The fundamentals of palliative nursing
Palliative nursing defined
According to Nurses for a Healthier Tomorrow, palliative care nursing—a relatively new specialty in the field of nursing—“is defined by the Last Acts Task Force (1999) as the comprehensive management of the physical, psychological, social, spiritual, and existential needs of patients, particularly those with incurable, progressive illness. The goal of palliative care is to help the patients achieve the best possible quality of life through relief of suffering, control of symptoms, and restoration of functional capacity, while remaining sensitive to personal, cultural and religious values, believes and practices.”
Palliative care nursing can take place in numerous types of settings, including the patient’s home, hospices, hospitals, and other outpatient community programs. The goal is to assist patients with life-limiting, chronic and debilitating disease states through a multi-disciplinary team of health care professionals. This team assesses and treats pain, encourages patient-centered decision-making, and coordinates care.
The National Consensus Project for Quality Palliative Care has been instrumental in developing Clinical Practice Guidelines for Quality Palliative Care. These protocols and guidelines include the essential fundamentals of palliative nursing within eight domains. The guidelines act as a resource for palliative care nurses and aim for quality patient care.
Guidelines for Quality Palliative Care
In the Clinical Practice Guidelines for Quality Palliative Care, Second Edition, the essential guidelines embody the goals of palliative care nursing, and since they are based on evidence-based practice, they continually evolve. The following guidelines are the fundamentals of palliative care nursing:
- The care plan is based on a comprehensive interdisciplinary assessment of the patient and family.
- The plan of care is based on the identified and expressed preferences, values, goals, and needs of the patient and family and is developed with professional guidance and support for decision making.
- An interdisciplinary team provides services to the patient and family consistent with the care plan.
- The use of appropriately trained and supervised volunteers within the interdisciplinary team is strongly encouraged.
- Support for education and training is available to the interdisciplinary team.
- The palliative care program develops, implements, and maintains an ongoing data driven process, reflecting the complexity of the organization, and focuses on palliative care outcomes.
- The palliative care program recognizes the emotional impact on the palliative care team of providing care to patients with life-threatening illnesses and their families.
- Palliative care programs should have a relationship with one or more hospices and other community resources to ensure continuity of the highest-quality palliative care across the illness trajectory.
- The physical environment in which care is provided should meet the preferences, needs, and circumstances of the patient and family to the extent possible.
Domains associated with Joint Commission Standards of Care
The domains that are addressed in the guidelines include:
- Structure and Processes of Care
- Physical Aspects of Care
- Psychological and Psychiatric Aspects
- Social Aspects of Care
- Spiritual, Religious and Existential Aspects of Care
- Cultural Aspects of Care
- Care of the Imminently Dying Patient
- Ethical and Legal Aspects of Care
The Hospice and Palliative Nurses Association is a professional organization which provides support and resources to nursing health care professionals working in hospice and palliative care. Of its membership, which is close to 10,000, over half have specialty certifications in hospice and palliative care nursing. Twenty-five percent of its members have either a master’s degree or a doctorate.
