Instructions for Continuing Nursing Education Contact Hours appear on page 221.
The Medical-Surgical Nurse’s Guide to
Understanding Palliative Care
and Hospice
emographic and health
D trends suggest medical-sur-
gical acute care nurses will
care for increasingly larger numbers
of aging and chronically ill persons
(Wallace, 2016). Because most
Americans die in hospitals, nurses
play a key role in symptom man-
agement, integration of supportive
care services, advance care plan-
ning, and quality end-of-life (EOL)
outcomes (Stanford School of
Medicine, 2016). However, medical-
surgical nurses face many chal-
lenges in providing comprehensive
care for patients with life-limiting
illness, including the fast pace of
busy units, uncertainty of progno-
sis, curative focus of treating illness,
interprofessional conflict regarding
the plan of care, and the reluctance
of patients, healthcare providers,
and families to discuss EOL issues
(Gagnon & Duggleby, 2014).
To provide safe and compassion-
ate EOL care, medical-surgical nurs-
es must understand available
options and how to assist a patient
in decision making. Two of the
most common options to help
patients and caregivers cope with
the challenges of serious illness are
palliative and hospice care. Many
misperceptions regarding palliative
care and hospice persist, making it
difficult for medical-surgical nurses
to advocate effectively for patients.
The purpose of this article is to pro-
vide an overview of hospice and
palliative care, and help the med-
July-August 2018 • Vol. 27/No. 4
Elizabeth Croson
Jessica Keim-Malpass
Susan Bohnenkamp
Virginia LeBaron
Understanding palliative care and hospice is critical for the medical-
surgical nurse to advocate for and support patients and families. An
understanding of primary palliative care and hospice care is rele-
vant for the medical-surgical nurse.
ical-surgical nurse support patients Palliative Care
and their caregivers by using the The World Health Organization
Eight Domains of the National (WHO) (2016) defined palliative
Consensus Project for Quality care as, “an approach that improves
Palliative Care (NCPQPC) (2018). the quality of life for patients and
their families facing the problems
associated with life-threatening ill-
Understanding Palliative
Care and Hospice ness, through the prevention and
relief of suffering by means of early
The terms palliative care and hos- identification and impeccable
pice often are used interchangeably, assessment and treatment of pain
creating confusion. Importantly, and other problems, physical, psy-
palliative and hospice care share the chosocial and spiritual” (para 1).
same aim to provide optimal symp- The WHO definition does not
tom management and comfort to include the terms death, dying, or
the patient and family by reducing end of life; instead, emphasis is on
distress in physical, emotional, optimizing quality of life and allevi-
social, and spiritual suffering ating distress. Palliative care is not
(Kamal, Currow, Ritchie, Bull, & prognosis-dependent. Rather, it can
Abernethy, 2013). See Table 1 for a and should be integrated alongside
comparison of palliative care and curative or life-prolonging therapies
hospice.
Elizabeth Croson, PhD, RN, is Course Instructor, Western Governor’s University, Salt Lake
City, UT.
Jessica Keim-Malpass, PhD, RN, is Assistant Professor, University of Virginia School of
Nursing, University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, VA.
Susan Bohnenkamp, MA, RN, ACNS-BC, CCM, is Clinical Nurse Specialist, University
Medical Center, Tucson, AZ.
Virginia LeBaron, PhD, APRN, FAANP, is Assistant Professor, University of Virginia School of
Nursing, Charlottesville, VA.
215
 TABLE 1.
Comparison of Palliative Care and Hospice

Palliative Care Hospice

Similarities • Focus on optimal symptom management in all domains (physical, emotional, social, spiritual)
• Care provided by interprofessional team
• View patient, family caregivers as unit of care
• No requirement regarding code status (patients do not have to be do not resuscitate/allow natural death)
• Discussions to clarify patient preferences, goals of care paramount
• Work with patients with any serious, life-limiting illness (e.g., cancer, HIV/AIDS, dementia, heart failure,
chronic obstructive pulmonary disease)

