The Role of Nurses in Hospice Care - Research Paper Example

The Role of Nurses in Hospice Care and the Issues affecting this Role Introduction What is Hospice Care? Ever since Dr. Cicely Saunders first articulated the idea of developing modern hospice care based on the careful observation of terminally ill patients in the late 1950’s, nurses have continued to play a progressively more vital role in the provision of hospice care to patients (Seymour, Clark & Winslow 2005). In describing hospice care the WHO termed it as essentially being an approach that serves to greatly improve the overall quality of the lives of patients and their respective families that happen to be facing a problem that is associated with life-threatening illness through relief and prevention of suffering. This can be achieved by impeccable assessment, and the early identification and treatment of not only pain, but also a range of other problems that might relate to psychosocial, physical and spiritual aspects. Care for dying patients has continued to remain a very fundamental aspect of nursing. As patients shift from a state where they are observed to be sick to that in which they are described as dying, it is principally the nurses who are tasked with the day-to-day duty of helping and supporting these patients and their families in their attempts to try and successfully live with the social, psychological, spiritual and physical consequences of a patient’s illness. When patients reach a state of terminal illness, the independent and autonomous dying role that they assume forces that there be a complementary shift on the part of the doctor and nurse. This is because the role of the doctor is primarily centered on curing and treatment; however when attempts at curing and treatment fail, the supportive and caring role that is played by nurses becomes increasingly more dominant as a patient dies. Despite the commitment that nurses have towards the fulfillment of their roles in /hospice care, there are however some negative factors that greatly inhibit the provision of good quality care by these nurses. This paper will seek to show that nurses play an important role in hospice care and the concerns inhibiting nurses from attending to this role need to urgently be addressed. The Role of Nurses in Hospice Care The important role that is played by hospice care nurses cannot be over emphasized. These nursing professionals bring in what is noted to be a unique set of qualities and skills that greatly enhance the overall support and care that is provided to patients facing the end of life. These nurses also serve the crucial role of supporting the families of their patients as well as the communities that support them. The skills possessed by hospice care nurses are developed after many years of interdisciplinary continuing education and clinical practice and they are well informed by hospice care’s founding philosophies (Becker, 2009). Hospice nurses are able to greatly distinguish themselves from their colleagues practicing in other branches of nursing specialties through their dedication and unwavering focus on end-of-life care. Hospice care basically includes family support, management of pain and 24-hour nursing availability. Through their role of providing of expert pain management combined with counseling and compassionate listening, hospice care nurses are able to promote the highest life quality for patients and their respective families (Chaffee, 1999; Lanken et al, 2008). The knowledge pertaining to end of life issues that specialist hospice care nurses have, combined with relatively strong commitments to hospice care ethics, is noted to normally extend to the work conducted by these specialist nurses who frequently go beyond the bedside to advocate for the need for hospice care on the larger socio political level (Becker, 2009). Hospice care nurses are also active in the role of promoting optimal well-being at the end of life of patients, regardless of the patient’s individual financial position and location. They work collectively and with others to try and advocate for change. They at times also provide policy advice to professional organizations and the government pertaining to a wide range of professional, service and clinical related issues. In the process of engaging in their practice, hospice care nurses frequently work in collaboration with other health providers such as chaplains, physicians, psychiatrists’ social workers and oncologists within the context of what is an interdisciplinary team. These interdisciplinary teams composed of socially trained and highly qualified volunteers and professionals are able to successfully blend their strengths together so as to successfully anticipate and meet the inherent needs of patients and their families that happen to be facing terminally illness and bereavement (Becker, 2009). Another key role ascribed to specialist hospice care nurses is that of demonstrating leaderships in collaborative and autonomous practice in the modeling of end of life care. They are also widely engaged in the provision of practical education and mentorship to other healthcare professionals and nurses. Due to their multidisciplinary healthcare education and practice, specialist hospice care nurses often tend to have a remarkably extensive experience and knowledge in the management of not only pain, but also a number of complex symptoms that are usually