Chapter 5: Enhancing Physical Comfort | Principles and Practices 99 Enhancing Physical Comfort Part 1: Principles and Practices Death is inevitable. Pain, distress and other symp- toms do not have to be. A nurse The principles for managing symptoms, using medications, and using opioids are key to increasing the physical com- fort of the dying person. Physical comfort and symptom management are essential to improving the person’s qual- ity of life. When symptoms are not controlled, the dying person and their family may experience increased suffering and anxiety. The principles for symptom management can be integrated into care in any setting. Globally, the medi- cations and guidelines for symptom management vary, but the principles remain the same. Understanding the person’s place in their illness trajectory will help guide investigations and treatments. Consider using the Gold Standards Framework Prognostic Indica- tor Guidance (GSF PIG) tool, the Supportive and Palliative Care Indicators Tool (SPICT), and tools for assessing frailty and one-year mortality (see Chapter 4, “Using Standard- ized Tools”) to help inform goals-of-care conversations and determine whether investigations are appropriate. Remember that physical symptoms are not managed in isolation. In order to manage symptoms in a way that meets the needs of the dying person and is appropriate for their decline, it is essential to address psychosocial issues. Using the Psychosocial Assessment Form (see Chapter 4, “Using Standardized Tools”) will help the health care team to understand the dying person, in terms of who they are, what is important to them and their family, and their com- munity support. Principles of Symptom Management Physical symptoms are managed by addressing the under- lying disease causing the symptoms, by using medica- tions and treatments to diminish or mask the symptoms, by using nonpharmacological measures to enhance physical comfort, and by addressing psychosocial needs. Apply these principles for symptom management: • Focus on the person’s goals of care. • Educate the person and family. • Prevent symptoms that can be prevented. • Manage symptoms before they escalate. • Use nonpharmacological comfort measures when possible. • Support the family to participate in planning and pro- viding care. • Follow the care plan and administer medications as ordered. • Evaluate, record, and report the person’s responses to medications and comfort measures. (Pallium Canada, 2013; WHO, 2012; ELNEC, 2015) Ethics Touchstone Principle 2 Licensed Practical Nurses provide safe and competent care for their clients. Reflect on how nurses provide safe and compe- tent care by integrating the principles of symp- tom management to help prevent and manage symptoms. Code of Ethics for Licensed/Registered Practical Nurses (CCPNR, 2013) 5