About Serious Illness

The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care is both a philosophy of care and an organized, highly structured system for delivering care. Palliative care expands traditional disease-model medical treatments to include the goals of enhancing quality of life for patient and family, optimizing function, and helping with decision-making and providing opportunities for personal growth.

Palliative care can be offered anywhere patients are seen in any stage of illness. Palliative care programs are seen most often in hospitals, though there are programs being developed for outpatient and other areas.

Hospice care, a part of palliative care, is provided to patients during the end stages of their disease process and is defined by Medicare regulations stating that a patient is thought to be in their last six (6) months of life. Provided in the patient’s home; regardless of whether this is a private home, a personal care home, a skilled nursing facility, correctional facility, group home, or hospice run residential facility. There are also inpatient hospice units used most frequently control symptoms so that the patient can return to their home. Hospice care is focused on the patient and those who love them wherever they reside.

The Specialty of Palliative Nursing

Palliative Nursing is a specialty with its own art and science. Palliative Nursing is appropriate for any patient with a serious or life-threatening illness, regardless of the individual’s diagnosis, prognosis, age or care setting. (Palliative Nursing: Scope and Standards of Practice, ANA/HPNA, 2014) All Nursing care should incorporate components of Palliative Nursing into the plan of care. The scope and level of Palliative Nursing care provided is dependent upon the needs of the patient and family and the role and expertise of the nurse.

The specialty of Palliative Nursing includes both hospice and palliative nurses. Questions often arise about the difference between hospice and palliative nurses and whether hospice is a part of palliative care or whether palliative care is part of hospice care. As nurses, we should all be very proud of the profession we have chosen and the work (nursing specialty) that we do to provide the best care possible for our patients and their families. This applies to us as both a profession and as individual nurses.

Palliative Nursing reflects a holistic philosophy of care provided to patients with serious or life-threatening illnesses in diverse settings, across the lifespan. Palliative Nursing is an evidence-based nursing practice that includes “the assessment, diagnosis, and treatment of human responses to actual or potential life-limiting illnesses within the context of a dynamic caring relationship with the patient and family, in order to reduce or relieve suffering and optimize health.” ( Lynch, Dahlin, Hultman & Coakley, 2011).

The hallmarks of palliative care include the following components; patient and family-centered, expert pain and symptom management to enhance comfort and quality of life, expert communication skills and coordination of interdisciplinary care to best meet the needs of the patient and family. Palliative care should begin at the time of diagnosis of a serious or life-threatening illness. Hospice care incorporates the tenants of palliative care for individuals with a life-expectancy of 6 months or less. The restrictive time period and patient population, was established by the Federal government in the Medicare Hospice Benefit. When the Medicare Hospice Benefit was developed, it was quite progressive as a per diem payment method for a particular type of care (palliative care) for a specified group of patients (the terminally ill). However, the model has outgrown the payment limitations of the benefit.

The success of the hospice model of care has led to the expansion of this model of care further “upstream” for individuals who are first diagnosed with a serious and or life-threatening illnesses. Over the past 10 years, Palliative Care Teams have been growing in academic and community hospitals across the United States. More recently, palliative care services have been expanding into community settings. Even more significant, Medicare is recognizing the importance of palliative care. The high quality and often lower costs of palliative care have resulted in the incorporation of palliative care into Medicare Demonstration Projects and Innovation Grant programs. In addition, some payers have been piloting Concurrent Care projects that provide for palliative care, while the patient is receiving curative treatment.

Since palliative care is embedded in all nursing practice in the relief of suffering; all nurses practice Primary Palliative Nursing. Registered Nurses and Advanced Practice Registered Nurses who work in hospice and palliative care settings practice Specialty Palliative Nursing. Nurses practicing at the specialty level are expected to have a higher level of knowledge and skills in the specialty, especially related to pain and symptom management, communication skills and coordination of complex care (Palliative Nursing: Scope and Standards of Practice, ANA/HPNA, 2014). Numerous educational opportunities are available to help nurses obtain education in Palliative Nursing. Educational programs. Resources are available through the Hospice and Palliative Nurses Association (HPNA), the End of Life Nursing Education Consortium (ELNEC) Program, in addition to other programs.

Specialty certification demonstrates that the nurse has achieved a certain level of knowledge and skills within the specialty practice of Palliative Nursing. The National Board for Hospice and Palliative Nurses (NBCHPN) offers credentialing programs for hospice and palliative nurses and also other members of the interdisciplinary team. Nurses who work in the specialty, should consider obtaining and maintaining this specialty certification.

About Hospice Nursing
  • Regardless of the setting, hospice care is given by an interdisciplinary team. The team typically consists of RNs, LP/VNs, nursing assistants, social worker, chaplain, volunteers, and a medical director. The patient and family are also considered part of the team. Others can be brought into the team as need, for example occupational, physical, and speech therapists. All team members work toward meeting the goals of the patient and family.
  • RNs who see patients outside of the hospital are responsible for assessing the patient, delivering care as needed, organizing and managing a patient’s plan of care; including scheduled visits for nursing and nursing assistants, referrals to additional services and volunteers, calls to insurances and physicians, and monitoring costs related to pharmacy, supplies, and durable medical equipment.
  • As hospice nurses work in a variety of settings, there can be extensive travel, care environments that may be threatening, unpredictable hours, and variable levels of reimbursement.

About Palliative Care Nursing
  • Palliative care should be a part of all care given to patients with life-limiting illnesses, whether it is integrated into routine care or part of a structured program.
  • The structure of palliative care programs varies greatly based on the setting in which it is delivered. No matter the setting, palliative usually involves a team similar to hospice care.
  • Requirements for hospice and palliative care nurses:
    • Most services require RN’s to have at least one year of acute care experience.
    • Excellent assessment skills: the interdisciplinary team depends on the nurse’s assessment skills when making decisions for the plan of care.
    • Clear and concise communication skills: the entire interdisciplinary team, patient, and family will need information provided accurately and succinctly.

How will you know if hospice and palliative care nursing is right for you?
  • Talk to several hospices and palliative care teams/units in your area about:
    • Job requirements
    • Job description
    • Plan for orientation and mentoring
    • Opportunities for professional growth and development within the organization
    • Requirements for certification
  • Talk with several nurses in the specialty
  • Consider being a hospice/palliative care volunteer first
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