associated with terminal illness (Seymour, Clark & Winslow, 2005). Specialist hospice care nurses are important to hospice care as they frequently work together with other professionals to advance the current body of knowledge pertaining to end of life care. They are instrumental in the initiation of research, conduction of the research as well as the eventual incorporation of research findings where appropriate. Specialist hospice care nurses are key advocate for the friends and families of their hospice care patients. These specialists are able to extend the benefits of hospice care and bring health to the wider community through the teaching and promotion of positive approaches to grieving. Issues Affecting Hospice care Nurses Despite the vital role that hospice care nurses play in the care of patients, there are however some issues noted to be greatly inhibiting these nurses from effectively playing their role in offering hospice care to patients. Some of these include: Moral and Ethical Distress: Among specialist hospice care nurses moral and ethical distress can eventually result in their feeling angry and distressed. This distress if often noted to occur when nurses are demanded to act in a fashion found to be quite contrary to their beliefs. A blatant disregard for their professional and personal values can have the effect of severely undermining the integrity of these nurses. Hospice care nurses often struggle with the ethical dilemma between their medical obligation of following the orders given by the physicians and their duty to ensure that they provide a comfortable death. Personal Pain: According to Morgan (2009), hospice care nurses have been shown to suffer from the eventual termination of the already firmly established relationships they tend to create with patients and their families. In an effort to protect themselves, nurses tend to keep to themselves busy with the administration of physical care while constantly trying to minimize physical interaction with the patient’s and their families in a concerted effort to try and avoid distress. Lack of support and Collaboration: Some hospitals are noted as failing to employ enough numbers of hospice care supportive staff such as social workers, clinical nurse specialists, chaplains and clinical nurse specialists. This can have the effect of causing hospice care nurses to experience feelings of lack of support from the administrative personnel, their peers and other healthcare team members Morgan (2009). Burnout: Given the relatively high levels of personal pain, ethical and moral distress, as well as a general lack of support from some of the other healthcare personnel, employee turn-over rates for hospice specialist nurses are usually negatively affected as hospice care nurses seek less stressful work environments. The high levels of stress are noted to greatly contribute to burnout among these professionals (Wowchuk, McClement & Bond, 2007) . Conclusion Since the start of the hospice movement, the main focus of the subspecialty has been on the provision of comprehensive psychosocial, physical, spiritual and emotional care to terminally ill persons and their respective families. Specialist hospice care nurses help promote the quality of life that is enjoyed by their patients from burdensome interventions in addition to wherever possible, providing them with care at home instead of the hospital. Hospice medicine has proven that it is basically a continuation of the struggle to accept life in its own terms. Having taken its place in academic medicine, it is now possible for the new subspecialty to advance to such a level that future generation of specialist hospice care nurses will be able to gain skills in the subspecialty. This will ultimately help them to continue providing care to patients and their families even in the event that treatments happen to fail. Nursing has an important role in the delivery of hospice care and as such, the continued development of nursing skills and knowledge in hospice care is crucial in the further advancement of this subspecialty. However as has been shown in this paper, some concerns continue to limit nurses in the delivery of good quality hospice care, nurses play an important role in hospice care and as such it is important for the concerns inhibiting nurses from attending to this role to urgently be addressed to further enhance the delivery of this crucial service by nurses. References Becker, R. (2009). Palliative care 2: exploring the skills that nurses need to deliver high-quality care. Nursing times, 105(14), 18-20. Chaffee, S. (1999). Cancer Pain Relief and Palliative Care in Children. Journal of Palliative Medicine, 2(4), 425-426. Lanken, P. N., Terry, P. B., DeLisser, H. M., Fahy, B. F., Hansen-Flaschen, J., Heffner, J. E. & Yankaskas, J. R. (2008). An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. American journal of respiratory and critical care medicine, 177(8), 912-927. Morgan, D. (2009). Caring for dying children: Assessing the needs of the pediatric palliative care nurse. Pediatric nursing, 35(2), 86. Seymour, J., Clark, D., & Winslow, M. (2005). Pain and palliative care: the emergence of new specialties. Journal of pain and symptom management,29 (1), 2-13. Wowchuk, S. M., McClement, S., & Bond Jr, J. (2007). The challenge of providing palliative care in the nursing home part II: internal factors. Int J Palliat Nurs, 13(7), 345-350. Read More