Hospice and Palliative Care: What Is the Nurse's Role?

NursingMay 06, 2014

Like doctors, nurses are trained to help people heal from their illnesses and injuries and to focus on facilitating a cure. But sometimes, a cure is no longer an option, and the focus of care shifts to comfort measures, or what is called palliative care. Hospice and palliative care focus on the physical, emotional and spiritual needs of a patient facing a life-threatening illness. And it's a specialty where nurses really get to use their strengths as caregivers.

Treat the Symptoms

When a doctor recommends hospice because a patient has a prognosis of six months or less to live, besides the fear of dying, a person's greatest concern is avoiding pain. Not only is there a great possibility of physical pain, but other symptoms may arise from chronic or acute illnesses such as nausea, diarrhea, respiratory difficulties and severe anxiety. Palliative care means keeping these symptoms in check without oversedating the patient. It's a fine balance, but hospice nurses excel at doing this on a day-to-day basis. They are true experts when it comes to titrating pain medication to get maximum results with minimal side effects.

Hospice and palliative care nurses also specialize in educating the patient and families about the use of narcotics, addressing their fears about sedation and addiction. You'd be amazed at how many people are concerned with addiction — even with end-stage cancers. Nurses also educate their patients and families about new ideas in symptom management, such as using seizure medications to help treat nerve pain. The educational aspect of your role may even extend beyond your patients and families. As a nurse, you usually won't experience much difficulty in getting your hospice doctors on board with a recommended treatment, but if you have to go to an outside primary physician, you'll also have to educate the doctor regarding progressive methods of symptom management.

Lean on Me

Physical symptoms are just one aspect of hospice and palliative care. This specialty prides itself in providing holistic patient care more than any other. Nurses will often find themselves spending as much time — and sometimes more — acting as the emotional support for their patients rather than addressing medical needs. Emotions and stress run high with the shock of a terminal diagnosis and the harsh reality of facing death. Don't be surprised if some of your patients lean on you for support and advice more than their families — or even turn to you for spiritual support, despite the availability of chaplains.

All in the Family

Not only will the patient often turn to you to be their emotional rock, but don't be surprised if the whole family does the same. In times like this, you'll often find that neither the patient nor the family want to burden each other with their fears or ask tough questions about how much time they have left. ( And you will get asked that a lot.) You will become a family counselor in many cases.

Many people ask hospice nurses how they can do the job they do without becoming depressed. Hospice can be one of the most rewarding specialties in nursing, as you help people die with comfort and dignity, providing their families with peace of mind.

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