"Affective" "Relating to, arising from, or influencing feelings or emotions, expressing emotion."
"Empathic actions" "Simple actions that communicate understanding of the patient's experience."
"Empathic statements" "Reflect the emotions expressed by the patient and family."
"Empathy" "The ability to recognize and to some extent share the emotions and states of mind of another; understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner."
"Facial expression" "Nonverbal method of communicating information. Listening to the patient includes being aware of nonverbal communication such as body position, eye contact and physical distance, as well as language content and style. Facial expressions associated with pain may not be a reliable indicator of the amount of pain expereinced by a person."
"Intonation" "Manner of utterance; specifically, the rise and fall in pitch of the voice in speech."
"Intuition" "The power or faculty of attaining to direct knowledge or cognition without evident rational thought and inference."
"Intuitive knowledge" "Knowing or perceiving by intuition; quick and ready insight; knowledge or conviction gained by intuition : the power or faculty of attaining to direct knowledge or cognition without evident rational thought and inference."
"Linguistic elements" "A meaningful unit of speech (as a morpheme, word, or sentence) -- called also speech form."
"Listening (effective)" "To pay attention; to hear something with thoughtful attention : give consideration."
"Nonverbal communication" "The gestures, movements, and mannerisms by which a person or animal communicates with others. Unintentional transmissions or messages between persons."
"Open-ended questions" "Questions which have no ""yes"" or ""no"" answers; they may be answered in many ways."
"Pause" "A brief suspension of the voice to indicate the limits and relations of sentences and their parts."
"Pitch" "The relative level, intensity, or extent of some quality or state; the difference in the relative vibration frequency of the human voice that contributes to the total meaning of speech; a definite relative pitch that is a significant phenomenon in speech."
"Presence" "The fact or condition of being present attending to the needs of the patient and family."
"Reflective statements" "A statement made by one person which repeats the substance or meaning of a statement made by another person."
"Verbal communication--language content and style" "An act or instance of transmitting; information communicated; a verbal or written message; a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior; a technique for expressing ideas effectively (as in speech)."
"Acceptance" "Understanding the meaning of the illness within the context of the bio-medical model."
"Agitation" "Condition of psychomotor excitement characterized by purposeless, restless activity, irritability, crying, pacing or laughing, usually associated with fear and the unknown; extreme emotional disturbance; perturbation."
"Anasarca" "Generalized infiltration of edema fluid into subcutaneous connective tissue."
"Anorexia" "Diminished appetite; aversion to food."
"Anxiety" "Mental uneasiness or distress arising from fear of what might happen, often accompanied by tension, restlessness, tachycardia and dyspnea; an abnormal and overwhelming sense of apprehension and fear often marked by physiological signs (sweating, tension, and increased pulse), by doubt concerning the reality and nature of the threat, and by self-doubt about one's capacity to cope with it."
"Assurance" "To inspire confidence in, guaranty; confidence of mind or manner freedom from self-doubt or uncertainty."
"Asthenia" "Loss or lack of physical strength; weakness; debility."
"Attention, paying" "Act or state of attending especially through applying the mind to an object of sense or thought; condition of readiness for such attention involving especially a selective narrowing or focusing of consciousness and receptivity; consideration with a view to action."
"Attitudes" "A mental position with regard to a fact or state; a feeling or emotion toward a fact or state; an organismic state of readiness to respond in a characteristic way to a stimulus (as an object, concept, or situation)."
"Bad news" "Verbal delivery of a diagnosis of an uncurable, life threatening illness such as cancer, or helping a patient and family understand that a chronic ongoing disease, such as COPD or heart disease is unlikely to improve."
"Barriers" "Issues inhibiting agreement regarding the meaning of events. Any thing that prevents passage of persons, things, ideas or social interactions barriers (internal or external-patient's and healh care professional's)."
"Beliefs" "A state or habit of mind in which trust or confidence is placed in some person or thing; something believed; especially, a tenet or body of tenets held by a group; conviction of the truth of some statement or the reality of some being or phenomenon especially when based on examination of evidence."
"Cachexia" "A general lack of nutrition, weight loss and and muscle wasting occurring in the course of a chronic disease or emotional disturbance."
"Comfort" "Emphasizing physical and psychological support or relief throughout the patient's end of life."
"Communication (effective)" "A complex task--first you conceptualize what it is you wish to express in your mind. Then you must use words as a means of expressing what you have conceptualized. The words you choose may or may not accurately transmit what you mean to communicate. Then the listener interprets the symbols (words) you speak. The listener's understanding of what you have said may or may not reflect what you actually said and are further removed from what you originally thought in your mind."
"Communication skills " "Skills natural or acquired that facilitate effective communication."
"Compassion" "Sympathetic consciousness of others' distress together with a desire to alleviate it."
"Confront/confronting" "To face especially in challenges to cause to meet, bring face-to-face."
"Consensus (reaching consensus)" "Having the patient, family and health professionals come to a common understanding of what the medical diagnosis and prognosis means."
"Assent" "Developmentally appropriate awareness of condition.
- knowing what to expect with tests or treatments
- assessing childÆs knowledge and response to tests or treatment
- soliciting childÆs willingness; but if refusal will not be honored, child should not be deceived"
"Consent" "Provide information seeking permission from the person for procedure to therapy (e.g., inform of possible therapies, risks, benefits prior to permission given by person receiving the procedure or therapy).
-Assess patientÆs capacity and understanding of the information AND / OR
-Assess surrogateÆs capacity and understanding of the information
-Assess that the patient or surrogate is not being manipulated or coerced."
"Mind-body systems" "This subcategory involves whole systems of mind-body practice that are used largely as primary interventions for disease. They are rarely delivered alone; instead, they are used in combination with lifestyle interventions, or are part of a traditional medical system."
"Mind-body methods" "Individual modalities used in mind-body approaches to health. These approaches are often considered conventional practice and overlap with CAM only when applied to medical conditions for which they are not usually used (for example, hypnosis for genetic problems). e.g.,
CAM: Yoga, Internal Qigong, Tai Chi.
Behavioral Medicine (BM): Psychotherapy, Meditation, Imagery, Hypnosis, Biofeedback, Support groups.
Overlapping CAM/BM: Art therapy, Music Therapy, Dance Therapy, Journaling, Humor, Body psychotherapy."
"Dyspnea" "Shortness of breath, a subjective difficulty or distress in breathing, usually associated with disease of the heart or lungs."
"Hospice" "An institution that provides a centralized program of palliative and supportive services to dying persons and their families, in the form of physical, psychological, social, and spiritual care; such services are provided by an interdisciplinary team of professionals and volunteers who are available at home and in specialized inpatient settings. Hospice care is family-centered care designed to assist the chronically ill person to be comfortable and maintain satisfactory lifestyle through the terminal stages of dying.
- A discrete site of care, a free standing facility or a designated area in another institution where services are delivered.
- A program that provides, arranges, and consults on services to the dying and their families.
- An approach to or philosophy of care for dying patients."
"Jargon" "Language or terminology peculiar to a specific field, profession, or group."
"Palliative care" "Care designed to relieve or reduce intensity of uncomfortable symptoms but not to produce a cure."
"Path" "Initiating the care plan."
"Spirituality" "Something that in ecclesiastical law belongs to the church or to a cleric as such; sensitivity or attachment to religious values; the quality or state of being spiritual. Merriam-Webster Collegiate Dictionary, 2001."
"Uncertainty" "The inability to accurately predict the disease course for individuals."
"Values" "Relative worth, utility, or importance; something (as a principle or quality) intrinsically valuable or desirable."
