In July 2001, Promoting Excellence in End-of-Life Care, a national program office of The Robert Wood Johnson Foundation, convened a group of advanced practice nurses (APNs) to discuss the state of palliative care advanced practice nursing in the United States, to identify gaps in and barriers to that practice, and to develop strategies for the future. The report from this day-and-a-half- long meeting, Pioneering Practices in Palliative Care, has three objectives: to facilitate conversation among nursing leaders about how to improve the state of palliative care advanced practice nursing, to illustrate successful models of pioneers in advanced practice nursing and to promote the advanced practice nurse’s role in providing palliative care.
Principles of Palliative Care
A primary tenet of palliative care is that clinical
professionals be aware of and respect patients’
treatment wishes. Although preferences vary
according to race, ethnicity and religion, most
Americans—more than 90 percent in a recent
Gallup poll—wish to be in their own homes or
in a homelike setting when they die. Unfortunately,
barely 20 percent of Americans die at
home.
Other principles of palliative care, such as attention to physical comfort and personal dignity, pertain regardless of where a dying person resides. Certainly, the 80 percent of Americans who die in institutions need—and deserve— expert symptom management and attention to personal and interpersonal aspects of life closure. (See sidebar "What is Palliative Care?")
The Impact of an Aging Society
At the start of the 21st
century, the oldest of
America’s 76 million
baby boomers are in
their mid 50s and the
youngest are approaching
age 40. As advances in
medical technology
continue to extend life, these aging Americans will
have to contend with the aches, pains and progressive
disabilities of chronic illness. The need
for specialized palliative care to improve comfort
and quality of life for this population is great—
and it is growing. Policymakers, payers and
consumer groups must encourage the development
and application of better tools and strategies for
bringing palliative care to more Americans.
Nursing Leadership
By articulating and asserting their values and
vision, nurses can positively influence public
discourse and social policy on caring for the most
ill, infirm and aged Americans. Nurses are
present in every setting where Americans receive
care. In many health care facilities, it is a nurse
who sees and evaluates patients first. Even when
a patient dies at home, a home health or hospice
nurse has been overseeing the person’s care.
Advanced practice nurses play a critical role in expanding access to services and improving quality of care for patients with advanced chronic illness. By facilitating coordination and maximizing continuity of care, APNs are not only particularly helpful to patients and families, but also highly valued by their clinical colleagues and administrators.
APNs: Improving Quality and Access to
Palliative Care
In communities and health systems nationwide,
APNs with specialized training and experience
in palliative care are leading the effort to
improve access, promote clinical excellence and
improve cost effectiveness. In addition, advanced
practice nurses are contributing to health
services research in palliative care, oncology,
neurology, critical care, surgery and pediatrics.
APNs: Valuable Members of Interdisciplinary Teams
Palliative care advanced practice nurses often
can provide patient care and family support
throughout the continuum of care and disease
trajectory. Practicing as members of
interdisciplinary teams, APNs work with:
- Patients and families: APNs use listening skills to learn the full spectrum of patient and family concerns and to serve as patient/family advocates.
- Physicians and the palliative care team: APNs contribute to diagnostic evaluations and treatment. They also model and mentor effective modes of caring.
- Facility administrators: APNs manage the delivery of valuable health care services at the point of patient contact. Working within institutions and communities, APNs reach those in need while managing resources in an efficient, cost-effective fashion.
What’s Inside
This report provides a window into the practices
of APNs who specialize in palliative care. The
practice settings described span the spectrum
from hospital-based to independent practice to
academia. Most of the featured pioneering APNs
work as part of an interdisciplinary clinical team;
others work in private practice or as consultants
to teams or physicians.
As this monograph illustrates, APNs specializing in palliative care effectively and compassionately address the needs of patients and families who are experiencing life-threatening illness. They exemplify both the science and art of nursing by coupling expert knowledge and clinical judgment with respect, dignity and care. By melding basic human values with the pragmatism needed to be effective in today’s environment, APNs are an invaluable resource as we strive to care for our nation’s ill, infirm and elderly.
This report is available in the following formats:
Advanced Practice Nursing: Pioneering Practices in Palliative Care A Position Statement from American Nursing Leaders |