Differences • No prognosis requirement • Patient prognosis of 6 months or less

• No specific eligibility criteria
• Primarily hospital-based care
• Provided with curative or
life-prolonging therapies
• Primarily home-based care; time-limited inpatient options
available in certain situations
• Eligibility criteria based on disease process
• Medicare benefit
• Generally most appropriate for patients who have decided to
stop life-prolonging therapies
• Provides structured bereavement support for family

and can be provided to patients and
families at any point along the ill-
ness trajectory, not just in a
patient’s final weeks or days. The
flexibility of palliative care can be
especially beneficial to patients suf-
fering from conditions such as heart
failure (HF) and chronic obstructive
pulmonary disease, for which prog-
nosis is difficult to determine and
unpredictable exacerbations are
common (Holmes & Scullion, 2015;
Kheirbek et al., 2013). Importantly,
a growing body of compelling evi-
dence demonstrates early palliative
care improves health and survival
outcomes (Adelson et al., 2017).
Hospice
Hospice is defined as, “a service
delivery system that provides pallia-
tive care for patients who have a
limited life expectancy and require
comprehensive biomedical, psy-
chosocial, and spiritual support as
they enter the terminal stage of an
illness or condition” (Center to
Advance Palliative Care [CAPC],
n.d., p. iii). CAPC suggested one
way to conceptualize hospice is as
an intensification of palliative care
specifically designed for a patient’s
final months. In the United States,
Congress established hospice as a
Medicare benefit in 1986 and set
the benchmark eligibility criteria
for patient enrollment in hospice.
While certain aspects of eligibility
criteria may differ among individ-
ual hospices, enrollment in all
Medicare-certified hospices requires
a physician to certify the patient is
terminally ill and has a prognosis of
6 months or less if the disease runs
its normal course. Specific criteria
also exist for most major illnesses
(e.g., cancer, HF, HIV/AIDs, demen-
tia) and hospices can be consulted
for informational patient visits to
help determine eligibility. Many
hospices also require patients to
forego life-prolonging therapies, for
which the burden outweighs the
benefit and can contribute to symp-
tom distress (e.g., total parental
nutrition for patients with metasta-
tic cancer, blood transfusions for
patients with end-stage HF). How-
ever, individual therapies often are
considered on a case-by-case basis.
NCPQPC Domains of
Palliative Care
In 2001, the National Consensus
Project established eight essential
domains of palliative care to provide
benchmarks and guidance for clini-
cians and institutions regarding
delivery of quality palliative care
(American Association of Colleges of
Nursing, 2016; NCPQPC, 2013):
1. Structure and process
2. Physical aspects
3. Psychological and psychiatric
aspects
4. Social aspects
5. Spiritual and existential aspects
6. Cultural aspects
7. Care at the EOL
8. Ethical and legal aspects
Medical-surgical nurses can assess
patients’ needs through the lens of
each domain and match those needs
with available resources. Under-
standing the domains of palliative
care provides nurses with a useful,
concrete framework to care for
patients coping with life-limiting ill-
ness.
Structure and Process of
Care
Medical-surgical units housing
patients with serious illness should
have a structure in place for offering
and providing palliative care servic-
es. Structure formality varies
depending on location and avail-
able resources; however, as illness
progresses, communication among
patient, family, provider, and team
should increase (Agency for
Healthcare Research and Quality
[AHRQ)], 2013). When and how to
introduce conversations regarding
palliative care should be delineated
clearly, and taught to nurses and
other team members.

216 July-August 2018 • Vol. 27/No. 4

The Medical-Surgical Nurse’s Guide to Understanding Palliative Care and Hospice

TABLE 2.
Internet Palliative Care Resources for the Medical-Surgical Nurse

Name of Organization Website Relevance for Medical-Surgical Nurses

Palliative Care Network of
Wisconsin
Center to Advance Palliative
Care
American Academy of
Hospice and Palliative
Medicine (AAHPM)
Hospice and Palliative Nurses
Association (HPNA)
National Palliative Care
Research Center (NPCRC)
End-of-Life Nursing Education elnec.academy.reliaslearning.com/
Consortium (ELNEC)
Five Wishes
National Coalition for Hospice
and Palliative Care
www.mypcnow.org/fast-facts One-page evidence-based summaries of how to
manage difficult symptoms and palliative care
issues; relevant, helpful for nurses and
physicians
www.capc.org Tools and resources to plan, implement,
evaluate palliative care services within an
institution
www.aahpm.org Professional organization for healthcare
providers (particularly physicians) specializing in
hospice and palliative medicine
www.hpna.org Professional organization for nurses specializing
in hospice and palliative care; contains
information regarding specialty credentialing
www.npcrc.org Grants/funding available for research to improve
care for seriously ill patients, their families
National initiative to provide high-quality
palliative care training to nurses; various
trainings available around the country focused
on specific patient populations and care settings
www.agingwithdignity.org/ Clear, simple advance care document
recognized by the majority of states, does not
require a lawyer to execute; available online for
nominal fee
www.nationalcoalitionhpc.org/ Clinical practice guidelines for quality palliative
care with focus on eight domains