"Cognitive function" "An intellectual process by which one becomes aware of, perceives, or comprehends ideas; it involves all aspects of perception, thinking, reasoning, and remembering."
"Collaborator role" "In the role of collaborator the health professional exchanges information with the patient and family to promote a common understanding of the diagnosis and illness experience and work together to choose the treatment path. The collaborator role includes that of the consultant but extends it by adding additional traits. The collaborator; acts as a coordinator, assuring all members of the team are providing patient and family care harmonious with treatment plan; serves as a facilitator, working with the patient/family and other team members to promote the care plan; provides a therapeutic role by promoting healing through discussions and actions with the patient and family regarding medical, psychological, spiritual, and social issues related to the care plan; is a team member, working within the care plan using and respecting other team members' skills."
"Coordinator" "Assuring all members of the team are providing the patient/family care harmonious within the treatment plan."
"Guide's role" "Health professional consults and collaborates with the patient and family to achieve their goals within the medical context."
"Roles" "A socially expected behavior pattern usually determined by an individual's status in a particular society; a function or part performed especially in a particular operation or process."
"Autonomy" "An ethical principle that affirms the right of the individual to self-determination, in particular over what happens to his or her physical body."
"Patient advocate" "To act on behalf of a patient; to defend the patient's rights, primarily the patient's right to self-determinism in healthcare decision-making."
"Moral outrage" "Knowing what is the right thing to do but being unable to act, usually due to institutional constraints. Similar to moral distress."
"Moral distress" "Knowing what is the right thing to do but being unable to act, usually due to institutional constraints. Similar to moral outrage."
"Moral uncertainty" "Being unsure of what is the ethical action or even the ethical problem."
"Withholding therapy" "To withhold therapy implies that the therapy will not be initiated, e.g., examples include not attempting CPR in the event of an arrest or not initiating hemodialysis in spite of increasing renal failure."
"Withdrawing therapy" "To withdraw therapy means that the therapy has already been initiated in the care of a patient, regardless of whether the therapy is continuously administered (such as mechanical ventilation) or intermittently utilized (such as antibiotics, hemodialysis, or blood transfusions)."
"Religion and Spirituality" "This subcategory deals with those non-behavioral aspects of spirituality and religion that examine their relationship to biological function or clinical conditions.
e.g., Confession, Soul Retrieval, Nonlocality, Spiritual Healing, Nontemporality, Special Healers"
"Social and contextual areas" "This subcategory refers to social, cultural, symbolic, and contextual interventions that are not covered in other areas. e.g.,
Overlapping: Placebo, Explanatory Models, Community-based Approaches (for example, Alcoholics Anonymous, Native American sweat rituals)."
"Alternative medical systems" "Complete systems of theory and practice that have been developed outside of the Western biomedical approach. It is divided into four subcategories: Acupuncture and Oriental medicine; Traditional Indigenous systems; unconventional Western systems; naturopathy."
"Acupuncture and oriental medicine" "Acupuncture, Tai Chi, herbal formulas, massage and manipulation (Tui Na), diet, acupotomy, external & internal Qi Gong."
"Traditional indigenous systems" "This subcategory includes major indigenous systems of medicine other than acupuncture and traditional oriental medicine. Native American Medicine, Traditional Aboriginal, Ayurvedic Medicine, Unani-Tibbi, SDDHI, Curanderismo, Kampo Medicine, Central and South American, Traditional African Medicine, Psychic Surgery."
"Unconventional Western systems" "This subcategory includes alternative medical systems developed in the West that are not classified elsewhere. CAM: Homeopathy, Functional Medicine, Environmental Medicine, Radiesthesia, Psionic Medicine, Cayce-based Systems, Kneipp ôclassicalö, Orthomolecular Medicine, Radionics. Overlapping: Anthroposophically-extended Medicine."
"Naturopathy" "This subcategory is an eclectic collection of natural systems and therapies that has gained prominence in the United States."
"Physician-assisted suicide" "Patient requests assistance from his or her doctor to commit suicide."
"Mechanical ventilation" "The use of a machine to support a patient's pulmonary status by ensuring adequate lung inflation via an endotracheal or tracheostomy tube. (Note that the correct term for these machines is ventilators, not respirators: ventilation is the expansion of the lungs with air while respiration is the exchange of O2 and CO2 at the membrane level.)"
"Artificially-provided nutrition or hydration" "An artificial means to convey food into the body such as an intravenous infusion, nasogastric (NG) or percutaneous enteral gastrostomy (PEG) tube. The nutrition and hydration provided via these means are not artificial, but generally are in liquid forms. In contrast, a special feeding spoon, bottle, or diet designed to reduce the risk of choking are not considered artificial means."
"Parental nutrition" "The provision of nutrition via a central line directly into the blood stream. Also called total parental nutrition."
"Killing" "An action, whether intentional or accidental, that results in another person's death."
"Assisted suicide" "To assist another to take his or her life by providing the means to accomplish his or her death; e.g., a loaded gun or a type and quantity of prescription medication that will result in death."
"Mercy killing" "Lay term used to describe cases where someone kills another person out of ""compassion"" or mercy such as when the person is in unremitting pain."
"Competency" "A legal state; a person is presumed competent and must be proven incompetent. Decision is made by a judge and generally reflects a permanent lack of mental capacity for the person."
"Incompetency" "Persons who are not capable of making healthcare decisions for themselves have several mechanisms for ensuring that someone close to them speaks for them and/or that their previously stated wishes are honored."
"Euthanasia" "A general term derived from the Greek eu, well, + thanatos, death, or "" good death."" Currently used broadly to refer to the act of causing a painless death for a person or animal."
"Voluntary euthanasia" "The act of painlessly killing another person at that person's request or with the person's informed consent."
"Involuntary euthanasia" "The act of painlessly killing another person without the person's expressed permission or even without their prior knowledge."
"DNR order" "Do-not-resuscitate order; a physician's order to not attempt cardiopulmonary resuscitation should a patient experience a respiratory or cardiac arrest; sometimes called a ""no code"" order, code blue, or DNAR order."
"DNAR order" "Do-not-ATTEMPT-resuscitation order; same as a DNR order but this term has gained popularity to emphasize the fact that resuscitation is unlikely to be successful given the relatively low success rates for in-hospital CPR."
"Portable or community-based DNR order" "A physician's order that has the informed consent of the patient or their legal surrogate to withhold (CPR) in the community setting; applies to emergency medical personnel."
"Surrogate [proxy]" "Person or persons who make decisions for an incapacitated person."
"Decisional incapacity" "Unable to make decisions related to healthcare or other areas due to a permenent or temporary disruption in a person's cognitive abilities (e.g., anesthesia, head injury, severe illness, post-cardiac arrest, meningitis, coma, etc.). Determination is made by a physician often in consultation with a psychiatrist if the person is alert but there are questions of thought disturbances due to depression, mental illness, etc."
"Prima facie" "Evidence that is adequate to establish a fact unless it is specifically refuted."
"Guardian" "A person who has been appointed, usually by the court, to ensure an incompetent person's rights are respected; similar to a surrogate or proxy in terms of healthcare decision-making but generally also has the power to make decisions about housing, financial matters, etc."
"Durable power of attorney for health care" "Legal appointment of an individual to speak for a person if that person should become decisionally incapacitated. There are multiple types of durable power of attorney, some of which cover business decisions, financial decisions, or healthcare decisions."
"Advance directive" "A document completed by an individual that specifies treatment preferences for healthcare decision making (particularly around end-of-life care and life-sustaining treatment decisions; e.g., a Living Will or directive to Physician). Or, an Advance Directive that specifies a surrogate decision-maker (e.g., a Durable Power of Attorney for Health Care)."
