BACKGROUND

This document is a revision of the 2001 position statement developed by nurse leaders in the field under the sponsorship of Promoting Excellence in End-of-Life Care and the Robert Wood Johnson Foundation.1

America has moved into the twenty-first century, and the healthcare crisis surrounding how people die continues. At the beginning of the twentieth century, people died at younger ages of acute illnesses cared for by family and friends in the home setting. By comparison, Americans now live longer. This longer life span often means living with chronic illness that ultimately leads to declining quality of life and increasing healthcare use and cost as health problems worsen, however. The burden on families grows as they cope with the demands of caregiving and complex healthcare regimens. Although most Americans state that they would like to die at home, more often than not, death occurs in hospitals and nursing homes.2 Access to high-quality palliative care can address this crisis in healthcare.3

The National Quality Forum's endorsement of a National Framework and Preferred Practices for Palliative and Hospice Care Quality, based in part on the 2004 National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care, establishes both the standard for access to and provision of high-quality palliative care.4,5 Although these guidelines reflect a multidisciplinary interest and concern about improving care at the end of life, the nursing profession is particularly well suited to these efforts. Nurses, by virtue of their education and scope of practice, promote the principles of palliative care in all settings. The goal of palliative care is to achieve the best possible quality of life through relief of suffering, control of symptoms, and restoration of functional capacity while remaining sensitive to the personal, cultural, and religious values, beliefs, and practices of patients and families.5,6 This is similar to the goal of nursing: to assist patients to attain, maintain, or restore health or experience a dignified death.7

Nurses are essential providers in every practice setting in which patients receive care and eventually die. Nursing is based in the principles of the biological, physical, behavioral, and social sciences and focuses on the diagnosis and management of human responses to actual and potential health problems. Nurses use critical thinking to assess patients and apply the best available research and evidence to maximize quality of life across the life span.7 APNs are uniquely qualified and positioned to address the myriad needs facing individuals who have life-limiting, progressive illness. Although collaboration with other providers (eg, physicians and social workers) must occur to attend to these vulnerable patients, APNs have the knowledge and clinical judgment to provide primary palliative care in all settings. APNs who have specialty preparation in palliative care through education or clinical practice function as palliative care experts.

APNs are situated to model optimal palliative care, not only to nursing colleagues but also to all members of the interdisciplinary healthcare team and to assume leadership roles in education, practice, research, and public policy arenas.7,8

POSITION STATEMENT

It is the position of the HPNA Board of Directors that APNs represent a valuable resource in national efforts to improve care and quality of life for all Americans and their families living with advanced, life-limiting illness and conditions. To maximize use of this resource and improve access to high-quality palliative care, leaders in the clinical professions, nursing educators, health service providers, healthcare payers, and public policy advocates are urged to continue to pursue the following actions:

* Professional associations in nursing, medicine, hospice, and palliative care are called on to support and further the APN role in palliative care.

* Nursing educators must become knowledgeable about palliative care and expand the following areas:

- Continuing education to prepare and develop existing APNs in palliative care competencies across all settings

- Integration of core palliative care competencies into the education of all APN students regardless of role or degree

- Academic and clinical programs fro APN students who intend to specialize in palliative care

* Payers of health services are called on to recognize the specialty of palliative care and provide APNs with adequate and consistent compensation and reimbursement that is commensurate with APN scope of practice, authority, and responsibility, regardless of practice setting and specialty/subspecialty.

* Individual state boards of nursing are called on to work collaboratively to consistently recognize APN scopes of practice and privileges regardless of specialty/subspecialty.

* Health systems or health service providers are called on to develop or expand palliative care practice opportunities for APNs across all settings.

* APNs who practice in palliative care are requested to document and disseminate the outcomes of their practice experience and roles, participate in interdisciplinary research and its publication, and translate research findings into practice.

* APNS who practice as specialists in palliative care are encouraged to seek certification in their specialty through the National Board for Certification of Hospice and Palliative Nurses (NBCHPN) and mentor a new generation of palliative care APNs.

DEFINITION OF TERMS

Palliative care: Both a philosophy of care and an organized, highly structured system for delivery of care focused on the prevention and relief of suffering and the best possible quality of life for patients and their families. The key element of palliative care is that it is patient and family-centered, comprehensive, interdisciplinary care appropriate for patients of all ages who are experiencing debilitating chronic or life-threatening illness, condition, or injury from diagnosis through cure or death and into the family's bereavement period.5

APN: A nurse who has earned a graduate level degree in nursing and is prepared to exercise independent judgment, synthesize complex assessment data, initiate care plans and treatment regimens, and evaluate healthcare environments. The APN demonstrates advanced specialized clinical knowledge and skills.8,9

References