Hospice and Palliative Care: A helpful resource for nurses.

Lets Define Hospice Hospice is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments (Hospice Foundation of America [HFA], 2014. Para. 1).

Lets Discuss Hospice Hospice care is based on knowledge, communication and the cooperation of interdisciplinary teams needed for the patients rely on. The hospice team collectively focuses on the care of the patient with a unique focus on his or her individual wishes. Hospice care includes physical, psychosocial, spiritual, and emotional care for both the patient and their family. Hospice care provides support, choices, and dignity during very difficult time for patients and family. Hospice care allows individuals and families to take control of what in many cases is an inevitable situation.

Lets Define Palliative Care Palliative care is specialized medical care focused on identifying and relieving the pain and other symptoms of a serious illness. Its goal is to improve quality of life for such patients at any stage of illness regardless of current treatment plans, and it is tailored to the needs of the patient and the family (Strand, Kamdar & Carey, 2013, p. 859). Palliative Care is focused on quality of life rather then curing disease.

Why Nurses? Nurses are on the front line of healthcare, we work at the bedside "Nurses spend more time with dying patients and their families than any other health professional, and every nurse will provide palliative care to patients, no matter what setting they work, making end-of-life care an essential component of nursing education -(Pullis 2013, p. 463). Simply put, patients and families trust nurses and in many cases are more willing to listen to us.

Why Nurses? Nurses are on the front line of healthcare, we work at the bedside "Nurses spend more time with dying patients and their families than any other health professional, and every nurse will provide palliative care to patients, no matter what setting they work, making end-of-life care an essential component of nursing education -(Pullis 2013, p. 463). Simply put, patients and families trust nurses and in many cases are more willing to listen to us.

The Stigma of End of Life Care. A major barrier to end of life care is the stigma attached to the care simply because of common misconceptions including: Accepting Hospice care means one has giving up and is hopeless or even speeding up the process of dying. Loss of control. The belief that utilizing end of life care takes away all control and that the patient and family are at the mercy of healthcare providers. Must spend ones last days in a facility. End of life care is too expensive. Palliative care and Hospice care are the same service.

Hopelessness The utilization of end of life care is often seen as having given up on hope or speeding up the process of death. This can be misleading in that death will occur with or without end of life care; the important choice is not whether one will die but rather, how one will die. End of life care focuses on the life one has left rather then what is to come. According to Meierhenry (2003), hospice does not equate defeat and hopelessness: Hospice does offer hope; the hope that quality of life, and of death, can be improved. ( p. 29).

Loss of Control Often end of life care is discussed after experiencing a traumatic event or receiving overwhelming news. This leads to poor educational moments and unfortunate associations between end of life care services and the inability to control the situation. This misconception however, is far from the truth. Often one is able to gain personal and day to day control through end of life care. Patients who begin hospice or palliative care have the ability to establish a plan of care that meets their desired needs and future wishes. Hospice care gives the patient and families the ability to take some control of a seemingly uncontrollable process.

You Must Spend Your Last Days in a Facility Hospice care is available for patients wherever they call home and can be offered in nursing homes, assisted living facilities, and/or in designated in- patient units (Meierhenry, 2003). Hospice care teams often have the distinct ability to come to the patient. This gives many patients the ability to die in their own bed with their own family, friends, and or pets surrounding them.

Affordability Affordability is a major contributor to the hesitation associated with end of life care. It is important to know that financial options are available and no one should suffer simply because they feel they cannot afford this service. "In 1983, Congress introduced a Medicare hospice benefit. For a person to be eligible, a physician must certify that the patient has a six month life expectancy or less, if the disease progresses as anticipated. (Meierhenry, 2003)." Eligibility for the service reflects the diagnosis and need for the program not what can be paid out of pocket by the individual. It is important to encourage patients and families to investigate and speak with healthcare providers and social workers to aid with this assistance.

