Welcome to the Symptom Management module in the ELNEC-Core Curriculum. This module will provide you with an overview of symptoms common in patients, necessitating palliative care, and will emphasize your important role in managing them. There is a wide variety of physical and psychological symptoms common in palliative care, thus this module is divided by systems (e.g. respiratory, gastrointestinal, psychological, etc.). Those with life-threatening illness will most likely present with multiple symptoms. That is why it is important for you to be knowledgeable about evidence-based symptom management and optimum treatments. You play a critical role in recognizing, assessing, and managing symptoms. It is vital that you work collaboratively with physicians and other healthcare providers in managing symptoms to enhance quality of life and reduce unnecessary suffering.
Provider approved by the California Board of Registered Nursing, CEP# 13791
Nurses will receive 1.50 contact hours for participating in this course.
District of Columbia Board of Nursing Approved Continuing Education program (CEBroker Provider #50-290).
Florida Board of Nursing (CEBroker Provider #50-290)
In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Georgia Board of Nursing (CEBroker Provider #50-290)
South Carolina Board of Nursing (CEBroker Provider #50-290)
West Virginia Board of Registered Nursing (CEBroker Provider #50-290)
New Mexico Board of Nursing (CEBroker Provider #50-290)
Arkansas State Board Of Nursing Approved Continuing Education program (CEBroker Provider #50-290).
Section 1: Introduction
About This Course
Section 2: Introduction to Symptom Management
Symptoms and Suffering
Common End-of-Life Symptoms
Section 3: Respiratory Symptoms
Causes of Dyspnea
Watch how one team member performed a symptom assessment in a seriously ill patient.
Symptom Assessment Vignette
Think About It
Pharmacologic Treatment of Dyspnea
Non-Pharmacologic Treatment of Dyspnea
Section 4: Gastrointestinal Symptoms
Anorexia and Cachexia
Causes of Anorexia and Cachexia
Assessment of Anorexia and Cachexia
Treatment of Anorexia and Cachexia
Causes of Constipation
Assessment of Constipation
Treatment of Constipation
Causes of Diarrhea
Assessment of Diarrhea
Treatment of Diarrhea
Nausea and Vomiting
Causes of Nausea and Vomiting
Assessment of Nausea and Vomiting
Pharmacologic Treatment of Nausea and Vomiting
Non-Drug Treatment of Nausea and Vomiting
Section 5: Psychosocial Issues
Causes of Depression
Assessment of Depression
Pharmacologic Interventions for Depression
Non-Pharmacologic Interventions for Depression
Assessment of Anxiety
Interventions for Anxiety
Post-Traumatic Stress Disorder
PTSD and End-of-Life Care
Causes of Cognitive Changes
Assessment of Cognitive Changes
Treatment of Cognitive Changes
Section 6: General Symptoms
Assessment of Wounds
Treatment of Wounds
Unable to Self-Report
Section 7: Conclusion
The content for this course was created or revised by The ELNEC Project Team:
Betty Ferrell, RN, PhD, MA, FAAN, FPCN, CHPN has been in nursing for 41 years and has focused her clinical expertise and research in pain management, quality of life, and palliative care. Dr. Ferrell is the Director of Nursing Research & Education and a Professor at the City of Hope Medical Center in Duarte, California. She is a Fellow of the American Academy of Nursing and she has over 450 publications in peer-reviewed journals and texts. She is Principal Investigator of a Research Project funded by the National Cancer Institute on "Palliative Care for Patients with Solid Tumors on Phase 1 Clinical Trials" and Principal Investigator of the "End-of-Life Nursing Education Consortium (ELNEC)" project. She directs several other funded projects related to palliative care in cancer centers and QOL issues. Dr. Ferrell is the Co-Chairperson of the National Consensus Project for Quality Palliative Care. Dr. Ferrell completed a Masters's degree in Theology, Ethics, and Culture from Claremont Graduate University in 2007. She has authored eleven books including the Oxford Textbook of Palliative Nursing (5th Edition, 2019) published by Oxford University Press. She is co-author of the text, The Nature of Suffering and the Goals of Nursing published in 2008 by Oxford University Press and Making Health Care Whole: Integrating Spirituality into Patient Care (Templeton Press, 2010). In 2013 Dr. Ferrell was named one of the 30 Visionaries in the field by the American Academy of Hospice and Palliative Medicine.
