Evolution of the Palliative APRN

Question 1

Dame Cicely Saunders

Answer 1

Sure, social worker and physician.
Dedicated career to improving care of dying in England
Concept of “total pain” - physical psychosocial, spiritual, focus on whole person through expert pain and symptoms control.
Foundation of modern hospice care.
Taught at Yale

Question 2

Hospice Nurses Foundation

Answer 2

founded 1986

Question 3

Medicare Hospice Benefit

Answer 3

1982

Question 4

Medicare definition of Hospice

Answer 4

A program of care and support that focuses on comfort, not cure of illness, appropriate for terminally ill patients who have a prognosis of 6 months or less and their families.

Question 5

Palliative care

Answer 5

Balfour Mount - 1970’s

Care of patients that focuses on comfort for patients with life threatening illnesses from diagnosis to time of death

Question 6

SUPPORT study

Answer 6

Study to UnderstandPrognoses and Preferences for Outcomes and Risks of Treatment - advanced cause of palliative care.

Pervasive lack of communication about end of life care, poorly managed pain in the advanced illness, difference between stated end of life goals and continued aggressive measures.

Question 7

National Consensus Project for Quality Palliative care (NCP)

Answer 7

coalition of the HPNA, AAHPM, NHPCO and CAPC. made clinical practice guidelines for palliative care and hospice.

Question 8

NCP definition of palliative care

Answer 8

Operationalized through effective management of pain and other distressing symptoms which incorporating psychosocial and spiritual care with consideration of patient/family needs, values and preferences. Evaluation and treatment should be patient centered and focus on the family unit as he central unit in decision making. Affirms life by supporting the patient and families goals for the future including hope for a cure or life-prolongation, hopes for peace and dignity throughout the illness, dying process and death. It is interdisciplinary

Question 9

Primary Palliative Care

Answer 9

All healthcare professionals

Includes basic symptom management, communication, advanced directives.

Question 10

Specific areas of expertise for the hospice and palliative care nurse

Answer 10

Clinical Judgement
Advocacy and Ethics
Professionalism 
Collaboration
Systems thinking
Cultural Competence
Facillitator of learning
Communication.
Includes generalist and advanced practice nursing roles.

Question 11

Pioneers of APRN Palliative Care

Answer 11

Nessa Coyle and Patricia Murphy

Question 12

LACE

Answer 12

Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Palliative APRNs must have graduate education and certification in a population focus, with a subspecialty certification in palliative care.