. Submit Part One Portfolio .Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.Practice 1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families. 2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others. 3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death. 4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified. Education 1. Those who practice in secondary or tertiary palliative care will have specialist education and certification. 2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula. 3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available. 4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families. Research 1. Increase the integration of evidence-based care across the dimensions of end-of-life care. 2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal. 3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life. 4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments. 5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices. Administration 1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families. 2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care. 3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury. 4. Support the development and integration of palliative care services for all in- and outpatients and their families. Discussion Board Question 2: End of Life Care.Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management.