"Attitude" "A state of mind or a feeling; disposition (e.g., an attitude of open hostility)."
"Value" "A principle, standard, or quality considered worthwhile or desirable."
"Belief" "Something believed or accepted as true, especially a particular tenet or a body of tenets accepted by a group of persons."
"Societal" "Of or relating to the structure, organization, or functioning of society. Relating to human society and its members, ""social institutions,"" ""societal evolution,"" ""societal forces,"" ""social legislation."""
"Culture" "The totality of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought."
"Grief" "The process of psychological, social and somatic reactions to the perception of loss."
"Bereavement" "State of having suffered a loss."
"Mourning" "Culturally influenced responses to grief as well as the intrapsychic process which enable the bereaved to relinquish their emotional bonds to the deceased and promotes healing by helping the bereaved to learn how to live in a world without their loved one."
"Stressor" """Events that have the capacity to induce emotional distress."" (Nott, Vedhara, & Spickett, 1995: 456)"
"Stress" """Refers to the experience of emotional distress."" (Nott, Vedhara, & Spickett, 1995: 456)"
"Denial" "An unconscious defense mechanism characterized by refusal to acknowledge painful realities, thoughts, or feelings."
"Fear" "A feeling of agitation and anxiety caused by the presence or imminence of danger. A feeling of disquiet or apprehension."
"Depression" "A psychotic or neurotic condition characterized by an inability to concentrate, insomnia, and feelings of extreme sadness, dejection, and hopelessness."
"Withdrawal" "The act or process of withdrawing; detachment, as from social or emotional involvement."
"Resignation" "Unresisting acceptance of something as inescapable; submission. The state of being resigned or submissive; quiet or patient submission; unresisting acquiescence; as, resignation to the will and providence of God."
"Transendence" "A state of being or existence above and beyond the limits of material experience."
"Clinical preventative practices" "Unconventional approaches used to screen for and prevent health-related imbalances, dysfunction and disease."
"Lifestyle therapies" "This subcategory deals with complete systems of lifestyle management that include behavioral changes, dietary changes, exercise, stress management, and addiction control. To be classified as CAM, the changes in lifestyle must be based on a nonorthodox system of medicine, be applied in unconventional ways, or be applied across non-Western diagnostic. Approaches"
"Health promotion" "Involves laboratory and epidemiological research on healing, the healing process, health promoting factors, and autoregulatory mechanisms that forms the basis for health messages to the public."
"Biologically-based therapies" "Natural and biologically-based practices, interventions, and products. Many overlap with conventional medicineÆs use of dietary supplements. Includes four types of therapies--phytotherapy or herbalism; special diet therapies; orthomolecular medicine; pharmacological, biological and instrumental interventions."
"Cortex" "Outer areas/layers of an organ ( i.e., the brain)."
"Excitatory interneurons" "Spinal cord cells that enhance transmission of nociceptive signal from first-order neuron to second neuron in spinal cord (projection cell)."
"Inhibitory interneurons" "Spinal cord cells that block or inhibit transmission of nociceptive signal to brain. It is not transmitted beyond the first order neuron."
"Projection cells" "Second-order neuron responsible for transmitting action potential from PAN to third-order neurons in brain (Rostral ventral medulla or thalamus, predominately)."
"Neuroablative procedures" "Procedures that block pain pathways by destroying nerve tissue, sometimes using chemicals or thermal lesions."
"Self-transcedence" """Is characterized by an increased understanding of self and moving beyond self that is associated with rising above crisis situations such as physical and emotional pain due to ill health, loss and threat of loss. It is often accompanied by a sense of feeling uplifted; a physical lightness, and relief of burden; a closeness to ohers, to environment and to God; a renewed commitment to life purpose; and an acceptance of inescapable circumstances."" Mellors, Riley & Erlen (1997)"
"Nonsteroidal anti-inflammatory drugs (NSAIDs)" "Large class of drugs with anti-inflammatory, analgesic and antipyretic effects.
prototype: aspirin"
"Anti-inflammatory" "Reducing pain, redness, swelling and heat."
"Analgesic" "Pain relieving agent."
"Antipyretic" "Reducing fever."
"Narcotic" "A drug that produces stupor or narcosis (sleep); an obsolete term for analgesics-legal definitions that applies to all drugs that cause dependence."
"Opiate" "A drug that is a derivative from opium."
"Opioid" "A drug that binds to opiate receptors and produces morphine-like action (generic-like term for opium derivatives and synthetic drugs). Opiate and Opioid are used interchangeably in clinical practice and much of the literature."
"Analgesia" "Absence of sensibility to pain; not the same as suffering."
"Mu receptor" "Primary receptor for morphine."
"Delta receptors" "Primary receptor for the endogenous opioid enkephalin."
"Kappa receptors" "Primary receptor for the endogenous opioid dynorphin."
"Agonists" "Drugs that bind and produce morphine-like actions at mu, delta and kappa receptors."
"Mixed agonists antagonists" "Bind and produce morphine-like actions at kappa receptors; bind, but do not produce morphine-like effects at mu and delta receptors (don't produce full morphine-like effects; e.g., can cause withdrawal symptoms in people dependent on agonists, potentially life threatening."
"Partial agonists" "Bind and produce morphine-like actions at mu receptors."
"Antagonists" "Drugs that bind to mu, delta and kappa receptors, but do not produce morphine-like effects, a competitive agonist such as naloxone (Narcan)."
"Tolerance" "Increased dose required to produce the same effects when pain stimulus remains unchanged."
"Cross-tolerance" "Refers to incomplete tolerance to similar drugs, e.g., morphine and hydromorphone; when switching drugs reduce equianalgesic dose by 2/3 to adjust for incomplete cross-tolerance."
"Dependence" "Abstinence from drug use produces physical withdrawal syndrome (runny nose, sweating, anxiety, irritability, abdominal cramps, diarrhea). To withdraw from morphine, decrease the 24 hour dose by 50% and 25% of this dose every 6 hours; after 2 days, reduce daily dose by an additional 25% every 2 days until 24 hour dose is 30 mg. PO per day, then discontinue the morphine."
"Addiction" "Psychological drive (desire) to take a drug (opioid) for euphoric reasons. Rare event when opioids are used for medically indicated purposes."
"Equianalgesic dose" "Dose considered equivalent when considering different drugs or adminstration routes."
"Equianalgesic conversion" "Change of dose, adminstration route or drug based on equianalgesic guidelines."
"Titration" "Increasing dose of an alagesic based on the pain relief and side effects of the dose."
"Nociception" "The activation of primary afferent nerves with peripheral terminals that respond differently to noxious (i.e. tissue damaging) stimuli. Nociception may or may not be perceived as pain, depending on a complex interaction within the nociceptive pathways."
"Suffering" "The state of severe distress associated with events that threaten the intactness of the person (Cassell, 1982)."
"Affective pain dimension" "Dimension that focuses on emotional and psychological aspects of pain."
"Behavioral pain dimension" "Dimension that focuses on actions or behaviors exhibited by people in pain."
"Evaluative pain dimension" "Same as cognitive dimension of pain."
"Cognitive pain dimension" "Peoples thoughts about pain, illness and pain therapies depending on their attitudes, beliefs and experiences."
"Neural mechanisms of pain" "Anatomy, physiology and pathophysiology of pain."
"Assessment" "The act of determining the importance, size, or value of something. Making an estimate.
(WebsterÆs, 1974)"
"Measurement" "The act of applying a metric to quantify how much there is of something.
