Oncology Nursing Palliative Care Study

Patients that qualify or use palliative care also have a terminal diagnosis but usually have a longer life expectancy than those with hospice. The definition for hospice and palliative care is something many nursing students learn during their program. Young-Ran, Min, and Kyoung-Soon (2015) found in a study that 70% of nurses in a general hospital setting that had cared for a terminal patient had no prior education or training for palliative care. Nursing education continues to evolve in attempts to better prepare nursing students for life after their program completion. Attempts to better familiarize students with end of life care some programs are using simulation. Simulation has been found to be an effective method of teaching when related to high stress and emotional situations (Moreland, Lemieux, and Myers, 2012). It is great that there have been attempts to increase the amount of education in this specialty area especially since 76% of dying patients are receiving nursing care at time of death (Moreland, Lemieux, and Myers, 2012). Now it will be important for current nurses and educators to continue to increase the amount of information provided in nursing programs and to novice nurses about hospice and palliative specialty

Hospice patients often receive palliative care to help them cope with the stress, pain, and anxiety that comes with hospice care. Galfin, Watkins, and Harlow (2011) explored the need to train palliative care nurses how to provide not just physical care, but also psychological care. The authors reference previous studies that addressed similar training programs, but point out that many lack an explanation of what the palliative care entails, or statistical evidence to show if guided self-help improved patient’s psychological distress.

A survey was conducted in 2000 on more than 9,000 patients discharged from more than 2,000 hospices on the services they received (Carlson, 2007). It revealed that 22% of them received five major palliative care services, which varied among the hospices. These palliative care services were nursing care, physician care, medication management, psychological care, and caregiver support. Approximately 14% of the hospices provided all five services and 33% provided only one or two services. Only 59% of these patients received medication management services. These included administering medication, dispensing correct dosages, and setting and following dosage schedule.

Before I started this class I thought palliative care was only used as end of life care, or for when a curative treatment was unavailable or had failed. As we learned about the different models of care, and how they have changed over the years, it became evident that the use of palliative care has changed drastically over the past several decades. In the 1800s to 1900s, palliative care was only used once the patient had reached the dying stage, and only included the patient in this care, not their families1. Before taking this course, this is what I thought of palliative care as well. Since the late 1900s though, palliative care has been used in a more proactive approach. From the moment an individual receives a life threatening illness, palliative care begins. This includes caring for the family of the patient as well. This care increases as the patient’s illness progresses, and even continues for the family after the death of the patient. Learning this has really made an impact on how I would like to work as a

Nurses: Assist the patients and families to cope with the end-of-life process such as assessing and

According to Allen et al. (2012), “millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved psychosocial or spiritual problems.” This issue occurs because palliative care is often considered a form of end-of-life care. Palliative care is a treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling & Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with end-of-life care. However, end-of-life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues

This might be one reason why some patients choose conventional treatment instead of choosing a hospice program, there is many other factors that may contribute to this decision such as; financial status. This research will help give nurses a stronger knowledge base of characteristics and advantage of hospice care. In addition, nurses will be able to explain the advantages of Hospice programs to more of their patients, thus, they will be able to educate and encourage more families to choose hospice care. Not only will it help the patient live out a comfortable life it will also help the caregivers with

The present-day misconception of palliative care possibly comes from the circumstance that palliative care was used interchangeably with hospice care until the 1980s. (Clark & Seymour, 1999). Clark and Seymour (1999) extensively write on the beginnings and evolution of palliative care. They describe the progression of palliative care as a whole and explain the movement from palliative starting out as supplemental care to terminal patients to the concept division of palliative and hospice care. They describe the differences in each and explain why palliative is its own concept that differentiates from hospice care. In 2002, the World Health Organization defined palliative care as “an approach” that increases the quality of life of

End of life issues involving education on palliative care and hospice; are these issues important to you and your loved ones? The purpose of this paper is to discuss end of life care and how the legislative process affects this important topic. As the American population keeps growing, so does the amount of an aging population. Is the amount of training and education in nursing school sufficient for palliative care and hospice? Do we need to provide more training to the medical field to help support the growing need for end of life care? At some point in our careers we might be faced with helping someone in their final days. Being educated and having the ability to provide appropriate care is part of our scope of practice. (American Nurses Association, 2010, pp.1-2)

Palliative care is a relatively new concept. Palliative care programs have become more numerous and better utilized since 2000 and continue to grow. It is now accepted that the palliative care model is appropriate for patients with life-limiting illnesses. Chan et al. (2013) stated that the ultimate goal of palliative care is to relieve suffering and to maximize the quality of life for dying patients and their families, regardless of the stage of illness or the need for other medical treatments (p. 133). As life-expectancy increases, there is a growing need for these services. People are living longer with chronic diseases and palliative care services can provide an extra layer of support to patients and their families. Evidence has shown that 13% - 36% of hospital inpatients qualify for palliative care services (Robinson, Gott, & Ingleton, 2014).

I would like to be a hospice nurse practitioner in the future. I worked in the cancer center for two years when I was in Taiwan. Most of our patients were underline with solid cancer which included Nasopharynx cancer, esophageal cancer, gastric cancer, pancreas cancer, colon cancer and liver cancer. The characteristics of solid cancer illness are long-term progression which means their five-year survival rate usually higher than hematology patients. A lot of patients in our nurse station kept in-and-out for more than two years, therefor, we build deep and strong relationship with them. As a result, we not only concerned about patients’ health condition, also we pay more attention on their quality of life. However, being a hospice nurse need professional knowledge background, also they need counseling skills to help patients, family members and caregivers to deal with sorrow and feeling of lost. To be a professional hospice nurse practitioner, there are several counseling skills are very crucial.

Another disparity recognized is the standards of care from one palliative care or hospice care center to another. The varying degrees of care are due to lack of education and standards of care. The Center to Advance Palliative Care has recommendations for hospice and palliative care centers to measure and monitor care standards. These guidelines will help quantify data and allow for process improvement to occur among hospice and palliative care facilities. These improvements essentially allow for better education standards and improved standards of care within the hospice and palliative care centers. The most essential part of the paradigm that is palliative and hospice care is the patient. In the article, Is This Palliative care’s Moment,

Hospice is a concept of care that is based on the belief that meaningful living is achievable during a terminal illness that is free of interventions that prolong physiologic dying. The role of a hospice nurse is to take on a holistic approach to patient care that involves a careful evaluation of not only physical problems but also the psychosocial and spiritual dimensions of the patient and the patient’s family (Hinkle & Cheever, 2014). The hospice nurse is culturally aware and sensitive in their approach to communication that respects beliefs, attitudes, and values of the patient and family about end-of-life care. The hospice nurse also provides support to families even after the death of the patient (Nies & McEwen, 2015).

I have been a registered nurse at UCLA for 18 months. One particular issue that has captured my attention is the utilization of palliative care in health care. Because nurses are generally at the bedside all the time, they have an important role to play in voicing the importance of its utilization and implementation in the patient’s care.

Key importance of the palliative care approach in nursing is for it to be responsive, rather than