Page 405 - Encyclopedia of Nursing Research

372 n PAllIATIve CARe

confirmed the high reports of pain among Saunders, a nurse who later became a social
dying patients (more than 50%), the clini- worker and physician, is credited with open-
P cians’ lack of training in pain manage- ing Saint Christopher’s Hospice in london
ment, and the institutional limitations on where she championed the need for a multi-
the delivery of pain-control interventions. disciplinary approach and around-the-clock
In addition, the SUPPORT data confirmed administration of opioids when caring for
that patients’ end-of-life treatment prefer- dying patients. Her approach to care focused
ences, whether written or verbally commu- on comfort, skilled nursing, family counsel-
nicated to nurses or family members, were ing, physical therapy, and addressing spiri-
often ignored by physicians or were other- tual needs. These fundamental elements of
wise ineffective in furthering the autono- care characterize quality palliative care. The
mous choices made by patients (SUPPORT hospice model serves as the gold standard for
Principal Investigators, 1995). offering the best end-of-life care to patients
In palliative care, death is also viewed and their families; palliative care found its
as an outcome measure for improving end- roots in the hospice movement. The World
of-life care. The IOM’s (1997) report provided Health Organization (2002) defines palliative
some conceptual benchmarks from which care as an approach that improves the qual-
quality outcome indicators can be developed. ity of life of patients and families who face
A “good death” was defined as one free from life-threatening illness by providing pain
avoidable stress and suffering for patients and symptom relief, spiritual and psychoso-
and families and caregivers, in general accord cial support to from diagnosis to the end of
with patients’ and families’ wishes, and rea- life, and bereavement.
sonably consistent with clinical, cultural, and Newer models of palliative care address
ethical standards. In contrast, a “bad death” both disease-specific therapies as well as
was one in which there was needless suffer- supportive-comfort therapies that pro-
ing, disregard for patients’ or family’s wishes mote the optimal function and well-being
or values, and a sense among participants or of patients and their family caregivers. The
observers that the norms of decency had been Canadian Palliative Care Association’s (1995)
offended. This is the challenge of nurses and model documented how palliative care needs
all health professionals in the twenty-first intensify at the end of life. The core issues of
century. palliation, comfort, and function are salient
Two reports that followed, Improving throughout the course of disease. A palliative
Palliative Care for Cancer (IOM, 2002a) and care model recognizes the need to address
When Children Die: Improving Palliative and End symptom distress, physical impairments,
of-Life Care for Children and Their Families (IOM, and psychosocial disturbance even during
2002b), continued the argument that medical the period of aggressive primary therapy
and other support for people with fatal or with goals of cure or the prolongation of life
potentially fatal conditions often fall short of (NCP for Quality Palliative Care, 2009).
what is reasonable, if not simply attainable. Definitions of palliative care have
The IOM report highlighted the inadequacy evolved based on the work of the NCP for
of current knowledge to guide the practice of palliative care (NCP for Quality Palliative
clinicians in end-of-life care and the need for Care, 2009). Palliative care and hospice pro-
support from policy makers. grams have grown in the United States in
The hospice concept originated in the response to a population living with chronic,
Middle Ages when pilgrims traveling to the debilitating, and life-threatening illness and
Holy land found their minds and bodies to clinician interest in effective approaches to
restored when they stopped at way stations providing care. In 2004, five major palliative
attended by religious orders. Dame Cicely care organizations led an NCP for Quality