(WebsterÆs, 1974)"
"Location of pain" "The site or sites where the pain is experienced."
"Intensity of pain" "Amount of pain that is experienced."
"Quality of Pain" "Nature or characteristics of the pain (e.g., shooting, stabbing, dull, burning)."
"Pattern of pain" "The experienced timing, duration and course of the pain."
"Phytotherapy or herbalism" "This subcategory addresses plant-derived preparations that are used for therapeutic and preventive purposes."
"Special diet therapies" "This subcategory includes dietary approaches and special diets that are applied as alternative therapies for risk factors or chronic disease in general."
"Anticipatory grief" "Phenomenon encompassing the processes of mourning, coping, interaction, planning and psychosocial reorganization that are stimulated and begin in part due to the awareness of the impending loss of a loved one and the recognition of associated losses in the past, present, and future."
"Transduction" "Conversion of a mechanical, thermal or chemical stimulus to a neuronal action potential."
"Death-defying" "Refuse to believe that death would take anything away and believe it could be overcome."
"Death-accepting" "View death as inevitable and natural part of the life cycle. Behaviors and events of the dying process are integrated into everyday life."
"Death-denying" "Refuse to confront death, believe that death is antithetical to living and that is not a natural part of human existence."
"Orthomolecular medicine" "This subcategory refers to products used as nutritional and food supplements (and not covered in other categories). These products are used for preventive or therapeutic purposes. They are usually used in combinations and at high doses. Examples include niacinamide for arthritis and melatonin to prevent breast cancer."
"Manipulative and body-based systems" "This category refers to systems that are based on manipulation, movement of the body or both, and is divided into three subcategories: chiropractic medicine; massage and body work; unconventional physical therapies."
"Biofield" "Biofield medicine involves systems that use subtle energy fields in and around the body for medical purposes."
"Cheyne-stokes breathing" "rhythmic waxing and waning of respiratory depth with regularly recurring apnea, seen in coma"
"Anuria" "No urinary output."
"Structural losses" "Through amputation (e.g., mastectomy, colostomy, hysterectomy, heart and kidney transplant, etc.) and through disfigurement due to congenital deformation, accidents, bums, etc."
"Functional losses" "Through loss of mobility due to paralysis, stroke, spinal cord injury; loss of one or more of the five senses; loss of elimination control; loss of sexual functioning; loss of health; etc."
"Physical loss" "Loss of body parts or normal body functions and abilities."
"Developmental losses" "The ""necessary losses"" that come with physical, emotional and psychological growth and development are significant issues."
"Chronic grief" "Reaction is one that is prolonged, is excessive in duration, and never comes to a satisfactory conclusion."
"Delayed grief" "Reaction is one, which has been inhibited, suppressed or postponed. A subsequent loss may illicit an exaggerated reaction because the bereaved is grieving for two losses."
"Exaggerated grief" "Reaction occurs when feelings of fear, hopelessness, depression or other symptoms become so excessive that they interfere with the daily existence of the bereaved."
"Death rattle" "A rattling or gurgling in the throat of a dying person."
"Masked grief" "Reactions are symptoms and behaviors experienced by a person who does not recognize the fact that these are related to a loss."
"Secondary losses" "Losses that develop as a consequence of the death of the loved one."
"Conventional grief" "Post-death grief."
"Rituals" "Ceremonial act or series of such acts."
"Coping" "Management through cognitive and behavioral efforts of specific external/internal demands that are judged as challenging the person's resources."
"High hopes" "Concept usually refers to achievement of some goal; namely, a successful outcome to some venture."
"Little hope" "Often applied after an airplane crash, or other devastating occurrence such as a mud-slide regarding finding anyone alive."
"False hope" "Indicates that a specified outcome is not very likely to occur."
"Hopeless" "Giving no ground for hope."
"Well-being" "The state of being happy, healthy, or prosperous often in combination."
"Psychosocial" "Involving both psychological and social aspects."
"Psychological well-being" "Seeking a sense of control in the face of life-threatening illness characterized by emotional distress, altered life priorities, and fears of the unknown, as well as positive life changes."
"Supernatural" "Of or relating to an order of existence beyond the visible observable universe; especially of or relating to God or a god, demigod, spirit, or devil."
"Complementary and alternative medicine (CAM)" "Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. CAM therapies are treatments and healthcare practices that do not form part of the dominant healthcare management paradigm (e.g., not approved by the Food and Drug Administration; not routinely taught in conventional medical schools; are used 'off-label' from FDA recommendations(e.g., different dosage, disease or condition differing from the FDA approval, etc.; or are not covered by most insurance policies). Therapies used alone are often referred to as alternative, and when in combination with other alternative therapies, or in addition to conventional therapies they are often referred to as complementary."
"Complementary methods" "Methods applied by conventionally trained physicians and health care providers are based on tradition, or the perspective of the human arts, which are not investigated or taught at universities."
"Mind-body medicine" "Mind-body medicine involves behavioral, psychological, social, and spiritual approaches to health. It is divided into four subcategories: mind-body systems; mind-body methods; religion and spirituality; social and contextual areas."
"Olgiuria" "Diminished urinary output compared to fluid intake, less than 400 cc per day."
"Signs of death" "Cessation of heart beat and respiration, pupils fixed and dilated, no response to stimuli, eyelids open without blinking, decreasing body temperature, jaw relaxed and slightly open, body color is a waxen pallor."
"Quality of Life" "Measures difference, at a particular point in time, between the hopes and expectations of the individual and that individual's present experience. (Calman 1984)"
"Hope" "A desire of some good accompanied with at least a slight expectation of obtaining it, or a belief that it its obtainable; expectationn of something desirable; confidence in a future event."
"Religious" "Relating to or concerned with religion or spiritual things; especially dedicated to service in a religion."
"Spiritual well-being" "A sense of inner peace, compassion for others, reverence for life, gratitude and appreciation of both unity and diversity. (Vaughn)"
"Alternative medicine" "Alternative medicine is defined as any treatment (substance or modality) that is used by or prescribed to patients that is not a Food and Drug Administration (FDA) approved pharmaceutical substance or device; FDA -approved substances or devices that are being used for indications and in doses not approved by the FDA for that agent or device. This definition addresses the legitimating power of the FDA and the process by which drugs are approved."
"Complementary medicine" "Alternative therapies are sometimes also termed complementary. There are subtle differences in the meaning of these terms. Most complementary practitioners in the United States, whatever their training, view their work as additional to conventional therapies, not in competition to them."
"Double effect" "Derives from Catholic theology and distinguishes between intent and consequences. It holds that when an act has two foreseeable effects (such as pain relief and suppression of respirations) it is ethical to provide the act if oneÆs intent is the good effect not the bad."
"Minor" "A person under the age of 18 or 21 (depending on state law) who cannot legally make healthcare decisions for him or herself independently (also cannot enter into legal contracts, etc. without parental permission)."
"Emancipated minor" "A person under the age of 18 or 21 (but usually at least 16) who is legally considered to be an adult due to circumstances that are defined by state law. For example, marriage usually leads to a minor being considered emancipated. (Each state differs as to the circumstances leading to emancipation so check your state law)."
"PAS" "Physician-assisted suicide: a patient requests assistance from his or her doctor to commit suicide."
"A-alpha fibers" "Large, myelinated sensory nerve fibers that transmit sensation of soft touch to skin and vibration. A-alpha fibers have a lower threshold for activation and transmit signals more rapidly than smaller, or unmyelinated fibers."
"A-beta fibers" "Smaller, myelinated sensory nerve fibers that transmit sensation of light pressure to deep muscles."
"Delta fibers" "Small, myelinated fibers that are important in the transmission of acute pain."