Interprofessional Palliative
Care and Team Training
Palliative care teams are interpro-
fessional, ideally including physi-
cians, nurses, social workers, and
chaplains at a minimum. Larger
teams may include trained volun-
teers, psychologists, and therapists.
Medical-surgical nurses and other
providers benefit from palliative
care training focused on symptom
assessment and management, care
of the actively dying patient, discus-
sion of advance directives and how
to lead family meetings, and effec-
tive use of resources in the hospital
and community (Sheldon, Dahlin,
Maingi, & Sanchez, 2017). Team
building and communication train-
ing should be ongoing so team
members can collaborate and coor-
dinate advanced care planning
meetings with patients and families
(Wittenberg, Ferrell, Goldsmith,
Ragan, & Paice, 2016). Nurse leaders
should find an accessible training
program that is relevant to the
needs of their units (see Table 2).
Physicians and nurses may be
trained as palliative care specialists,
or be general practice providers who
implement a basic palliative care
approach (primary palliative care) in
their patient care. Economic and
resource constraints mean hiring
palliative care specialists is not
always feasible. One cost-effective
alternative can be development of a
partnership between palliative care
specialists outside the hospital and
generalists inside the hospital (Quill
& Abernathy, 2013). As part of a
coordinated model of care, general-
ists can deliver primary palliative
care by beginning conversations
related to goals of care and address-
ing basic symptom management
needs. For particularly difficult or
refractory symptoms, a palliative
care specialist referral can be made.
In this type of model, basic pallia-
tive care training must be mandato-
ry for all acute care providers (Quill
& Abernathy, 2013).
When to Initiate
Conversations about
Palliative Care
Important questions should be
addressed when identifying a pat-
ient who may benefit from pallia-
tive care. For example, is the patient
experiencing disease progression,
especially with functional decline?
Is the patient experiencing pain or
other symptoms not responding to
optimal medical treatment? Is there
a need for advance care planning
and clarification of goals of care
(NCPQPC, 2013)? If a patient meets
any of the three criteria, the nurse
should communicate with the pri-
mary provider about the potential
for enhancing palliative care sup-
port. Another method to identify
patients for palliative care is to use

