care: A Practical Resource for Every Nurse Chapter 4: Using Standardized Tools The screening, assessing, and communication tools refer- enced in the text are gathered together in this chapter—a hospice and palliative care toolbox. When a tool is men- tioned in the text, refer to this chapter to view the full-size tool and read the instructions for use. Chapter 5: Enhancing Physical Comfort In Part 1, read the principles and practices for enhancing physical comfort—the heart of providing care—in hospice and palliative care. In Part 2, learn to recognize and as- sess common symptoms dying people experience and to incorporate strategies for managing symptoms using non- pharmacological comfort measures and pharmacological measures. Chapter 6: Providing Psychosocial Care Explore common psychosocial needs of the dying person and their family and learn strategies for supporting them. Examine and reflect on medical assistance in dying, and physician assisted dying and the impact on HCPs. Con- sider the importance of strengthening the “social” in psychosocial. Chapter 7: Last Days and Hours Learn the common changes that a dying person might experience in their last days and hours, and ways to pro- vide comfort and support for the person and their family. Understand the importance of preparation in planning for care at the time of and following death, and the use of rituals. Chapter 8: Caring for You! Develop your understanding of compassion fatigue and your ability to self-evaluate for early signs of compassion fatigue. Learn ways to minimize your risk of developing compassion fatigue by caring for yourself even as you strive to provide excellent care for others. Addressing Ethical Issues The text in “Ethics Touchstone” boxes addresses ethical principles and issues. The term “touchstone” is commonly used to mean a standard against which to evaluate quality or genuineness. In this text, the ethics touchstones draw upon the following codes of ethics: y y The International Council of Nurses (ICN) (Appendix 1) y y The Canadian Nurses Association (Appendix 2) y y The Canadian Council for Practical Nurse Regulators (CCPNR) (Appendix 3) y y The American Nurses Association (ANA) (Appendix 4) The ethics touchstones also include thought-providing reflective questions designed to unearth previously un- noticed or overlooked ethical dimensions of practice. As you read, use the ethics touchstones to assess the value of your new understandings in terms of relationships, responsibilities, behaviors, and decision making, as well as for self-reflection and peer feedback. Return to these touchstones as your nursing practice develops, and recon- sider your earlier responses to the reflective questions. The icon for the ethics touchstones consists of a box to represent the framework in which every nurse provides care, a heart to remind you to provide care from the heart, and an “e” signifying ethical questions for reflection. The 2012 code of ethics of the ICN states, very simply, that “nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering” (International Council of Nurses, 2012). This text will help you to fulfill the responsibilities the ICN has identified as you work to prevent or manage common symptoms, support healthy grieving, prevent or respond to complicated grief, and decrease suffering asso- ciated with dying, death, loss, and grief. Ethics Touchstone Have you, or anyone you know, been affected by the sudden death of a loved one? Were there advantages to this trajectory? Were there disadvantages?