"C fibers" "Small, unmyelinated sensory nerve fibers that convey noxious information to the entral nervous system; conducts slowy."
"Nociceptive pain" "Pain resulting from activation of primary afferent nociceptors by mechanical, thermal or chemical stimuli."
"Primary afferent nociceptors (PAN)" "Nerve cell primarily responsible for for sensing and transmitting pain information."
"Stimuli (chemical, mechanical, thermal)" "Chemical, mechanical or thermal events that can cause pain to be transmitted."
"Silent nociceptors" "Mechancally insensitive nociceptors that become active when tissues are injured."
"Neuropathic pain" "Pain resulting from damage to peripheral nervous or central nervous system tissue or from altered processing of pain in the central nervous system.
(Cassell, 1982)"
"Noxious stimulus" "Stimulus which is damaging to normal tissues."
"Cure" "Treatment of disease or illness with the intent to overcome it."
"Preemptive Analgesia" "Preventing pain bebore it begins."
"Palliation" "Treatment to relieve symptoms and distress of disease process or illness."
"Sensitization" "Increased sensitivity of a nerve fiber as a result of repeated stimulation."
"Activation of neuronal action potential" "The condition in which a stimulus causes a nerve fiber to begin to transmit a signal."
"Allodynia" "A condition in which pain is perceived after a stimulus that would not normally cause pain."
"Primary hyperalgesia" "Increased pain sensation occurring at the site of the damaged tissue."
"Secondary hyperalgesia" "Increased pain sensation occurring at a site tissue is not damaged."
"Neuroma" "Nerve tissue tumor."
"Sympathetic ganglia" "Bundles of nerves of the autonomic nervous system connecting in the thoracic and upper lumbar spinal segments."
"Efferent fibers" "Nerve fibers that carry signals back to muscles and glands."
"Stellate ganglion block" "Injection of anesthetic into the nerves of the sympathetic nervous system in the neck."
"Superior hypogastric plexus block" "Use of local anesthetics to block the nerves of the superior hypogastric plexus that normally carry pain information from middle pelvic organs such as the bladder and uterus."
"Celiac plexus block" "Use of local anesthetics or surgical procedure to block the nerves of the celiac plexus that normally carry pain information from organs in the abdomen."
"Lumbar blocks" "Injections of medication in the lumbar region of the spine to block pain in the lower body."
"Epidural blocks" "Injections of medication into the epidural space in the outer layers of the spinal cord to block pain."
"Neurolysis" "Destruction of nerve tissue."
"Dorsal rhizotomy" "Cutting or disabling of dorsal nerve root in order to stop transmission of pain."
"Counterirritation (DNIC)" "A modulating stimulus affecting receptors near the pain site that lessens the intensity of pain."
"Transcutaneous electrical stimulation (TENS)" "Process of passing small electric currents through the skin to stimulate nerve fibers."
"Dorsal root entry zone lesion (DREZ)" "Lesions created to block pain transmission at the entry point of nerves into the dorsal horn of the spinal column."
"Intrathecal blocks or neurolysis" "Injections of medication into the intrathecal space surrounding the spinal cord to block pain."
"Cordotomy (surgical or percutaneous)" "Operation to cut nerves in the spinal cord in order to stop them from transmitting pain signals to the brain."
"Ascending tracts" "Nerve pathways that carry pain signals to the brain."
"Reticular activating system (RAS)" "Connections in the brainstem that are involved with alertness and waking/sleep."
"Thalamus" "Portion of the brain where sensory impulses are processed before being relayed to the cerebral cortex."
"Music therapy" "Prescribed use of music and musical interventions in order to restore, maintain, and improve emotional, physical, physiological, and spiritual health and well-being."
"Art therapy" "As a form of psychotherapy, is an interdisciplinary practice across health and medicine, using various visual art forms such as drawing, painting, sculpture and collage."
"Guided-imagery" "A mind-body intervention aimed at easing stress, and promoting a sense of peace and tranquillity at a stressful or difficult time in someone's life."
"Terminal sedation" "Sedation for intractable distress in the dying."
"Bioelectromagnetics" "Bioelectromagnetics refers to the unconventional use of electromagnetic fields for medical purposes."
"Pharmacological and instrumental interventions" "This subcategory includes products and procedures applied in an unconventional manner that are not covered in other categories."
"Holistic nursing" "Holistic Nursing is given as an example of a caring-based approach and is considered CAM.
On the other hand Alcoholics Anonymous and Native American ôsweatö rituals are considered overlapping."
"End-of-life care" "Health care provided in the last six months of life when the person is nearing death."
"End of life" "The time period for patients in which: a) there is little likelihood of cure for their disease, and b) further aggressive therapy is judged to be futile, and c) comfort is the primary goal of health care."
"Life expectancy" "The average number of years people born in a given year are expected to live based on a set of age-specific death rates."
"Years of healthy life" "The difference between life expectancy and years of healthy life reflects the average amount of time spent in less than optimal health because of chronic or acute limitations."
"Illness and disease trajectories" "Sudden, unexpected death -- Less than 10% of the American population die suddenly from a myocardial infarction, accident, homicide or another, unexpected event.
-Chronic, steady -- a lengthy life-threatening illness, usually with a highly predictable steady course ending with a shorter ôterminalö phase which results in death (most frequently cancer).
-Chronic, intermittent -- an illness characterized by a slow decline interrupted by crises (congestive heart failure or emphysema)."
"Futility" "Quantitative futility: research suggests that a therapy will have a less than 1% chance of producing the desired physiological effect, e.g., CPR will restore cardiac function (Jecker, 1994; Schneiderman et al., 1990).
- Qualitative futility: where personal, professional or public opinion suggests that while a therapy can achieve a desired effect, it will not produce the desired benefit; e.g., a situation such as persistent vegetative state (PVS) where CPR is expected to be successful in restoring cardiac function but the individual will not and cannot regain neurological function or meaningful consciousness. Qualitative futility is dangerous in that the definition of what is beneficial lacks any kind of clear societal (or professional) consensus. Hence, hospital policies that address withholding CPR on the basis of futility, generally specify quantitative futility versus qualitative (Schneiderman et al., 1990)."
"Probabilistic" "A point on a continuum where the probability of cost (physical, emotional, cognitive, financial, resources) vs. benefit is very low, i.e., 1 in 100."
"Family caregivers" "The immediate family, relatives by blood, marriage, or adoption, partners, or close friends who provide directly or manage the care of people who need medical and non-medical assistance, emotional support, and advocacy because they are ill or disabled."
"Quality of care" "The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."
"Continuous quality improvement (CQI)" "A set of principles that reinforce change implementation and often include ""targeting systemic defects rather than individual mistakes; encouraging close relationships among the participants in health care; using planning, control, assessment, and improvement activities that are grounded in statistical and scientific precepts and techniques; provide the statistical information back to practitioners on how their practices may differ from their peers' or depart from evidence-based standards for practice; standardizing processes to reduce the opportunity for error and link specific care processes to outcomes; and striving for continuous improvement in contrast to merely meeting established goals or criteria. Also known as Total Quality Management (TQM)."
"Outcomes research" "Research that seeks to understand the end results of particular health care practices and interventions. End results include effects that people experience and care about, such as change in the ability to function. In particular, for individuals with chronic conditionsùwhere cure is not always possibleùend results include quality of life as well as mortality."
