Palliative Care: The Next Frontier for APRNs?
Advanced Practice Nurses Find Deep Satisfaction in Improving Care for People with Serious Illness
Palliative care is delivered to patients and their families when they are at their most vulnerable, a perfect fit for advanced practice registered nurses (APRNs) who love the challenge of working with complex situations and building close relationships with their patients and families.
Palliative care focuses on providing relief from physical symptoms and stress of a serious illnesses, addressing the whole person. Although sometimes confused with hospice, it’s important to remember hospice is a specific type of palliative care designed to address the needs of those who have 6 months or less to live. In other words, hospice care is always palliative, but not all palliative care is hospice care. Palliative care can be offered at any point in a serious illness, from diagnosis onward—alongside curative treatment or without it.
Palliative practice offers the opportunity to work closely with an interdisciplinary team, including nursing, physicians, psychologists, social work, dietary, pharmacy and volunteers, all functioning to treat pain, depression, fatigue, constipation and a number of other symptoms related to physical and mental health. Serious illnesses that respond well to palliative care include conditions such as:
- Congestive heart failure
- Chronic obstructive pulmonary disease (COPD)
- Kidney disease
- Alzheimer’s disease
- Parkinson’s disease
- Amyotrophic lateral sclerosis (ALS)
Advanced Practice Nurses Play a Unique Role in Palliative Care
In American culture, the topic of long-term care, or death and dying, is often avoided, even by some healthcare providers. As an APRN or APN engaging with patients during a long-term illness, developing palliative care skills allows you to offer a holistic approach that addresses the physical, emotional, spiritual and social aspects of your patient’s and family’s needs.
Together with other members of the healthcare team, you help establish decision-making processes with the patient and family taking into account their preferences, physiological realities and individualized patient and family needs. Many who live with serious chronic illnesses often find themselves bouncing in and out of the hospital and struggling to get the treatment they need to maintain quality of life.
Increasingly, research supports what you likely already know — comprehensive palliative care offers meaningful quality of life, and in many cases may prolongs life as patients are better equipped to maintain medication programs and adhere to treatment plans. APRNs working in palliative care find the work to be challenging, but also empowering.
Your role is multifaceted, often resulting in strong bonds with the family, reducing the burden on the individual and the family while offering support for unique physical, social and psychological needs. In one study evaluating palliative care, researchers found in 79% of cases studied, the most common professionals working in teams or as sole practitioners, were nurses.
Meeting a Growing Need as Numbers Suffering Chronic Diseases Continues to Rise
There is a growing need for palliative care practitioners to meet the needs of our rapidly aging population and the increase in the number of people suffering from serious illness. According to the U.S. Centers for Disease Control and Prevention (CDC), 60% of adults in the U.S. have one chronic disease and 40% have two or more.
These growing numbers have led the American Nurses Association, in partnership with Hospice and Palliative Nurses Association, to call for nurses to lead a healthcare transformation that expands palliative care. The panel recognizes the challenges facing patients and their palliative care practitioners and calls for an increase in education and resource support for practitioners.
Many believe working with patients who are facing long-term disability or end-of-life issues may be depressing. However, those who practice palliative care report high job satisfaction, based in part on practicing a type of care that helps patients manage symptoms and increase the joy they find in life. In the end, it’s about helping patients to live each day, the best they can.
Palliative Care Builds on Current Nursing Roles
Palliative practice builds on many of the skills you already use each day. Pathophysiology of disease, pain management and symptom assessment, as well as counseling, communication skills and advance care planning all play a role in caring for patients with chronic disease.
Some organizations look for APRNs who have become experts in palliative care practice gaining more knowledge in medications, leadership and advocacy, identifying challenging symptoms and managing many of the common side effects of chronic disease, such as nausea and vomiting, pain and constipation or diarrhea.
APRNs fluent in palliative care may also offer patients non-pharmaceutical approaches to managing their health. For example, patients with lung disease may benefit from learning simple breathing techniques and incorporating exercise, while those with cardiovascular disease benefit from nutritional education and specific exercise programs. Successes help avoid unnecessary and costly emergency department visits, reduce the overall cost of care and many times lengthen a patient’s life.
Palliative Care Is a Partnership
Throughout history nurses have been like the hub of a wheel, in the center of a collaborative relationship between physicians and other allied health professionals. In today’s healthcare environment, interdisciplinary collaboration and teamwork has a demonstrated positive impact on organizational performance and patient outcomes. Furthermore, research shows specifically that palliative care provided by nurses improves outcomes.
Rapid advancement in medicine and clinical technologies, combined with economic pressures and consumer demands, have had an impact on the healthcare landscape. You are in a unique and strong position to effectively manage palliative care partnerships, thus helping to extend the life of your patients, reduce costs and increase your own emotional and professional satisfaction.
What is Palliative Care? (January 14, 2018) U.S. National Library of Medicine
Schroeder, K., Nursing and the Future of Palliative Care. (2018) Asia-Pacific Journal of Oncology Nursing, 5(1):4-8
About Chronic Disease, U.S. Centers for Disease Control and Prevention
Call for Action: Nurses Lead and Transform Palliative Care (2017) American Nurses Association Board of Directors.
Spaulding, A., Harrison, D.A., Harrison, J.P., Palliative Care: A Partnership across the Continuum of Care. (2016) Health Care Manager, 35(3):189
McKinlay, E., McBain, L., Evaluation of the Palliative Care Partnership: A New Zealand Solution to the Provision of Integrated Palliative Care. (2007) New Zealand Medical Journal, 120(1263):U2745