Rose Virani, BSN, MHA, FPCN is a Senior Research Specialist in the Nursing Research and Education Department at the City of Hope in Duarte, CA. Ms. Virani has worked in various clinical and administrative areas in oncology nursing for over 45 years. She has been the Project Director of ELNEC since its inception 20 years ago, starting with the RWJF supported "End-of-Life Nursing Education Consortium (ELNEC)" conducted from 2000-2005, and presently is the Project Director of all ELNEC projects. As project director, she has participated in the development, coordination and implementation of all ELNEC projects including data collection and follow-up of participants' goals. The data from these projects have resulted in over 40 peer-reviewed outcomes publications on the importance and dissemination of palliative care in nursing education--Ms. Virani was the recipient of the 2006 "Excellence in Supportive Care", the 2006 "Mary Nowotny Excellence in Cancer Nursing Education," and the 2009 ONS Pearl Moore, "Making a Difference" Oncology Nursing Society (ONS) awards. Ms. Virani was inducted as a fellow in the Hospice and Palliative Nurses Association in 2009 and is a Florence Wald fellow. In 2016, she was the recipient of The Hospice and Palliative Nurses Association (HPNA) Distinguished Career Achievement Award in 2016. Ms. Virani has co-authored over 60 journal articles and is the primary author of seven book chapters.
Denice Economou, RN, PhD, CHPN is a senior research specialist at City of Hope in the Division of Nursing Research and Education. She is an oncology clinical nurse specialist and certified in hospice and palliative nursing as well as a geriatric resource nurse. Her background has been in palliative care and cancer survivorship. Dr. Economou's dissertation work has led her into advanced cancer recurrence and treatment choices for older adults with cancer. She is Co-Investigator for an R25 in Geriatric Oncology: Educating Nurses to Improve Quality Care as well as Co-Investigator for a pilot study providing psychosocial support for gynecological patients with advanced cancer: Conquer Fear Support: A Nurse-led Intervention. Dr. Economou completed two consecutive R25 training grants as the project director for Cancer Survivorship Education. She has been an ELNEC faculty since 2006 and an active member of the Greater-Los Angeles Oncology Nursing Society. Dr. Economou is an Associate Editor for the Journal of the Advanced Practitioner in Oncology. She has published in multiple journals and textbooks. Dr. Economou lectures on cancer pain and palliative care as well as oncology core in comfort and survivorship care. She continues to support the Oncology Nursing Foundation for future nurse researchers.
Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN is an oncology palliative care advanced practice nurse who has been on the ELNEC Faculty since 2001, teaching palliative care nationally and internationally. She has had extensive clinical experience in integrating palliative care into outpatient oncology settings and hospice programs and into nursing education. Dr. Mazanec is a Research Associate Professor at Case Western Reserve University's Frances Payne Bolton School of Nursing (Cleveland, OH) and Co-Investigator on a Web-based intervention for long-distance caregivers of parents with advanced cancer. She is also the Co-Investigator for the ELNEC-Undergraduate and Graduate curriculum, funded by the Cambia Health Foundation. An important part of the ELNEC Undergraduate and Graduate projects has been the development of primary palliative care competencies for undergraduate, Master's and Doctor of Nursing Practice (DNP) students, with online curricula to assist educators in undergraduate and graduate nursing programs prepare nurses to provide palliative care to seriously ill patients and their families. Dr. Mazanec has published and presented in the areas of palliative care in the oncology setting, cultural considerations at end of life, interprofessional education in oncology and palliative care, and caregiving.
Judith Paice, PhD, RN, FAAN is the Director of the Cancer Pain Program in the Division of Hematology-Oncology and a Research Professor of Medicine, Northwestern University; Feinberg School of Medicine. She is also a member of the Robert H. Lurie Comprehensive Cancer Center. Dr. Paice is presently a member of the NIH HEAL Initiative Multidisciplinary Working Group and has served as President of the American Pain Society and Secretary of the International Association for the Study of Pain. Currently the Vice-Chair of the NCCN Adult Cancer Pain Clinical Practice Guideline, much of Dr. Paice's clinical work has been in the relief of pain associated with cancer. She has traveled widely within six continents to educate healthcare professionals regarding cancer pain relief and palliative care. Dr. Paice serves on the editorial board of the Journal of Pain and the Journal of Pain and Symptom Management and is the author of more than 170 scientific manuscripts. She was one of the original consultants in the End of Life Nursing Education Consortium (ELNEC) and has continued serving as a faculty member in this program. In 2018, Dr. Paice was named one of the 30 Visionaries in the field by the Academy of Hospice and Palliative Care.
The ELNEC Project, which began in 2000, is a partnership between the American Association of Colleges of Nursing (AACN), Washington, DC and the City of Hope, Duarte, CA. For more information about ELNEC, go to www.aacnnursing.org/ELNEC.Disclosure: The ELNEC Project Team has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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