palliative care for dignified dying · rhonda p. oakes, rn, chpn, team lead, clinical informatics,...

PALLIATIVE CARE FOR DIGNIFIED DYING

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Copyright © 2017 by ICN – International Council of Nurses, 3, place Jean-Marteau, 1201 Geneva, Switzerland

Copyright © 2017 by ICN – International Council of Nurses, 3, place Jean-Marteau, 1201 Geneva, Switzerland Page 2

Title: Palliative Care for Dignified Dying

Catalogue Type: Terminology Subset

Publication Date: 2009, Updated 2013, Updated 2015, Updated 2017

Authors: Ardith Z. Doorenbos, PhD, RN, FAAN, Associate Professor, University of Washington School of Nursing, Seattle, Washington, USA

Kay Jansen, DNP, RN, Terminology Manager, ICNP® Programme, International Council of Nurses, Geneva, Switzerland

Rhonda P. Oakes, RN, CHPN, Team Lead, Clinical Informatics, Describing Function LLC, Knoxville, Tennessee, USA

Sarah A. Wilson, PhD, RN, Associate Professor Emeritus, Marquette University College of Nursing, Milwaukee, Wisconsin, USA

Creation of this catalogue was a group endeavour. Author order does not indicate amount of contribution.

Expert Reviewers: Murat Abazi (Kosovo) Gail Chambers (USA) Bruno Fonseca (Portugal) Jan Marie Graham (Canada) Yi-fang Yvonne Hsiung (USA) Kae-Hwa Jo (Korea) Susan McClemet (Canada) Bonnie Morgan (USA) Stephanie Myers (USA) Margaret O’Connor (Australia) Carol Ott (USA) Stephanie Myers Schim (USA) Dena Jean Sutermaster (USA) Theresa Wadas (USA)

Note: This catalogue provides ICNP concepts to support the nursing care of adults in palliative care

Background: The International Classification for Nursing Practice (ICNP®) is a unified nursing language system that supports the standardisation of nursing documentation at the point of care. The resulting data-based information can be used for planning and managing nursing care, financial forecasting, analysis of patient outcomes and policy development. The ICNP Strategic Advisory Group and many other expert nurses involved with ICNP have recognised that manageable subsets of the terminology should be available to nurses working with patients or clients in selected specialties and settings.

The purpose of a catalogue is to make ICNP a useful tool for nurses at the point of care. Catalogues are subsets of ICNP that allow nurses to more readily integrate ICNP into their practice as they work in a specialty area or with clients having specific health conditions or needs.

Catalogues do not replace the clinical judgement of the nurse. Nurses can use Catalogues as reference tools for documenting care and reflecting on their practice. Nurses’ clinical judgement and


decision-making are essential for individualised care of patients and their families and cannot be replaced by any tool.

References: American Nurses Association (ANA) (2005). Code of ethics for nurses with interpretative statements. Washington, DC: American Nurses Association.

Braun KL, Pietsch JH & Blanchette PL (Eds.) (2000). Cultural issues in end-of-life decision making. Thousand Oaks, CA: Sage.

Chochinov HM (2002). Dignity-conserving care-a new model for palliative care: Helping the patient feel valued. JAMA 287, 2253-2260.

Chochinov HM (2006). Dying, dignity, and new horizons in palliative end-of-life care. CA Cancer J Clin 56, 84-103.

Chochinov HM, Hack T, McClement S, Kristjanson L, Harlos M (2002). Dignity in the terminally ill: A developing empirical model. Social Science and Medicine 54(3), 433-443.

Chochinov HM, Kristjanson L, Hack TF Hassard T, McClement S & Harlos M (2006). Journal of Palliative Medicine 9(3), 666-672.

Gelfand DE, Raspa R, Briller SH & Schim SM (Eds.) (2005). End of life stories: Crossing disciplinary boundaries. New York: Springer.

International Council of Nurses (ICN) (2001). International Classification for Nursing Practice Beta 2 Version. Geneva, Switzerland: International Council of Nurses.

International Council of Nurses (ICN) (2005). International Classification for Nursing Practice Version 1.0. Geneva, Switzerland: International Council of Nurses.

International Council of Nurses (ICN) (2006a). The ICN Code of Ethics for Nurses. Geneva, Switzerland: International Council of Nurses.