July-August 2018 • Vol. 27/No. 4 217

trigger criteria. With this approach,
the electronic medical record
prompts providers to consult pallia-
tive care if the patient has met cer-
tain baseline criteria (Adelson et al.,
2017; Glare & Chow, 2015). Such
criteria may include age over 80,
pre-existing functional dependence,
and advanced malignancy. Having
such criteria in place may expedite
the referral to palliative care and
improve patient outcomes (Hua, Li,
Blinderman, & Wunsch, 2014).
Additionally, CAPC (n.d.) pro-
vides two checklists to use on
admission and daily while a patient
is hospitalized to screen for pallia-
tive care and address unmet pallia-
tive care needs. These checklists are
among the many tools available
online in the handbook Policies and
Tools for Hospital Palliative Care
Programs. This handbook offers a
starting point for medical-surgical
units with no formally developed
policy and procedure for caring for
patients receiving palliative care
and hospice. After identifying
patients who will benefit from pal-
liative care, the nurse should evalu-
ate the level of trust he or she has
developed with the patient and
family. The nurse can prepare for
conversations with the patient and
family first by discussing the
patient’s condition and prognosis
with the primary provider so they
deliver consistent messages to
patients and families (Clabots,
2012).
How to Initiate
Conversations Regarding
Palliative Care
Communication is arguably the
most critical element of palliative
care. An essential task of the nurse is
to assist with organizing and lead-
ing family meetings. Family meet-
ings are structured discussions that
commonly involve patients (if
able), family members/caregivers,
and interprofessional healthcare
team members to discuss goals of
care, clarify prognosis and treat-
ment options, and make plans for
future care. Ideally, family meetings
should elicit patient and family pre-
vious experiences with serious ill-
ness, decrease stress through estab-
218
lishment of realistic goals, and build
trust through consistent communi-
cation. A time should be established
when all team and family members
can attend so the meeting is not
rushed. Healthcare team members
should have a pre-meeting huddle
to clarify or address any differences
in opinion that may exist among
them. This step is critical to avoid
unnecessary confusion when talk-
ing with the family. Designating
one team leader to guide and direct
the meeting and set acceptable
ground rules, such as allowing every
person to talk in turn, is helpful.
The meeting should include time
for a thorough discussion, ques-
tions, silence, and tears; it should be
held in a quiet, private room where
everyone can be seated. The conver-
sation can begin with assessment of
patient and family understanding
of the current medical situation,
with an open-ended question such
as, “Can you tell me what you
understand about your current
medical situation?” This clarifying
question is essential to ensure
everyone has the same understand-
ing before attempting further dis-
cussions and decisions. Use of clear,
direct, non-jargon language is
important to avoid confusion or
misunderstanding. Nurses play a
key role in family meetings by
advocating for patients and families
and coordinating communication
among team members (AHRQ, 2013).
Helpful communication phrases are
listed in Table 3.
Physical Aspects of Care
Pain, dyspnea, fatigue, and con-
stipation are among the most
reported symptoms at EOL, with
nearly half of patients reporting
pain in their last 3 days of life
(NCPQPC, 2013; National Institutes
of Health [NIH], 2014). Vigilant
assessment of other physical symp-
toms should be done regularly to
prevent distress (Wheeler, 2016). As
physical symptoms are inherently
subjective, an important aspect of
palliative care is to listen actively to
the patient, allow him or her to pri-
oritize the most bothersome symp-
July-August 2018 • Vol. 27/No. 4
toms, effectively treat distressing
symptoms, and reassess interven-
tion effectiveness so adjustments
can be made. Underlying causes
should be investigated and treated,
with careful consideration given to
the burdens and benefit of inter-
vention based on the patient’s wish-
es, goals, and prognosis.
Conducting a thorough pain
assessment will help determine the
potential cause of the pain and
management strategy (Sigakis &
Bittner, 2015). The goal should be
safe, timely, effective pain reduction
with minimal treatment side effects
(NCPQPC, 2013). Although medica-
tion is the most common approach
for moderate to severe pain, non-
pharmacologic choices can be effec-
tive alone or in combination with
medication (e.g., position changes,
heat or cold compresses, music
therapy, relaxation techniques, dis-
traction) (Sigakis & Bittner, 2015).
Opioid treatment may be met with
resistance due to fears about side
effects, fatigue, addiction, difficulty
breathing, and hastened death.
Acknowledging these fears and
addressing them with each patient
and family should be a priority so
effective pain management is possi-
ble (NCPQPC, 2013). Providers also
should screen patients and families
for appropriateness of opioid thera-
py to avoid unintended harms (e.g.,
with Opioid Risk Screening Tool)
(Webster & Webster, 2005). The
nurse should monitor opioid thera-
py appropriately, and educate
patients and family members
regarding safe storage and disposal
of controlled substances. If primary
care providers are uncertain about
opioid dosing or management, con-
sulting a pharmacist or palliative
care specialist may be warranted.
Dyspnea, a sensation of shortness
of breath (SOB), often is managed
with opioids in a palliative care con-
text. Supplemental oxygen may be
added if helpful but should not
increase patient distress; for exam-
ple, a face mask can restrict touch
with loved ones or contribute to feel-
ings of claustrophobia without alle-
viating SOB (Wheeler, 2016). Fatigue
is a state of physical and mental
The Medical-Surgical Nurse’s Guide to Understanding Palliative Care and Hospice

TABLE 3.
Helpful Palliative Care Communication Phrases for the Medical-Surgical Nurse

Concept and Examples Rationale

Open-Ended Questions • Helps guide effective conversations regarding prognosis,
“Can you tell me what you understand about your current treatment options
medical situation?” • Assesses patient’s level of understanding
“What is your understanding of where things stand with your • Allows clarification of misunderstandings before
illness now?” proceeding
• Explores patient’s goals, values, preferences
“What feels most important to you now?”

Prompting • Allows patient to tell his or her story

“Go on. Please tell me more.” • Demonstrates active listening, engagement
“What happened next?”

