Practice Tip of the Week: Pain Management, Suffering, and Palliative Care
Tuesday, November 14, 2017
Posted by: Nadia Tamez-Robledo
By Ellen Martin, PhD, RN, CPHQ
Director of Practice
Texas Nurses Association
An essential role of nurses is the relief of suffering. Palliative nursing emphasizes a holistic philosophy of care and services for patients and families with serious, life threatening illness. The Palliative Nursing Scope and Standards of Practice describes the essence of palliative nursing as attending to the patient's physiological, psychological, social and spiritual aspects of care. Competency-based palliative nursing practice emphasizes expert assessment skills, comprehensive pain and symptom management, and interdisciplinary teamwork. In July 2017, Medscape featured a Perspective: Nursing Roles article on palliative care nursing: What’s it like to be a Palliative Care Nurse?
There are many models of palliative care delivery in the US including hospice care, inpatient palliative care services, and outpatient clinic models. The Medicare Hospice Benefit covers over 80% of the hospice care in the US. In Texas, 45-50% of Medicare decedents died while receiving hospice care according to 2016 statistics.
With the recent focus on the opioid epidemic in the US, part of the national conversation is how do we ensure that efforts to address the issues of non-therapeutic use of opioids without negatively impacting patients with painful health conditions, especially vulnerable patients with life-limiting illness. This is an ethical dilemma of great concern to nurses. Off the Charts, the American Journal of Nursing blog, has an outstanding collection of articles on pain management and bioethics.
The Texas Health and Human Services Palliative Care Interdisciplinary Advisory committee is developing an informational website on palliative supportive care. Please check back as the content is continuing to be added. On October 23rd the committee had a CME/CNE event that was attended by hundreds of people across the state who attended by webcast and several attended in person. The presentations were recorded and will be posted on the website at some point in the future.
The nature of suffering and the goals of nursing by Betty Ferrell and Nessa Coyle uses narrative data from patients, family caregivers, and nurses to describe the fundamental role of nurses in caring for those who suffer. The authors describe 10 tenets of suffering, which is associated with intense emotions and spiritual distress, and difficulty expressing their experiences and feelings of loss. The goals of nursing in this practice area include listening and presence as well as physical care of the patient.
Palliative Care Resources
Center to Advance Palliative Care
National Hospice and Palliative Care Organization Palliative Care Resources (Includes a free download, FINDING CALM IN THE STORM: A PALLIATIVE CARE APPROACH TO NAVIGATING THE FAMILY MEETING)
The Schwartz Center for Compassionate Healthcare