Palliative care and Hospice are not the Same Service. Often a palliative type of care is applied by hospice services which, many times causes confusion about what palliative care is and how it is used outside of Hospice care. Facts: A person does not need to be actively dying to render Palliative care services. Palliative care gives focus on comfort and managing symptoms such as pain, and difficulty breathing but is not simply limited to hospice care. "The aim of palliative care is to reduce physical, psychological and spiritual suffering (Stringer, 2013, p 28). Studies have shown that palliative care is very effective in treating patient suffering much earlier than end of life. Its goal is to improve quality of life for such patients at any stage of illness regardless of current treatment plans, and it is tailored to the needs of the patient and the family (Strand, Kamdar & Carey, 2013, p. 859). The provision of palliative care is not restricted to those with incurable disease (Stringer, 2013, p 28).

So, What is the Purpose of End of Life Care? What do the experts say? According to Sander (2014) "The person who is dying Good death means different things to different people but, Beland (2013) suggests that it contains elements of choice and control over what happens, for example: Being made comfortable, Maintaining dignity, Being surrounded by family and being able to say goodbye to loved ones Having access to information, expertism and spiritual and emotional support (p 96). At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so (Iversen & Sessanna, 2012, p. 43). End of Life Care provides expert and individualized care for patients and families through an inevitably unbearable situation. The purpose of this care is to allow patients to die with dignity and minimal suffering while maintaining control and support for families.

So, What is the Nurses Role? Advocacy! The practice of advocacy in end-of-life care yields the outcomes of safe care, improved quality of life for the patient and the family, patient autonomy and self-determination, patient satisfaction, dignity, comfort and decreased suffering, and nurse satisfaction and empowerment (Pullis, 2013, p. 46). Nurses see the need for end of life care up close and have the unique ability to educate in a way not many other do. By advocating for a patient, the nurse is empowering the patient to make informed, autonomous decisions (Pullis, 2013, p. 46). Timely education and Referrals of end of life care done by the healthcare staff and in this case nurses, can decrease so much suffering!

Remember.. End of life care is not hopeless but, rather offers hope of dying comfortably, the way you would like, with the people you want around you. End of life care can offer a valuable sense of control over ones life during a time when the inevitable will happen with or with out this care. End of life care can give patients the ability to take their last breaths in their home surrounded loved ones and familiarity. End of life care has many types of funding and is very often affordable. Palliative care does not mean death and although it is often utilized by hospice care is not the same.

Remember.. Nurses are on the front line. We spend a significant amount of time with each patient and it is the nurse who has the ability to gain trust and provide influence. As nurses we deliver a unique type of care that is essential for treatment including the patients response and acceptance of treatments. The nurse patient-relationship often creates a unique circumstance which, allows for the nurses suggestions and education to be more widely accepted. We are trusted and therefore our educated opinions and assessments can impact patients and families thinking. Nurses have the opportunity to change thinking. Remember. to advocate when end of life care is needed.

Thank You for watching! Please ask any questions in the comment section below and I will be happy to answer.

References Hospice Foundation of America, (2014). What is hospice? Retrieved from http://www.hospicefoundation.org/whatishospice Iversen, A., & Sessanna, L. (2012). Utilizing Watsons Theory of Human Caring and Hills and Watsons Emancipatory Pedagogy to Educate Hospital-Based Multidisciplinary Healthcare Providers About Hospice. International Journal for Human Caring is the property of International Association for Human Caring, 16(4), 43-48. Meierhenry, P. (2003). Continuing education for nurses: hospice 101. Nebraska Nurse, 36(4), 29-32. Pullis, B. C. (2013). Integration of End-of-Life Education into a Community Health Nursing Course. Public Health Nursing, 30(5), 463-467. Sander, R. (2014). Don't be afraid to plan ahead for end-of life care delivery. Nursing & Residential Care, 16(2), 94-96 Stringer, S. (2013). Moral choices in end of life care for children. Cancer Nursing Practice, 12(7), 27-32.