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.