Karel,PracticeFor 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. EducationIntegration 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. ResearchIn 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. AdministrationEstablishing 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 families and the bestway to avoid adverse events in the care of the deceased. ReferencesParris, 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/pdfRamanayake, 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-fellowshipDianelys,Palliative care is the ability to improve efficiency, coordination, 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 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).ReferencesDuke University Medical Center. (n.d.). LibGuides: Introduction to Evidence-Based Practice : Overview. Retrieved from https://guides.mclibrary.duke.edu/c.php?g=158201&p=1036021Henry, 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.articleMeier, 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.xPayne, 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




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