HOSPICE/PALLIATIVE CARE NURSES
hospice movement has evolved in the United States over the past 25 years.
The focus of hospice care is on comprehensive physical, psychosocial,
emotional, and spiritual care to terminally ill persons and their families.
Hospice providers promote quality of life by protecting patients from
burdensome interventions and providing care at home, whenever possibly, instead
of the hospital. Hospice nurses provide care primarily under the guidelines of
the Medicare Benefit Act of 1983, a federal program that allows patients to die
in their homes with their families and friends at their side.
care, the more recent area of specialization, is defined by the Last Acts Task
Force (1999) as the “comprehensive management of the physical, psychological,
social, spiritual, and existential needs of patients, particularly those with
incurable, progressive illness. The goal of palliative care is to help them
achieve the best possible quality of life through relief of suffering, control
of symptoms, and restoration of functional capacity, while remaining sensitive
to personal, cultural and religious values, believes and practices”.
care that both hospice and palliative care nurses provide is essentially the
same as demonstrated by the Hospice and Palliative Nurses Role Delineation
Study. However, hospice and palliative care nurses differ in their preparation
and practice settings.
and palliative care nurses work in collaboration with other health providers
(such as physicians, social workers, or chaplains) within the context of an
interdisciplinary team. Composed of
highly qualified, specially trained professionals and volunteers, the team
blends their strengths together to anticipate and meet the needs of the patient
and family facing terminal illness and bereavement.
and palliative nurses distinguish themselves from their colleagues in other
nursing specialty practices by their unwavering focus on end-of-life care.
Hospice and palliative care includes 24-hour nursing availability, management of
pain and other symptoms, and family support. By providing expert management of
pain and other symptoms combined with compassionate listening and counseling
skills, hospice and palliative nurse promote the highest quality of life for the
patient and family.
of the setting, hospice and palliative nurses strive to achieve an understanding
of specific end-of-life issues from the perspective of each patient and his or
her family. To accomplish this,
nurses collaborate in a cultural assessment of the patient and family and
provide culturally sensitive care.
and palliative nursing is not only practiced at the bedside. Nurses, consistent
with their individual educational preparation, experience and roles, promote the
highest standards of end-of-lie care through community and professional
education, participation in demonstration grants, and in end-of-life research.
As society’s needs change and awareness of the issues surrounding the end of
life increases, nurses are called to advocate for the terminally ill and their
families through public policy forums, including the legislative process.
the majority of hospice and palliative care nurses are “generalists” some
elect to sub-specialize (for example, in oncology, pediatrics, or geriatrics)
and pursue advanced practice credentialing.
Both the hospice and palliative care nurse have a similar knowledge base.
Certification for nurses practicing in hospice and palliative care as a Certified Hospice and Palliative Nurse (CHPN) has been available
since 1999, following the initial development of the Certified Nurse Hospice (CRNH) in 1994. The certification process
reflects a competency basis for the evaluation of an individual’s practice and
is not an advanced certification.
nurses typically practice in the homes of terminally ill persons and their
family caregivers; however, some also work in in-patient hospice units.
Hospice nurses also visit patients who are enrolled in hospice and living
in a variety of long-term care settings (e.g., nursing homes, foster care,
assisted-living). On average, hospice patients usually die within a month of
enrolling in the hospice program. Palliative
care nurses typically practice in non-home settings including hospitals, nursing
homes, and rehabilitation units and they treat patients with longer prognoses.
is a distinct body of knowledge with direct application to the practice of
hospice and palliative care nursing. This includes: pain and symptom management;
end-stage disease processes; psychosocial, spiritual, and culturally sensitive
care of patients and their families; interdisciplinary collaborative practice;
loss and grief issues; patient education and advocacy; bereavement care; ethical
and legal considerations; communication skills; and awareness of community
and palliative nurses are registered nurses prepared at the associate- degree,
baccalaureate-degree, and/or master’s-degree level (there are currently two
master’s degree programs that focus on hospice/palliative care – New York
University (New York, NY) and Ursuline College (Pepper Pike, OH).
A small percentage of hospice and palliative nurses hold a doctoral
and palliative care nurses salaries are comparable to those of other registered
nurses. If the individual holds an
advanced practice degree, his or her salary is comparable to that of nurse
Hospice and Palliative Nurses Association (HPNA)
One Penn Center West Suite 229
Pittsburgh, PA 15276-0100