Screening • Ensures patients have shared the most important, relevant

“Before we talk about that, is there anything else you wish to information
tell me regarding what we have been talking about?” • Allows provider to obtain thorough patient history

Respecting • Validates patient as an individual

“You have shared a lot of information with me. I feel I have a • Acknowledges patient has been heard
better understanding of you.”
Exploring Treatment Options • Offers solutions without dictating a plan
“These are some of the options to help you be comfortable.” • Explores patient goals, values, preferences
“What do you think?” • Expresses empathy; “I wish” statements can be
particularly helpful as they are sincere and realistic.
“What if things do not go as we hope they will?”
“I wish this treatment had been effective in controlling your
cancer.”
Source: Adapted with permission from Dr. Nessa Coyle. Table adapted from her oral presentation about palliative care nursing
delivered at the University of Arizona, Tucson, 2007.

challenge that frequently occurs at
the EOL (Kirshbaum, Olson, Pong-
thavornkamol & Graffigna, 2013).
Fatigue can be managed by address-
ing potential underlying problems
such as sleep patterns, pain, nutri-
tion and exercise, and depression.
Fatigue may not need aggressive
intervention. Pharmacological man-
agement of fatigue is controversial,
and more research is needed to
determine what is most effective for
patients at the EOL (Mucke et al.,
2015). Constipation is common in
persons receiving opioids for pain
management in advanced disease.
Nursing assessment should involve
questioning patients on the frequen-
cy and quality of bowel movements,
with appropriate interventions as
needed.
Psychosocial and
Psychiatric Aspects of Care
Common psychosocial and psy-
chiatric symptoms for palliative
care patients include delirium, agi-
tation, anxiety, and depression
(NCPQPC, 2013). Delirium occurs
in 30%-50% of all patients in pallia-
tive care, with agitation occurring
13%-46% of the time (Hey, Hosker,
Ward, Kite, & Speechley, 2015).
Nonpharmacological management
includes oxygen, fluid and elec-
trolyte management, frequent reori-
entation to environment, exercise,
pain management, and bladder and
bowel management. Pharmacologic
treatment may include antipsy-
chotics, sedatives, psychostimu-
lants, and cholinesterase inhibitors;
each comes with risks, including
further interference with a patient’s
cognition and paradoxically wors-
ening agitation or delirium (Hey et
al., 2015). Treatment choice should
be individualized and adjusted to
meet patient and family needs.
Psychological distress commonly
occurs at the EOL and can be mag-
nified in the presence of pre-exist-
ing mental illness, particularly anx-
iety and depression. The idea of
depression as a normal part of the
terminal illness process contributes
to its under-treatment. Symptoms
include depressed mood, feelings of
worthlessness, fatigue, sleep distur-
bances, change in appetite, and loss
of memory. These symptoms can
overlap with others that normally
occur with terminal illness and
medication use, making diagnosis
difficult. Nurses can simply ask,
“Are you depressed?” as this ques-
tion has been found to be an
extremely effective way to identify
depression. Antidepressant therapy
takes time, usually several weeks, to
reach peak effect, so it may be nec-
essary to add a psychostimulant
such as methylphenidate to im-
prove mood more quickly (Jordan
et al., 2015). Prompt referral to
social work, psychology, psychiatry,
and/or a religious minister/spiritual
support may be helpful. Reflective
listening and focusing the conversa-
tion on the patient’s goals of care