International Council of Nurses (ICN) (2008). Guidelines for ICNP® Catalogue Development. Geneva, Switzerland: International Council of Nurses.

McClement SE, Chochinov HM, Hack TF, Kristjanson LJ & Harlos M (2004). Dignity-conserving care: Application of research findings to practice. International Journal of Palliative Nursing 10(4), 173-179.

Rankin MA, Donahue MP, Davis K, Katseres JK, Wedig JA, Johnson M & Maas M (1998). Dignified dying as a nursing outcome. Outcomes Management for Nursing Practice 2(3), 105-110.

Street AF & Kissane DW (2001). Constructions of dignity in end-of-life care. Journal of Palliative Care 17(2), 93-101.

Volker DL, Kahn D & Penticuff J (2004). Patient control and end-of-life care: Part I: The advanced practice nurse perspective. Oncol Nurs Forum 31(5), 945-953.

Wilson SA, Coenen A & Doorenbos A (2006). Dignified dying as a nursing phenomenon in the United States. Journal of Hospice and Palliative Nursing, 8(1), 34-41.

World Health Organization (2006). WHO definition of palliative care. Geneva, Switzerland: World Health Organization. Retrieved from http://www.who.int/cancer/palliative/definition/en/print.html

http://www.who.int/cancer/palliative/definition/en/print.html


Concept Type

Nursing Categories

Sub-categories Code ICNP Statement (2017 Release)

Diagnoses and Outcomes Dignity-Conserving Repertoire

Acceptance 10029480 Impaired Acceptance Of Health Status 10000863 Impaired Adjustment

Autonomy and Control 10000579 Decisional Conflict 10027120 Decreased Powerlessness 10027131 Low Self Efficacy 10001578 Powerlessness 10025672 Self Efficacy

Continuity of Self 10001079 Disturbed Body Image 10001257 Disturbed Personal Identity 10025664 Positive Personal Identity

Finding Spiritual Comfort 10021757 Conflicting Religious Belief 10022769 Conflicting Spiritual Belief 10027149 Decreased Spiritual Distress 10028529 Effective Spiritual Status 10001652 Spiritual Distress 10025588 Suffering

Hopefulness and Generativity 10025780 Hope 10000742 Hopelessness 10023423 Lack Of Meaning

Living in the Moment 10040367 Able To Perform Leisure Activity 10041017 Death Anxiety 10040351 Impaired Ability To Perform Leisure Activity

Maintaining Normality 10022027 Impaired Adaptation

Maintenance of Pride 10000533 Chronic Low Self Esteem 10025693 Lack Of Pride 10022724 Negative Self Image 10025779 Positive Pride 10025751 Positive Self Esteem 10027108 Positive Self Image 10000844 Situational Low Self Esteem

Resilience 10001120 Difficulty Coping 10022378 Effective Coping


Concept Type

Nursing Categories


10034770 Effective Family Coping 10034789 Impaired Family Coping

Role Preservation 10027955 Effective Parenting 10000925 Impaired Homemaking 10000941 Impaired Role Performance 10000788 Interrupted Family Process 10001385 Parental Stress

Illness-Related Concerns Cognitive Acuity

10000449 Acute Confusion 10000522 Chronic Confusion 10027098 Decreased Confusion 10022091 Delirium 10000669 Distorted Thinking Process 10022321 Impaired Cognition 10001203 Impaired Memory 10022070 Risk For Delirium

Functional Capacity 10000431 Activity Intolerance 10000956 Impaired Ability To Bath 10000960 Impaired Dressing And Grooming 10000918 Impaired Health Maintenance 10000973 Impaired Self Feeding 10000994 Impaired Self Toileting 10000987 Inability To Perform Hygiene 10015011 Risk For Activity Intolerance 10023410 Self Care Deficit

Physical Distress 10000454 Acute Pain 10024930 Adequate Sleep 10025705 Agitation 10001242 Altered Perception 10000546 Chronic Pain 10025574 Comfortable 10000567 Constipation 10041882 Dehydration 10000630 Diarrhoea 10023066 Discomfort 10022500 Hallucination 10001316 Impaired Breathing 10025746 Impaired Nutritional Status 10001288 Impaired Sexual Functioning


Concept Type

Nursing Categories


10001290 Impaired Skin Integrity 10027226 Impaired Sleep 10000859 Nausea 10023130 Pain 10025831 Pain Control 10025798 Pressure Ulcer 10025722 Restlessness 10015133 Risk For Infection 10015146 Risk For Injury 10025820 Symptom Control 10025686 Urinary Incontinence 10025981 Vomiting

