To the Editor:

I thoroughly enjoyed reading the article entitled "What Are the Potential Factors That Sustain Registered Nurses Who Provide Home-Based Palliative and End-of-Life Care?" by Kelly Penz published in the September/October 2008 edition of the Journal of Hospice & Palliative Nursing. Many pertinent issues regarding the sustenance and recognition of palliative care nurses were discussed. The author also proposed a vast array of areas where further research should be conducted to enhance the contributions provided by this unique group of caregivers. Two points in the article regarding the importance of team collaboration and the establishment of professional identity stood out as essential factors to the success of a palliative care organization.

As a student, I recently spent time with a local hospice organization, visiting patients and obtaining a glimpse of the work a hospice nurse performs. As an outsider, observing the practices and dynamics of this facility and its staff, I was able to witness the importance of a collaborative approach to palliative caregiving. Time was devoted, in a group setting, to supporting each member of the care team for the emotional losses they suffer because of the very nature of the work they have dedicated themselves. Then individual patients were discussed to determine the proper focus and direction of treatment. Contributions by nurses, social workers, and the facility's physician gave each member of the specific patient's case insight into how to assess the patient's response to treatment and indications on how to move forward with care.

Research done by Wittenberg-Lyles et al1 in 2007 found that although many hospice agencies are conducting regular collaborative meetings regarding their patients, not all are using the time to truly enhance the care they are providing. They found that meetings are not routinely attended by all discipline members and time is frequently devoted to issues regarding policy and agency dynamics over discussion of the patients themselves. While these issues are pertinent to an agency's function, interdisciplinary meetings need to be separate and focused if they are to produce their intended effect of enhanced patient care.

It has been my experience when discussing hospice care with people outside the healthcare field that there is a misunderstanding about the specific focus of palliative treatment. Furthermore, it is not always clear what role the nurses play in that care or the extent of their ability to assess and suggest interventions. The notion that palliative care is strictly the suspension of further medical treatment and the nurse is present simply to exercise the "historical virtues" mentioned in the article must be corrected. I agree that competent and confident nurses displaying their clinical knowledge along with the essential expressions of caring and comfort can accomplish this. However, the ability to effectively express the knowledge can only be achieved with a dedication to continuous training and education. If the nurses are unwilling or unable to devote time to broadening their educational foundation, their professional integrity will be limited by their personal knowledge deficiencies.

It became clear to me in my observations that hospice and palliative nurses possess special qualities that allow them to provide care in times of suffering and death. The factors described in the article are beneficial not only to the nurses working in this environment but also to all nurses because the potential for end-of-life care is always a possibility. As students, we need to understand the broad range of service our future discipline encompasses.

Thank you for this opportunity to discuss the information presented in the article.

Andrew T. Schultheis

is a BSN student at Saint Anthony College of Nursing

Rockford, IL

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