July-August 2018 • Vol. 27/No. 4 219

also may improve mood at the EOL.
A combination of pharmacologic
and nonpharmacologic treatment,
and proper referral can lead to
decreased rates of depression and
help maintain patient dignity at the
EOL (Marks & Heinrich, 2013).
Social Aspects of Care
Families and friends often want
to be involved in decision making
and play a pivotal role in patient
care at the EOL. Family members/
caregivers often alert nurses to spe-
cific symptoms, particularly for
non-verbal patients, noting the
patient may be restless or in pain.
Nurses should address those con-
cerns as quickly as if patients were
complaining themselves (NCPQPC,
2013; NIH, 2014). Families who par-
ticipate in decision making have
improved confidence and coping.
In addition, allowing families to
have a voice at the EOL may
improve the bereavement process
(NCPQPC, 2013; NIH, 2014).
Spiritual, Religious, and
Existential Aspects of Care
Religion is a focused set of beliefs,
often with a formal organization of
people and values. Spirituality is less
formally organized but equally
important (Nelson-Baker et al.,
2015). Spiritual care enhances “com-
fort, acceptance, and inner peace”
for patients at EOL (Broadhurst &
Harrington, 2016, p. 889). Nursing
qualities that add to effective spiritu-
al care include self-awareness, spiri-
tual sensitivity, and the willingness
to provide silence and therapeutic
touch (Tiew, Kwee, Creedy, & Chan,
2013). Building trust, a common
theme in palliative care, improves
therapeutic relationships and allows
nurses to provide more effective
spiritual care. Nurses should assess
spiritual and existential needs regu-
larly and document appropriately
(NCPQPC, 2013). Ignoring spiritual
needs leads to spiritual distress and
fear, which can contribute to an
emotionally painful death experi-
ence (Broadhurst & Harrington,
2016). Simply asking in a nonjudg-
mental manner what beliefs or prac-
220
Quiet spaces are important to allow staff and
patients a place to reflect, pray, and contemplate.
tices are important to an individual
or family is the first step in conduct-
ing an effective spiritual needs
assessment.
Quiet spaces are important to
allow staff and patients a place to
reflect, pray, and contemplate.
Nurses can cluster care to allow
patients and families to have quiet
time in their rooms, or they can
assist patients to relocate to quiet
areas in the hospital (Abu-El-Noor,
2016). Nurses who feel inexperi-
enced or need support in providing
spiritual care can seek assistance
from a hospital chaplain or relevant
community spiritual leader.
Cultural Aspects of Care
Culture uniquely influences each
patient’s attitude, behavior, prefer-
ences, and decisions. Healthcare
providers should practice cultural
humility to provide the most cul-
turally sensitive care possible at the
EOL (Aldridge et al., 2016). Some
key questions can help providers
assess cultural needs at the EOL:
“What are the cultural rituals for
coping with dying, the deceased
person’s body, the final arrange-
ments for the body and honoring
the death?” “What are the family’s
beliefs about what happens after
death?” “What does the family con-
sider to be the roles of each family
member in handling the death?”
“Who should the doctor talk to
about test results or diagnosis?”
“Are certain types of death less
acceptable (e.g., suicide) or are cer-
tain types of death especially hard
to handle for that culture?” (Mixer,
Lindley, Wallace, Fornehed, &
Wool, 2015). These questions get to
the heart of what culture means to
the individual and family. Through
assessing cultural needs, nurses can
express respect and interest in oth-
ers’ cultures, and collaborate with
patients and families to incorporate
meaningful cultural experiences
July-August 2018 • Vol. 27/No. 4
into care. Together, the healthcare
team and patient can develop
mutually acceptable care goals
(Kagawa Singer et al., 2016).
Ethical and Legal Aspects
of Care
No ethical principle may be
more important at the EOL than
the right of the patient to self-deter-
mination, also known as autonomy
(American Nurses Association, 2017).
Autonomy becomes more compli-
cated as a patient’s condition deteri-
orates, and he or she may not be
able to make decisions independ-
ently. An advance directive outlines
a patient’s healthcare wishes, partic-
ularly decisions at the EOL. A living
will, durable power of attorney for
health care, and do-not-resuscitate
order are examples of advance
directives, each with unique proper-
ties to execute a patient’s wishes
(American Cancer Society, 2015).
Encouraging all patients to create
an advance directive will help in
this gray area, but not all patients
come to the hospital with this in
place. When advance directives
have not been established and deci-
sions regarding wishes at the EOL
are unclear, particularly those that
involve withdrawing treatment, an
ethics consultation may be the best
option (Taylor, 2015).
Most hospitals are required to
have an ethics program, board, or
consultation team available as a
resource to healthcare providers
and patients. Traditionally, these
programs uphold the rights of the
patients, facilitate shared decision
making for patients and their
providers, and serve to enhance an
ethical environment. The latter
may include assisting the facility to
devise equitable, ethical policies,
particularly concerning advance
directives; withholding of treat-
ment, organ procurement; and in-
formed consent (Pearlman, 2016).
The Medical-Surgical Nurse’s Guide to Understanding Palliative Care and Hospice

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This article was reviewed and formatted for
ibilities in Providing Care and Support at the End of Life" at https://www.nursing
contact hour credit by Rosemarie Marmion,
world.org/~4af078/globalassets/docs/ana/ethics/endoflife-positionstatement.pdf MSN, RN-BC, NE-BC, AMSN Education
Director.
Fees — AMSN Member: FREE Regular: $20

Nurses can provide the patient with
as much autonomy as possible at
the EOL by remembering their roles
as patient advocates. When advo-
cating on behalf of a patient’s wish-
es is not possible, they should not
hesitate to call the ethics team for
help (Nelson et al., 2013).
Conclusion
Medical-surgical nurses with a
foundational understanding of pri-
mary palliative care principles and a
genuine desire to advocate for
patients and families can achieve
optimal care for patients with life-
limiting disease. The NCPQPC (2013)
provides a framework for delivery of
needs, medical-surgical nurses have
the opportunity to enhance quality
patient outcomes.
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