Psychological Distress 10027112 Adequate Knowledge 10030159 Adherence To Dietary Regime 10030192 Adherence To Medication Regime 10030214 Adherence To Safety Precautions 10000726 Anticipatory Grief 10000624 Denial 10022402 Depressed Mood 10001120 Difficulty Coping 10001183 Dysfunctional Grief 10000695 Fatigue 10000703 Fear 10038411 Impaired Psychological Status 10023819 Knowledge Of Medication Regime 10023826 Knowledge Of Pathological Process 10025733 Knowledge Of Treatment Regime 10000837 Lack Of Knowledge 10021994 Lack Of Knowledge Of Disease 10021941 Lack Of Knowledge Of Medication Regime 10021925 Lack Of Knowledge Of Treatment Regime 10038430 Positive Psychological Status 10022833 Treatment Exhaustion

Social Dignity Inventory Aftermath Concerns

10000477 Anxiety 10022345 Grief

Burden to Others 10025714 Able To Perform Self Care 10022563 Inadequate Income 10041323 Lack Of Access To Transportation

Care Tenor


Concept Type

Nursing Categories

Sub-categories Code ICNP Statement (2017 release)

10025655 Able To Perform Caretaking 10025629 Conflicting Caregiver Attitude 10025638 Positive Caregiver Attitude

Privacy Boundaries 10025601 Lack Of Privacy 10025590 Privacy

Social Support 10027773 Caregiver Stress 10022456 Conflicting Family Attitude 10000902 Impaired Family Ability To Manage Regime 10023078 Impaired Family Process 10001022 Impaired Socialisation 10022753 Lack Of Social Support 10025947 Lack Of Trust 10027787 Risk for Caregiver Stress 10001647 Social Isolation

Interventions Dignity-Conserving Repertoire

Acceptance 10026249 Assessing Acceptance Of Health Status 10024192 Assessing Attitude Toward Disease 10024205 Assessing Attitude Toward Treatment Regime 10026265 Facilitating Ability To Talk About Dying Process

Autonomy and Control 10024280 Assessing Self-efficacy 10026323 Involving In Decision Making Process 10026368 Protecting Cultural Beliefs 10026381 Protecting Religious Beliefs 10026188 Reinforcing Priority Setting 10022537 Reinforcing Self Efficacy 10024589 Supporting Decision Making Process 10026462 Supporting Family Decision Making Process

Continuity of Self 10024377 Encouraging Positive Affirmations 10026436 Reinforcing Capabilities 10026443 Reinforcing Personal Identity

Finding Spiritual Comfort 10024308 Assessing Spiritual Beliefs 10024312 Assessing Spiritual Beliefs Of Family 10030768 Assessing Spiritual Status 10026231 Counselling About Spiritual Distress 10024504 Providing Privacy For Spiritual Behaviour 10027067 Providing Spiritual Support


Concept Type

Nursing Categories


10024543 Referring To Religious Service 10026458 Supporting Beliefs 10024591 Supporting Spiritual Rituals

Hopefulness and Generativity 10026072 Assessing Expectations 10024440 Promoting Hope 10039376 Reminiscence Therapy

Living in the Moment 10026208 Counselling About Fears 10026212 Counselling About Hopes 10039348 Diversional Therapy

Maintaining Normality 10039353 Humour Therapy 10024464 Promote Social Support

Maintenance of Pride 10027079 Assessing Self Esteem 10027080 Assessing Self Image 10024455 Promoting Self-esteem 10026427 Reinforcing Achievements

Resilience 10002723 Assessing Coping 10026600 Assessing Family Coping

Role Preservation 10026142 Assessing Roles 10026277 Facilitating Ability To Perform Role

Illness-Related Concerns Cognitive Acuity

10025883 Assessing Cognition 10024438 Prioritising (treatment) Regime 10024472 Promoting Use of Memory Devices 10041072 Reality Orientation Therapy 10039382 Validation Therapy

Functional Capacity 10026040 Assessing Capabilities 10021844 Assessing Self Care 10026347 Promoting Self Care 10024527 Providing Safety Devices 10026415 Referring To Occupational Therapy 10024019 Referring To Physical Therapy

