The Role of Advanced Practice Nursing in Palliative Care

Katherine Yeager, PhD, RN

Research Assistant Professor

With the aging of the US population, the number of seriously ill patients with complex conditions is expected to rise.

These demands on the healthcare system require consideration of new care models to improve coordination, continuity, access, and quality of care. Palliative care is a model of care that has been shown to improve patient satisfaction and reduce the use of acute care services,¹ expanding traditional disease-model medical treatments to include the goals of enhancing quality of life for patient and family, optimizing function, and helping with decision-making. It is both a philosophy of care and an organized, highly structured system for delivering care.

The model includes effective management of pain and other distressing symptoms, while integrating psychosocial and spiritual care according to patient/family needs, values, beliefs, and culture(s). Evaluation and treatment is comprehensive and patient-centered, with a focus on the central role of the family in decision-making.

Palliative care affirms life by supporting the patient and family’s goals for the future, including their hopes for cure or life prolongation, as well as their hopes for peace and dignity throughout the course of illness, including the dying process and death.

Availability of Palliative Care Services

The need for additional palliative care services is expected to increase as the public becomes more aware of its benefits. Recent research by the polling firm Public Opinion Strategies reveals that even for those individuals who are unfamiliar with palliative care, once they understand what it is, 92% report they would be highly likely to consider palliative care for themselves or their families if they had a serious illness.²

Fortunately there has been significant growth in the number of palliative care programs over the past decade, but much work is still needed. Much heterogeneity remains in the infrastructure and delivery of palliative care in US cancer centers. Many of these programs are limited to providing inpatient consultation services, and only a few centers have a palliative care unit. Fewer than half of cancer centers offer palliative care outpatient services, which are key because of their potential to promote early access to integrated care.³

The Role of the Advanced Practice Nurse

With the increasing need for palliative care services, advanced practice nurses (APRNs) are well suited to play a pivotal role in this area. APRNs who have specialty preparation in palliative care through education and/or clinical practice function as palliative care experts in the clinical specialist or nurse practitioner roles.⁴ Certification as Advanced Practice Hospice and Palliative Nurse (ACHPN®) is available through the National Board for Certification of Hospice and Palliative Nurses. The value of the advanced practice palliative nursing role extends beyond specialized and expanded knowledge, critical thinking, and evidence-based practice to enhanced communication skills that facilitate direct patient care through informed decision-making, patient and family education, and psychosocial-spiritual care. The presence of APRNs in diverse care settings broadens access to palliative care.

In addition, palliative care offers an ideal setting for nursing leaders. Nurses have the communication skills necessary to engender trust and draw patients and their families into a partnership of care. Their commitment to quality and safety motivates them to continuously improve the care they provide and make valuable contributions to the interdisciplinary team.

Preparing Nursing Leaders

With an investment from the Helene Fuld Health Trust, Emory’s Nell Hodgson Woodruff School of Nursing, in collaboration with the Emory Palliative Care Center, has launched the Fuld Palliative Care Fellowship program to develop nurse leaders in palliative care, an emerging—and necessary— clinical paradigm. These specialized nurse leaders will be prepared to work interprofessionally to ensure high-quality outcomes for seriously and chronically ill patients and their families, develop new models of care, and shape public discourse and policy.

Situated in a fully interdisciplinary environment, this intensive, leadership-focused program augments the Accelerated Bachelor of Science in Nursing/Master of Science in nursing program (ABSN-MSN) curriculum with mentor-directed projects, consultations with palliative care leaders, simulations, certifications, and other targeted learning opportunities. Fellows will work in partnership with more than 30 palliative care clinicians in Emory’s nationally recognized Palliative Care Center. The school of nursing brings faculty expertise in cancer care, caregiver research, gerontology, HIV-AIDS, chronic disease management, systems development, and religion and spirituality to the partnership. Fellows will be fully prepared to step immediately into palliative care nursing positions and to quickly assume leadership positions to direct this emerging field.

“The Fuld Palliative Care Fellowship program is vitally important to preparing our students to be clinical leaders in delivering palliative care,” says Carolyn Clevenger, Clinical Associate Professor, Nell Hodgson Woodruff School of Nursing and coordinator of this program. “This fellowship program will serve as a national model for preparing nurses to be leaders in specialized areas. Advanced practice nurses are key members of palliative care teams, and the specialized training offered in this program will only increase APRN contribution to high-quality care to patients in this important setting.”

As our population ages and our healthcare system changes, nurses can serve in many roles to fill gaps and provide excellent care.

References

• Deitrick LM, Rockwell EH, Gratz N, et al. Delivering specialized palliative care in the community: a new role for nurse practitioners. ANS Adv Nurs Sci. 2011;34(4):E23-E36.
• Center to Advance Palliative Care. Get Palliative Care for Policymakers. http://www.getpalliativecare.org/resources/policymakers/2014. Accessed February 26, 2014.
• Hui D, Elsayem A, De la Cruz M, et al. Availability and integration of palliative care at US cancer centers. JAMA. 2010;303(11):1054-1061.
• Meier DE, Beresford L. Advanced practice nurses in palliative care: a pivotal role and perspective. J Palliat Med. 2006;9(3):624-627.