"Outcomes and effectiveness research (OER)" "OER evaluates the impact of health care (including discrete interventions such as particular drugs, medical devices, and procedures as well as broader programmatic or system interventions) on the health outcomes of patients and populations. OER may include evaluation of economic impacts linked to health outcomes, such as cost-effectiveness and cost utility. OER emphasizes health problem- (or disease-) oriented evaluations of care delivered in general, real-world settings; multidisciplinary teams; and a wide range of outcomes, including mortality, morbidity, functional status, mental well-being, and other aspects of health-related quality of life. OER may entail any in a range of primary data collection methods and secondary (or ""synthetic"") methods that combine data from primary studies."
"Nursing" "The diagnosis and treatment of human responses to actual or potential health problems."
"Purpose of nursing" "To assist the individual, sick or well, in the performance of those activities contributing to health or its recovery, or to a peaceful death, that he would perform unaided if he had the necessary strength, will, or knowledge."
"Attending physician" "Designated by the patient to manage his or her care."
"Bereavement counselor" "Supports patient and especially family throughout the dying process and offers follow-up grief support and education."
"Complementary / alternative medical practitioners" "Provide palliative care to patient and family including massage, acupuncture, aroma, music, art, drama, dance, pet, herbal, etc. therapies."
"Funeral director" "Assists patient and family with planning funeral and burial arrangements."
"Home health aide" "Assists with personal care and light housekeeping services."
"Hospice or palliative care nurse" "Acts as case manager, coordinates the individualized care plan, provides specialized palliative care to the patient and family, and may lead the team."
"Patient and family" "Are at the center of the interdisciplinary hospice or palliative care team and the most important members."
"Pharmacist" "Provides counseling and support as needed regarding medications including possible adverse interactions."
"Social worker" "Offers psychosocial (emotional) support, counseling and community resources support services."
"Specialist physicians" "May provide specialized palliative care such as radiation therapists, surgeons, etc."
"Spiritual care" "Spiritual care coordinator or chaplain assists with any spiritual concerns."
"Therapists" "Physical, occupational and speech therapists provide care according to the patient's care plan."
"Volunteers" "Trained volunteers provide multiple services including companionship and respite care."
"Kussmaul respiration" "Air hunger, distresing dyspnea occuring in paroxysms (sudden recurence or intensitfication of symptom)."
"Analgesic Ladder" "In 1986, the World Health Organization first proposed that clinicians use analgesic medications via a systematic plan (see WHO analgesic ladder slide). The systematic plan includes a three-step ladder approach. For chronic nonmalignant and cancer pain, drug use is recommended from the bottom of the ladder to the top, i.e., up the ladder from Step 1 to Step 2 to Step 3. For acute pain, the steps are ordered from the top step to the bottom step, i.e., down the ladder from Step 3 to Step 2 to Step 1."
"Access to care" "The extent to which health care is available and accessible to those who need it."
"Accountability" "The state of being accountable; taking responsibility for one's actions and outcomes of those actions."
"Acute pain" "Can become neuropathic pain if the pain persists without sufficient relief. Unrelieved pain has many pathophysiologic consequences that involve the nervous system and many other physical and psychological systems."
"Advance care planning" "Advance care planning is an ongoing process in which a person makes decisions about preferences for care. It includes a structured discussion and documentation that involves the patient, health care providers, family and surogate decision-maker. Usually, a document is completed that specifies treatment preferences for healthcare decision making (particularly around end-of-life care and life-sustaining treatment decisions; e.g., a Living Will or directive to Physician). Or, an Advance Directive that specifies a surrogate decision-maker (e.g., a Durable Power of Attorney for Health Care)."
"Agency for Health Care Policy and Research (AHCPR)" "Now called Agency for Health Research and Quality, a part of the U.S. Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of healthcare, reduce its cost, improve patient safety, decrease medical errors, and broaden access to essential services. See Agency for Health Research and Quality (AHRQ)."
"Agency for Health Research and Quality (AHRQ)" "AHRQ, a part of the U.S. Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of healthcare, reduce its cost, improve patient safety, decrease medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on healthcare outcomes; quality; and cost, use, and access. The information helps healthcare decisionmakersùpatients and clinicians, health system leaders, and policymakersùmake more informed decisions and improve the quality of healthcare services. Formerly was known as the Agency for Health Care Policy and Research (AHCPR)."
"Anorexia-cachexia syndrome" "This syndrome involves diminished appetite (anorexia) and wasting of muscle mass (cachexia). Decreased eating means that the energy a patient takes in does not cover the energy he or she expends. Cachexia affects a majority of terminal cancer patients and is also common in patients with chronic organ system failure and those with AIDS and dementia."
"Approaching Death" "There are predictable physical, physiologic and emotional changes that occur during the final days and hours of life. During this important phase of end-of-life care, the nurse serves as a consultant, collaborator, coach or guide to assist the patient to achieve symptom relief. Also the nurse helps the patient and family to prepare for the approaching death."
"Artificial nutrition and hydration" "A life-sustaining treatment in which chemically balanced mix of nutrients and fluids through some type of tube. Examples include intravenous tubes or a flexible tube inserted through the nasal passage into the stomach (nasogastric or NG tube) or surgically implanted through the wall of the abdomen into the stomach (gastrostomy, G tube or PEG) or intestine (jejunostomy). It is used when a person cannot eat or drink enough to sustain life."
"Ascites" "An accumulation of abnormal fluid in the abdominal cavity."
"Bad Death" "A ""Bad Death"" occurs when healthcare providers do things that increase patient and family distress and force them to adapt or change their meanings to endure the medical treatment."
"Barriers to Pain management" "Many misconceptions about analgesics and pain are important barriers to adequate analgesia, including to people facing the end-of-life transition. Generally information about tolerance, cross-tolerance, dependence, addiction, assisted suicide, euthanasia, and placebo. Nurses can play an important role in altering beliefs and attitudes held by patients, family members and professional colleagues."
"Beneficience principle" "Health care and medical treatment are guided based on a principle that doing good and no harm to someone."
"Bereavement support groups" "Support groups can be helpful in providing support, promoting healthy grief work and decreasing the likelihood of negative sequelae. One of the most valuable aspects of therapy for grievers is the opportunity for ongoing discussion about their loss, well beyond the immediate post-loss period. Regular counseling can provide the opportunity for the bereaved to continue to verbalize and process their issues with a supportive guide. This is especially important when the social network is not responsive or available."
"Brain death" "Brain death is defined as the irreversible loss of all functions of the brain including electric activity, blood flow, and other functional responses."
"Cancer pain" "A sensation of discomfort resulting from cancer or cancer-related treatments."
"Cancer patients, cure-to-care transition" "At the beginning stage of the disease, medical therapy focused on curative effect. In the trajectory of disease, the emphasis on care shifted to patients and family-related, including palliative care, life-prolonging treatments, and death preparation provided by the caring community."
"Cardiopulmonary resuscitation" "Also known as CPR and is a life saving procedure that includes the timed compression of the anterior chest wall in order to stimulate blood flow, alternating with mouth to mouth breathing which inflates the other person's lungs."
"Chronic illness" "An illness that has persisted for a long period of time and usually can be treated but not cured."
"Chronic obstructive pulmonary disease" "Also known as COPD and is disease with symptoms including difficulty breathing, wheezing and a chronic cough."
"Chronic pain" "Pain that persists beyond the normal healing process."
"Cirrhosis" "A liver disease in which the liver becomes smaller in size and more dense and fibrous in consistency."
"Clinical practice guidelines" "A clinical guideline is established by evidence-based research, for guiding clincial practice."
"Comfort care" "Health professionals provide active, desirable, and important comfort care to the dying. In order to provide quality comfort care to the dying, health professionals elicit, document, display, and assist in implementation of the patientÆs wishes for end of life care. This comfort care service is not assisted suicide or euthanasia."
