Karel, Practice For effectivecare in end of life management, nurses or APRN need to operate within a standard platform when practisingprimary palliative care. This is also evident in a study by Ramanayake, Dilanka, and Premasiri, which reveals that establishing palliative care models, and encouraging doctors and nurses to learn informative palliative care principles through improved skills and opportunities need to possible in order to address the future challenges (Ramanayake, Dilanka, & Premasiri, 2016). Therefore, nurses or APRN need to have a standard knowledge on how best to conduct primary palliative care in order toensure effectivecare in end of life management. This is vital in establishing discipline and professional when practisingprimary palliative care to the patient that isin pain and face near death situations.  Education Integration of primary palliative care into curricula in medical institutions and schools of nursing is essential in providing effective care in end of life management for APRN. By achieving this, nurses and practitioners are able to understand the scope of palliative care as well as the disease and its implications. Therefore, education through the integrationof primary palliative care into curriculaenables APRN to communicate effectivelyand professionally without compromising the integrity of their work. According to a studyby Zimmerman, “effective communication is the cornerstone of palliative care,”(Zimmerman, 2015). This means that by training nurses and practitioners on how to communicate effectively through the integrationof primary palliative care into curricula, they are able to understand the standard way of helping their patientswithout incurring any legal consequences. Practitioners and nurses need to understand the principles and knowledge required to successfully manage end of life care.  Research In order to understand whether the standard practices and education approached used in primary palliative care are effective, nurses or APRN need to research and gather more evidence across all dimension of end-of-lifecare. Based on a studybyVisser, Hadley, and Wee, it is argued that starting a treatment simply on the basis of agreement among colleagues is no longer an acceptable practice(Visser, Hadley, & Wee, 2015). There is a needfor more evidence-based care in different angles of the endof life care to make an informed decision. This means that doctors, nurses or APRN need to sure that there hasbeen actual evidence that the primary palliative care practice actually works before engaging in it. This makes primary palliative care much safer; while at the same time provide effectivecare in end of life management across different dimensions.  Administration Establishing a work environment where excellent standard care is extended through the patient’s death and into post-death care for families not only demonstrates compassion by the APRN or nursesbut also demonstrates respect to the patient an ...

1. Karel,
Practice
For effectivecare in end of life management, nurses or APRN
need to operate within a standard platform when
practisingprimary palliative care. This is also evident in a study
by Ramanayake, Dilanka, and Premasiri, which reveals that
establishing palliative care models, and encouraging doctors
and nurses to learn informative palliative care principles
through improved skills and opportunities need to possible in
order to address the future challenges (Ramanayake, Dilanka, &
Premasiri, 2016). Therefore, nurses or APRN need to have a
standard knowledge on how best to conduct primary palliative
care in order toensure effectivecare in end of life management.
This is vital in establishing discipline and professional when
practisingprimary palliative care to the patient that isin pain and
face near death situations.
Education
Integration of primary palliative care into curricula in medical
institutions and schools of nursing is essential in providing
effective care in end of life management for APRN. By
achieving this, nurses and practitioners are able to understand
the scope of palliative care as well as the disease and its
implications. Therefore, education through the integrationof
primary palliative care into curriculaenables APRN to
communicate effectivelyand professionally without
compromising the integrity of their work. According to a
studyby Zimmerman, “effective communication is the
cornerstone of palliative care,”(Zimmerman, 2015). This means
that by training nurses and practitioners on how to communicate

2. effectively through the integrationof primary palliative care into
curricula, they are able to understand the standard way of
helping their patientswithout incurring any legal consequences.
Practitioners and nurses need to understand the principles and
knowledge required to successfully manage end of life care.
Research
In order to understand whether the standard practices and
education approached used in primary palliative care are
effective, nurses or APRN need to research and gather more
evidence across all dimension of end-of-lifecare. Based on a
studybyVisser, Hadley, and Wee, it is argued that starting a
treatment simply on the basis of agreement among colleagues is
no longer an acceptable practice(Visser, Hadley, & Wee, 2015).
There is a needfor more evidence-based care in different angles
of the endof life care to make an informed decision. This means
that doctors, nurses or APRN need to sure that there hasbeen
actual evidence that the primary palliative care practice actua lly
works before engaging in it. This makes primary palliative care
much safer; while at the same time provide effectivecare in end
of life management across different dimensions.
Administration
Establishing a work environment where excellent standard care
is extended through the patient’s death and into post-death care
for families not only demonstrates compassion by the APRN or
nursesbut also demonstrates respect to the patient and his or her
families during and after death. A study by Parris and
Halereveals that the exact role of physician or nurses during and
after the death of a patientis not clearly defined in primary
palliative care (Parris & Hale, 2017). Therefore, APRN needsto
ensure that there is a standard guideline on how to handle
patient’s death and post-death process, understand the basics of
logistics after a patient has died, how to support their grieving

