What is the Future of Palliative Care Nursing?

An open door for palliative care nursing

The future of palliative care nursing is a relevant question for registered nurses, especially for those newly trained and beginning their careers during difficult economic times. To respond to the question appropriately, be aware of what palliative care nursing entails.

What is palliative care?

The word palliate originated in the year 1588 AD, with the Latin word pallium, meaning to cloak or to conceal. In medical terms, palliation refers to the moderation or abatement of the intensity of a disease or illness, as its severity is reduced. (1)

Palliative care nursing is nursing care administered to terminally ill patients in hospitals, nursing homes, private homes and hostels. Palliative care nurses are trained to take care of dying patients, in a way that relieves them of their symptoms, as much as possible, when it becomes evident that an illness or disease cannot be cured. For many terminally ill patients, this entails long term nursing care.

If there is just one word that is used to describe palliative care nursing, it is compassion. Terminally ill or dying patients are kept as comfortable as possible, through nursing care, concern and compassion of palliative care nurses, who are highly specialized and able to provide advanced levels of professional care for their patients.

Some registered nurses take specific courses in palliative care nursing. Many have previous experience in doctor's offices, private duty nursing or one-to-one care. Others come from medical or surgical nursing backgrounds. Palliative care nurses have a high degree of expertise in specialty areas like emergency, intensive care or step-down units. Some palliative care nurses are highly specialized in pediatric palliative care.

Palliative care nurses frequently enroll in university or college courses, like death and dying, religious studies or philosophy. Questions related to death and dying are important to terminally ill patients, regardless of their background or culture. Each culture has its own unique understanding of topics like the meaning of life and death, how to prepare for death, what happens at the time of death or when a person passes away. Many palliative care nurses minister to dying patients with regard to their spiritual needs.

A large majority of palliative care patients are cancer patients. This means that they may have to undergo surgery, chemotherapy, radiation or other medical treatments. The physicians, palliative care nurses and other care givers, work together as palliative care teams.

Many palliative nurses have training as professional counselors. Counseling skills are needed for palliative care nursing, as patients and family members have difficulty coping with terminal illness or the remission of an illness. What happens when a patient and his or her family expect the patient to die and then the patient lives? This can happen.

Often palliative care patients require special medications, treatments or procedures. Palliative care nurses administer medication regularly to people in severe pain. Medication may be by intravenous therapy, injections, sublingual, dermal, oral or rectal administration. Narcotics are also given. Patients may become addicted to them or other kinds of painkillers and thus, drug addiction counseling is needed.

Many palliative care patients are frightened by the treatments and procedures that they have to undergo. Many are too ill to live and yet, they are afraid to die. Many dying patients cling desperately to life, even while they watch their lives slipping away. They realize their inability to control what is happening in their lives.

Dying patients may find that their families are not supportive. There are mixed feelings of hopelessness and helplessness. Palliative care nurses assist patients and families to cope with these kinds of scenarios. Patients experience mood swings and depression, as a result of transitions in inter-personal relationships. Registered nurses, assuming the responsibility for the care of palliative patients, assist them and their families in numerous ways.

Many times, terminal illness involves serious financial concerns or legal matters. Long term nursing care is costly and ongoing financial assistance is often required. Legal counsel may be needed to resolve non-nursing issues like power of attorney, wills or estate settlements. Palliative care nurses assist patients and families to obtain proper assistance.

For younger nurses, who are seeking direction in their nursing careers, palliative care nursing is a legitimate pathway to pursue. Palliative care nursing can be difficult for young nurses emotionally, as they tend to be idealistic and have the expectation of having the patients they care for, live and not die. Coping with death and dying is never easy for any nurses, but death is a reality that must be dealt with in palliative care nursing.

Obtaining experience in multiple areas of nursing, before specializing in palliative care nursing is a good idea for new nurses. The expectations and demands on nurses are extremely high, particularly when the terminally ill patients are cared for at home. Palliative care nurses often have to work alone without the guidance, support or assistance of other nurses. Palliative care is a more realistic direction for older, more experienced registered nurses.

Many palliative care nurses relate well to people and love their patients. Palliative care patients and their families can become dependent on their nurses and become attached to them, because of the high levels of compassion and concern they demonstrate. Palliative care nurses focus on quality care nursing and are excellent nurses with outstanding inter-personal relationship skills.

Many families are appreciative of palliative care nurses, but there may be instances where fear, anger and frustration are projected onto palliative care nurses. People perceive nurses as being able to save the lives of others, but unfortunately that is not always possible. Some people do not comprehend or appreciate the kind of care that palliative care nurses give. Patients or family members may refuse treatments recommended by physicians, as well as the care given by palliative care nurses, because of utter despair.

What is the future of palliative care nurses?

In conclusion, one must suggest that palliative care nurses are needed, because people will always require compassion, concern and quality nursing care, when they are terminally ill. More palliative care nurses should be trained, in the future. The horizon for palliative care nursing is wide open for registered nurses, who choose to pursue this direction in nursing.

(1) Webster's Ninth Collegiate Dictionary, Merriam-Webster Inc., Springfield, Mass., 1983