"Communication with patients and families" "Before the members of the healthcare team start treatments we must first understand our patients and families as unique humans, unlike any others. It is in the richness of understanding diverse human experience that ""good"" care is provided by professional caregivers at the end of life. The foundation of understanding another person's experience is effective communication."
"Community health care systems" "A health care delivery system that offers comprehensive health care integrating care across various settings for patients, families, and clinicians."
"Congenital defects" "Birth defects."
"Congestive heart failure" "Also known as CHF, in which there is ineffective pumping of the heart which leads to fluid accumulation in the lungs. Symptoms such as shortness of breath with exertion, difficulty breathing when lying flat and leg or ankle swelling are common and can be distressing. Causes of CHF include chronic hypertension, cardiomyopathy and myocardial infarction."
"Cultural sensitivity in care" "The diversity of people's value and preference is taken into account in heatlh care delivery, including the individaul, spiritual and cultural differences in values and preferences."
"Curative care" "Health care that aims to halt the disease process, to cure the patient."
"Curative/life-prolonging therapies" "Therapies such as chemotherapy, surgery, or radiation therapy that aim to prolong life or cure the patient."
"Cure-to-care transition" "Changing health care goals from attempting to cure the illness or disease to one in which comfort care is the main focus of care. Providing comfort care simultaneously with curative intent care reduces some of the conflicts often associated with shifting care goals."
"Day-care services" "A range of services for people who need support in living includes: health care, recreational and social programs and social services."
"Death" "Cessation of normal body functions, notably circulatory and pulmonary. In legal terms defined as ""brain death."""
"Death with Dignity" "A dying patient's personal choices are given the utmost respect."
"Death, legal definition" "Death was defined for legal purpose as the irreversible cessation of respiratory, circulatory, and the entire brain function."
"Dementia" "A general loss of intellectual abilities involving impairment of memory, judgment and abstract thinking as well as changes in personality."
"Diagnosis" "The determination of a disease or human response."
"Diagnosis, terminal" "A clinical diagnosis expected to end in dying, or death."
"Dialysis discontinuation" "Discontinuation of dialysis therapy. This is one of the interventions being debated under circumstances in which patients received no benefit."
"Dignified Death" "Dignified death is afforded to competent and responsible adults who have the right to request physician-aided dying treatments under particular circumstances, accompanied by careful and respective care."
"Dimensions of end-of-life care" "The practical End-of-Life care covered with three major dimensions of caring: physical, emotional, and spiritual."
"Do-not-resuscitate (DNR) orders" "A do not resuscitate (DNR) order is an advance directive, a request not to attempt cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing."
"Drug tolerance" "Increased dose required to produce the same effects when the stimulus remains unchanged."
"Dysphagia" "Difficulty in swallowing."
"End-stage renal disease" "The final stages of renal diesase."
"Ethics" "The science of human duty; the body of rules of duty drawn from this science; a particular system of principles and rules concerting duty, whether true or false; rules of practice in respect to a single class of human actions; as, political or social ethics; medical ethics."
"Fatigue" "A feeling of weariness or tiredness."
"Functional status assessment" "Assessment for determining what patients can do for themselves; when, where, and which kind of assistance they would need."
"Futility of treatment" "It refers to the situation in which an unsuccessful treatment achieved nothing or no effects."
"Good Death" "Death is free from suffering and distress for patients, families, and the care community."
"Health care financing" "Financial system refers to health care and medical insurance."
"Health Care Financing Administration (HCFA)" "The organization identified the need for hospice care and integrated the evaluation into Medicare."
"Health care system" "The heatlh care organizations and services in a community, including analyzing, implementation, and evaluation of health care delivery and policies."
"Health service organizations" "Organizations that coordinate care, education and research."
"Holistic approach" "Healthcare that focuses on the entire person and family considering biobehavioral, psychologic and sociologic aspects of the person and family."
"Home care" "A program in which the care setting is the home and the focus of care is to fufill the needs of patients."
"Home health services" "Care provided by home care service."
"Hospice care" "Specialized, active health care, supportive in nature, provided to a dying person. A holistic approach is often taken, providing the patient and his or her family with legal, financial, emotional, or spiritual counseling in addition to meeting the patient's immediate physical needs. Care may be provided in the home, in the hospital, in specialised facilities (hospices), or in specially designated areas of long-term care facilities. The concept also includes bereavement care for the family."
"Hospital care clinical practice guidelines" "A clinical guideline applied in hospital settings to improve clinical practice and provide clinical decision support."
"Informal care systems" "Informal care systems include religious, family and popular culture."
"Informed consent" "Patients accept or refuse any medical intervention after understanding the risks or benefit, and possibility of alternative treatments."
"Joint Commission on Accreditation of Health Care Organizations" "This nonprofit and independent commission evaluates and accreditate nearly 19,000 health care organizations and programs in the United States, to imporve the safety and quality of care."
"Last Acts" "Last Acts is an unprecedented national effort to raise awareness of the need to improve care of the dying and to share issues and ideas at the national, state and local levels. The Honorary Chair of Last Acts is former First Lady Rosalynn Carter. http://www.lastacts.org/"
"Life prolonging technologies" "Therapeutic interventaions which allow patients to live for a longer time."
"Litigation" "A judicial proceeding."
"Living wills" "A written docutment that indicates a person's preference for the types of medical treatments he/she would like to have when he/she is very ill,likely to die and unable to communicte with other people about his/her wishes"
"Long-term care" "Health care and social service delivered for a period of time to a person."
"Malpractice litigation" "Litigation related to inappropriate medical practice, usually resulted from the conflicts between patients' wishes and clinicians' judgement."
"Managed care" "Patients are directed to a panel of health care providers for systematic use of services which includes administrative management skills."
"McGill University Palliative Care Program" "The palliative care program offers resources for issues related to life-threatening illness in childhood, symptom control, terminal care and bereavement. The team includes nurses, pastoral services, a psychiatrist, a psychologist and a social worker."
"Medicaid" "Medicaid is a jointly-funded, Federal-State health insurance program for certain low-income and needy people. It is called MediCal in California. Nation wide, it covers approximately 36 million individuals including children, the aged, blind, and/or disabled, and people who are eligible to receive federally assisted income maintenance payments."
"Medical Outcomes Trust" "The Medical Outcomes Trust is a not for profit organization dedicated to improving health and health care by promoting the science of outcomes measurement, and the development, evaluation and distribution of standardized, high quality instruments that measure health and the outcomes of medical care. The Trust supports the use of these instruments with services and publications."
"Medical review panels" "In medical ethics committees, a group of professionals are responsible for making neutral information available for patients."
"Medicare" "An insurance program administered by the U.S. Social Security Administration. Medicare reimburses hospitals and physicians for medical care provided to qualifying people, most of whom are over 65 years old."
"Medicare Rights Center" "The Medicare Rights Center (MRC) is a national, not-for-profit organization that helps ensure that older adults and people with disabilities get good affordable health care. It was established in 1989 to provide free counseling services to people with Medicare questions or problems. Since its founding, MRC has helped more than one million people with Medicare-related issues. MRC has conducted training programs and presentations for organizations as diverse as the U.S. HHS, the Administration on Aging, Ceridian Performance Partners, American Public Health Association, AARP, the Practising Law Institute, Families USA, AFSCME and Visiting Nurse Service. http://www.medicarerights.org/aboutmrc.html"
"Memorial Sloan-Kettering Cancer Center" "Memorial Sloan-Kettering Cancer Center, established in 1884, is the world's oldest and largest private institution devoted to prevention, patient care, research, and education in cancer."
