Page 406 - Encyclopedia of Nursing Research

PAllIATIve CARe n 373

Palliative Care (2004, 2009) to improve the and syndromes regardless of their underly-
quality of palliative care in the United ing condition. To decrease patient and fam-
States. efforts resulted in “Clinical Practice ily suffering at the end of life and improve P
Guidelines for Quality Palliative Care.” symptom control, in-hospital programs are
The guidelines were organized into eight adopting a palliative care model that offers
domains of care and aim to promote qual- comprehensive care for seriously ill patients
ity and reduce variation in new and existing and their families.
programs, to develop and encourage conti- Technologies that sustain life by artifi-
nuity of care across settings, and to facilitate cial means have increased our ability to pro-
collaborative partnerships among palliative long life, yet they have raised many moral,
care programs, community hospices, and ethical, and legal dilemmas for Americans.
other health care settings. Fundamental pro- Some bioethicists contend that the real
cesses that cross all domains include assess- political struggles of the twentieth century
ment, information sharing, decision making, have not been over legal rights, but over con-
care planning, and care delivery. Developers trol in the “way” individuals live their lives.
incorporated established standards of care Supreme Court rulings regarding the right
from Australia, New Zealand, Canadian, the to abortion, to die or cause death, to make
Children’s Hospital International, and the family decisions, to live, to control one’s
National Hospice and Palliative Care orga- own body, to health care, to refuse hydra-
nizations. Studies will be needed to evalu- tion, and to self-determination are examples
ate the usefulness of the guidelines to foster of health care issues brought forth in the last
access to care; continuity across settings, few decades (Annas, 1993, 1995; Matzo &
such as home, residential, hospital, and hos- Hijjazi, 2008).
pice; development of national benchmarks views toward death and dying in
for care; uniform definitions that assure American culture continue to change at a
reliable quality care and encourage perfor- relatively consistent pace as evidence is com-
mance measurement; and quality improve- piled documenting the need to improve the
ment initiatives for palliative care services. care of the dying and their families. This
Factors that have contributed to the pal- challenge to nurses and nurse educators is a
liative care movement in the United States formidable one in the decades ahead. Nurses
include the growing aging population, the leading the field need advanced education in
assisted suicide debate, the reduced patient palliative care. All nurses need to know when
autonomy, and the inappropriate end-of-life the services of an interdisciplinary specialist-
care (i.e., overtreatment of medical conditions level palliative care team are indicated and
and undertreatment of pain and depression). how to access them. They need to be aware of
Quality outcomes of good palliative care evidence-based clinical practice guidelines
ensure that patients’ values and decisions in palliative care and how to implement and
are respected; comfort is a priority; psycho- evaluate them to achieve desirable patient
social, spiritual, and practical needs will be and family outcomes.
addressed; and opportunities will be encour- Nurses are an essential voice in these
aged for growth and completion of unfin- discussions in their roles as patient and fam-
ished business (NCP for Quality Palliative ily advocates, clinicians, leaders, health care
Care, 2009). policy makers, educators, and as research-
Research results indicate that there is ers. education in the legal, moral, and ethi-
an overwhelming need for improved symp- cal principles and decision-making models
tom management at the end of life for both are essential for nurses to have an impact in
adults and children. Patients at the end-of- determining the quality of care offered to
life experience many of the same symptoms individuals at the end of life and empowering