I have been a registered nurse at UCLA for 18 months. One particular issue that has captured my attention is the utilization of palliative care in health care. Because nurses are generally at the bedside all the time, they have an important role to play in voicing the importance of its utilization and implementation in the patient’s care.
In 2003, the American Nurses’ Association published a position statement regarding “Pain Management and Control of Distressing Symptoms in Dying Patients.” The organization states:
In the context of the caring relationship, nurses perform a primary role in the assessment and management of pain and other
distressing symptoms in dying patients. Therefore, nurses must use effective doses of medications prescribed for symptom control
and nurses have a moral obligation to advocate on behalf of the patient when prescribed medication is insufficiently managing pain
and other distressing symptoms. The increasing titration of medication to achieve adequate symptom control is ethically justified.
I would like to expand this idea from what appears to be an end-of-life hospice position to the broader based idea of palliative care. My experience in both the medical-surgical and the intensive care settings have left me with the feeling that this specialty is often overlooked and underutilized in the acute care setting. It is generally believed that palliative care is the same thing as hospice or that a patient must stop aggressive treatment in order to receive it. Many of my colleagues, including physicians, have a preconceived notion that if palliative care is involved, it usually means the patient will be placed on an end-of-life protocol with a morphine drip. This could not be further from the truth.
The reality is that palliative care focuses on symptom management for individuals who deal with chronic illness. These symptoms can either manifest themselves as pain, anxiety, dyspnea, and/or delirium. It is a reprioritization of the patients, as well as their families’, preferences regarding their plan of care. The inclination is to optimize the patient’s quality of life by reducing the amount of suffering they experience with their chronic illness (e.g. COPD, cancer, autoimmune disorders).
Hospice is a component of palliative care. A person does not necessarily have to be dying in order to see a palliative care specialist. This is where the service is often underutilized in the hospital. In the 18 months I have been a nurse, I have cared for many patients with chronic illnesses who have dealt with symptoms that have severely...