"Missoula Demonstration Project Inc." "Established in March 1996 as a fifteen-year effort to research the experience of dying persons and their families and to demonstrate that a community-based approach to excellent medical care and psychosocial support can consistently improve the quality of life among those who are dying and their families."
"Morphine" "An opiate analgesic meaning it is an alkaloid extracted from opium."
"Mortality rates" "The ratio of deaths in an area to the population of that area; expressed per 1000 per year."
"National Cancer Institute" "The National Cancer Institute (NCI) is a component of the National Institutes of Health (NIH), one of eight agencies that compose the Public Health Service (PHS) in the Department of Health and Human Services (DHHS). The NCI, established under the National Cancer Act of 1937, is the Federal Government's principal agency for cancer research and training. The National Cancer Institute coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients. http://www.nci.nih.gov/klaus.htm"
"National Center for Health Statistics" "NCHS is the Federal Government's principal vital and health statistics agency. Since 1960, when the National Office of Vital Statistics and the National Health Survey merged to form NCHS, the agency has provided a wide variety of data with which to monitor the Nation's health. Since then, NCHS has received several legislative mandates and authorities. The National Center for Health Statistics (NCHS) is a part of the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services."
"Open Society Institute Project on Death in America" "The mission of the Project on Death in America is to understand and transform the culture and experience of dying and bereavement through initiatives in research, scholarship, the humanities, and the arts, and to foster innovations in the provision of care, public education, professional education, and public policy. http://www.soros.org/death/about_us.htm"
"Outcome measures" "Measurements that evaluate the outcome of treatments."
"Overtreatment and overutilization" "Giving care that is against patients' wishes and also clinically inappropriate, overuse of clinical treatment under certain circumstance."
"Pain" "According to the International Association for the Study of Pain, ""Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."""
"Pain management" "In 1986, the World Health Organization first proposed that clinicians use analgesic medications via a systematic plan (see WHO analgesic ladder slide). The systematic plan includes a three-step ladder approach. For chronic nonmalignant and cancer pain, drug use is recommended from the bottom of the ladder to the top, i.e., up the ladder from Step 1 to Step 2 to Step 3. For acute pain, the steps are ordered from the top step to the bottom step, i.e., down the ladder from Step 3 to Step 2 to Step 1."
"Pain management undertreatment" "Undertreatment in pain management indicates the underuse of appropriate treatment, such as failed to access to pain management strategies or inappropriate dose of analgesics."
"Pastoral counseling" "Couseling provided by a member of a particular religion usually focusing on spirtitual or religions issues."
"Patient Autonomy" "Patients right to make decisions concerning the course of their health care treatment."
"Patient Self-Determination Act" "The PSDA is a law requiring all states to recognize living wills and DPAHC's as advance directives, and that all institutions receiving aid from Medicare/Medicade provide patient information documents, healthcare provider training, and community and patient education programs that discuss advance directives. Most institutions have responded to the PSDA by training employees about facility policy during orientation and providing a pamphlet on advance directives to patients upon admittance."
"Physical dependence" "Dependence is an expected physiologic response to ongoing exposure to pharmacological agents. Withdrawal from opioids is characterized by symptoms such as sweating, runny nose, anxiety, irritability, abdominal cramps, and diarrhea when the drug dose is markedly decreased or abruptly discontinued. Dependence appears to be highly individualized."
"Physician Payment Review Commission (PPRC)" "PPRC monitors and advises on Medicare physician payment."
"Power of attorney" "A patient legally gives another person authority to sign legal documents in his/her place."
"Preparation for death" "People are prepared for death when their dying experience reflects their preferneces, cultural background and personal attitudes toward death."
"Preventive care" "Care aimed at preventing disease before it occurs, i.e. quitting smoking, exercising regularly, eating a low fat diet, giving preemptive analgesia."
"PRISM system" "The PRISM system is one of the models conducted in intensive care units for evaluating the quality of care. It is a consensus-derived scoring system which has been validated in a various settings."
"Processes of care" "A series of actions and events that are part of health care system, including communication with patients and families, patient-clinician relationship, determinants in health care systems, also refers to the quality of care."
"Prognosis" "The judegement about the likelyhood of illness or disease outcomes such as cure or death. Prognosis shared with a person facing a life-limiting illness is often called breaking bad news."
"Public policy on health care" "Public policy related to health care financing, legel issues, and quality of care research."
"Rationing of care" "Rationing is a system of limiting the amount of something, or consumption of potential service that each person is allowed to have, after eliminating inappropriate care. The possible basis for rationing of care includes age and community consensus."
"Religion" "Religion is noted to be the service and worship of God or the supernatural;
commitment or devotion to religious faith or observance; a personal set or institutionalized system of religious attitudes, beliefs, and practices."
"Respite programs" "Respite programs are designed to relieve families caring for patients with life-limiting illness from the physical and psychological burdens of caregiving. Patients receive care from others while the family members take time for themselves."
"Robert Wood Johnson Foundation" "The Robert Wood Johnson Foundation was established as a national philanthropy in 1972 and today it is the largest US foundation devoted to improving the health and health care of all Americans."
"Sacramento Health Care Decisions" "Sacramento Health Care Decision is a nonprofit organization committed to the public's participation, and ensure the community values are incorporated into health care policy and practice in Sacramento region."
"Social Security" "A system of payments made by the government to elderly people, people whose husbands or wives have died and people who are unable to work because of illness."
"Support systems" "In the whole-community model for End-of-Life care, support systems are provided through workplaces, religious congregations, and different institutions, to relieve the burdens experienced by dying patients and their families."
"Surrogates" "Legal guidelines specify who will make decisions for an incapacitated patient; that is, who will act as an incapacitated patientÆs surrogate or proxy decision-maker."
"Survey of the Last Days of Life (SLDOL)" "In 1985, the Survey of the Last Days of Life (SLDOL) reported the settings in which patients spent their last three months, also the symptoms patients suffered during the period of time."
"Survival time" "A clinical judgement of the expected length of time a patient may live under the situation."
"Symptom" "Subject evidence of disease, as perceived by the patient."
"Symptoms of dying" "Reduced level of consciousness; Taking no fluids or only sips;
No urine output or small amount of very dark urine (anuria or olgiuria);
Progressing coldness and purple discoloration in legs and arms;
Laborious breathing; periods of no breath (Cheyne-Stokes breathing);
Bubbling sounds in throat and chest (death rattle)."
"Terminal illness" "An illness that is expected to end in death."
"Total Quality Management (TQM)" "Total Quality Management is a set of reinforcing principles for the improvement in quality, including targeting system shortness, encouraging relationships among health care community members, and using a variety of techniques (e.g., statistical methods and its application) to continue the improvement."
"World Health Organization" "World Health Organization (WHO), specialized agency of the United Nations, with headquarters in Geneva. WHO was established in 1948. According to its constitution it is ôthe directing and coordinating authority on international health workö and is responsible for helping all peoples to attain ôthe highest possible levels of health.ö In 1987 the organization had 166 member countries."
"World Health Organization Analgesic Ladder" "In 1986, the World Health Organization proposed that health professionals use analgesic medications via a systematic plan. The systematic plan includes a three-step ladder approach relevant to pain management for all types of pain, including pain at end of life. For mild chronic nonmalignant and cancer pain, drug use is recommended from the bottom of the ladder to the top, i.e., up the ladder from Step 1 to Step 2 to Step 3. For severe acute pain or other types of pain experienced by people with life-limiting illness, the steps are ordered from the top step to the bottom step, i.e., down the ladder from Step 3 to Step 2 to Step 1."