Physical Distress 10023084 Administering Pain Medication 10002710 Assessing Control Of Pain 10002747 Assessing Eating Or Drinking Behaviour


Concept Type

Nursing Categories


10026064 Assessing Environment 10026119 Assessing Pain 10030694 Assessing Physiological Status 10023520 Assessing Risk For Falls 10002821 Assessing Susceptibility To Infection 10026161 Assessing Symptom Control 10024320 Assessing Use Of Traditional Therapies 10030930 Collaborating In Electrolyte Therapy 10030948 Collaborating In Fluid Therapy 10004561 Collaborating In Initiating Patient Controlled

Analgesia 10026190 Collaborating On Dietary Regime 10023554 Collaborating With Pharmacist 10023565 Collaborating With Physician 10024331 Consulting For Pain Management 10040248 Demonstrating Falls Prevention 10041415 Encouraging Rest 10042507 Environmental Safety Management 10007176 Evaluating Response To Fluid Therapy 10007182 Evaluating Response To Medication 10009872 Implementing Pain Guideline 10023861 Managing Dietary Regime 10023890 Managing Exercise Regime 10011641 Managing Medication 10023888 Managing Medication Regime 10011660 Managing Pain 10011673 Managing Regime 10012183 Monitoring Physiological Status 10012196 Monitoring Respiratory Status 10013517 Observing Altered Perception 10014761 Positioning Patient 10026491 Supporting Use Of Traditional Therapy 10046533 Teaching About Diet 10026502 Teaching About Dying Process 10040253 Teaching About Falls Prevention 10019489 Teaching About Managing Pain 10024618 Teaching About Nutrition 10024687 Teaching About Safety Measures 10026525 Teaching Family About Dietary Regime

Psychological Distress 10002687 Assessing Attitude Toward Medication

Management 10024246 Assessing Denial


Concept Type

Nursing Categories


10026055 Assessing Depressed Mood 10026086 Assessing Fatigue 10024267 Assessing Fear 10026093 Assessing Fear About Death 10026103 Assessing Grief 10024279 Assessing Response To Teaching 10030734 Assessing Psychological Status 10024354 Demonstrating Medication Administration 10024365 Demonstrating Relaxation Technique 10023738 Establishing Rapport

10007107 Evaluating Psychosocial Response To Instruction

10007130 Evaluating Psychosocial Response To Instruction About Medication

10007111 Evaluating Psychosocial Response To Instruction About Nutrition

10007148 Evaluating Psychosocial Response To Instruction About Pain

10007153 Evaluating Psychosocial Response To Plan Of Care

10027051 Providing Emotional Support 10026489 Supporting Mourning Process 10019161 Supporting Psychological Status 10024116 Teaching About Disease 10019470 Teaching About Medication 10024625 Teaching About Treatment Regime

Social Dignity Inventory Aftermath Concerns

10024233 Assessing Cultural Beliefs 10026616 Facilitating Ability To Communicate Feelings 10026174 Referring To Funeral Service 10026404 Referring To Legal Service

Burden to Others 10024171 Arranging Transportation Service 10026254 Assessing Fear About Being A Burden To Others 10021816 Consulting Home Care Service

Care Tenor 10006966 Ensuring Continuity Of Care 10009649 Identifying Attitude Toward Care 10024570 Supporting Caregiver 10026518 Teaching Family About Delirium 10021719 Teaching Family About Disease

Privacy Boundaries 10007391 Explaining Patient Right


Concept Type

Nursing Categories


10011527 Maintaining Dignity And Privacy 10026334 Promoting Limit Setting 10015919 Protecting Patient Right 10026399 Providing Privacy

Social Support 10024222 Assessing Caregiver Stress 10024298 Assessing Social Support 10023577 Collaborating With Social Worker 10024396 Establishing Trust 10024401 Facilitating Access To Treatment 10024464 Promoting Social Support 10026375 Providing Family Anticipatory Guidance 10027046 Providing Social Support 10016825 Reporting Status To Family Member 10026470 Supporting Family Mourning Process 10024656 Teaching Family About Treatment Regime

International Council of Nurses3, place Jean-Marteau1201 Geneva, Switzerland

Tel: +41 22 908 0100Fax: +41 22 908 0101email: [email protected]

palliative care for dignified dying · rhonda p. oakes, rn, chpn, team lead, clinical informatics,...

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