3. families and the bestway to avoid adverse events in the care of
the deceased.
References
Parris, J., & Hale, A. (2017). Death and Dignity: Exploring
Physicians’ Responsibilities After a Patient’s Death.
Alliance for Academic Internal Medicine
, 1- 4. Retrieved from https://www.amjmed.com/article/S0002-
9343(17)30483-7/pdf
Ramanayake, R. P., Dilanka, G. V., & Premasiri, L. W. (2016,
April).
Palliative care; role of family physicians
. Retrieved from National Center for Biotechnology
Information:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5084539/
Visser, C., Hadley, G., & Wee, B. (2015, September).
Reality of evidence-based practice in palliative care
. Retrieved from National Center for Biotechnology
Information:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607825/
Zimmerman, C. T. (2015, July 27).
The Importance of Palliative Medical Education in Fellowship
. Retrieved from Amrican Society of Clinical Oncology:
https://connection.asco.org/magazine/career/importance-
palliative-medical-education-fellowship
Dianelys,
Palliative care is the ability to improve efficiency, coordination,

4. and quality of healthcare outcomes for patients and their
families (Payne et al., 2017). Patients can use their skills to
manage and recognize symptoms. Nurses are required to have
skills and knowledge to manage pain as well as other symptoms
associated with terminal diseases. APRNs, therefore, work with
patients and the patient’s family in end-of-life and palliative
care decision making.
Specialist education and certification is essential to APRNs as it
ensures that they have skills. One of the barriers to quality
palliative care is lack of workforce (Meier, 2011). Certifications
and education will ensure that there is adequate workforce to
meet the needs of patients. Therefore, when a nurse gets
education and certification, they will likely use palliative care
to patients with terminal illness and who are at the end of their
lives.
Evidence-based care involves use of scientific research as
means of delivering patient care. The use of evidence-based
care allows an APRN to care that is specific to a certain patient
and as a result improving the outcome of health services (Duke
University Medical Center, n.d.). This because it allows
integration of a patient’s values and beliefs into the health care
delivery. Therefore, given that it combines clinical expertise,
best research evidence, and patient values and preferences, the
best or optimal clinical outcomes are achieved (Duke University
Medical Center, n.d.).
Promoting work environments where by standards for excellent
care is adhered to is important in providing end-of-life care.
Healthcare facilities have the capability of creating and
enforcing policies that enhance palliative care among the
workforce. This involves ensuring that from the time a patient is
received in a facility to the moment he or she dies, there is
accessible palliative care. Health care facilities can always
insist on optimal care for patients with serious illness. This will

5. help nurses to be aware that they always need to provide
optimal care for patients at the end-of-life. Nurses can continue
with caring for the family members even after death. This can
include honoring cultural and religious requirements or wishes
of the dead and his/her family (Henry & Wilson, 2012).
References
Duke University Medical Center. (n.d.). LibGuides:
Introduction to Evidence-Based Practice : Overview. Retrieved
from
https://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021
Henry, C., & Wilson, J. (2012, May 8). Personal care at the end
of life and after death. Retrieved from
https://www.nursingtimes.net/clinical-archive/end-of-life-and-
palliative-care/personal-care-at-the-end-of-life-and-after-
death/5044559.article
Meier, D. E. (2011). Increased Access to Palliative Care and
Hospice Services: Opportunities to Improve Value in Health
Care.
Milbank Quarterly
,
89
(3), 343-380. doi:10.1111/j.1468-0009.2011.00632.x
Payne, S., Eastham, R., Hughes, S., Varey, S., Hasselaar, J., &
Preston, N. (2017). Enhancing integrated palliative care: what
models are appropriate? A cross-case analysis.
BMC Palliative Care
,
16
(1). doi:10.1186/s12904-017-0250-8