Clinical meaning
Palliative care is an approach to care that improves the quality of life of patients and their families facing life-threatening illness through the prevention and relief of suffering by means of early identification, assessment, and treatment of pain and other physical, psychosocial, and spiritual problems (World Health Organization). Palliative care is NOT synonymous with end-of-life care -- it can and should be provided alongside curative or disease-modifying treatment from the time of diagnosis of a serious illness. The principles of palliative care include: affirming life and regarding dying as a normal process; neither hastening nor postponing death; providing relief from pain and other distressing symptoms; integrating psychological and spiritual aspects of care; offering a support system to help patients live as actively as possible until death; and supporting the family during the patient's illness and in their bereavement. End-of-life care is the subset of palliative care focusing on comfort and dignity in the final days to weeks of life. The dying process involves predictable physiological changes: decreasing consciousness and increasing sleep, loss of appetite and thirst (normal and not distressing to the dying person), changes in breathing patterns (Cheyne-Stokes respirations, agonal breathing), peripheral cooling and mottling (from decreased circulation), and accumulation of pharyngeal secretions ('death rattle'). The practical nurse plays a vital role in symptom management, emotional support, and ensuring a peaceful, dignified death.