3 Hospice Philosophy and the Role of the Nurse The original Christian perspective that Sanders infused into hospice work ensured that each life was valued until its natural end and that each person received the highest quality of care until that time came (Wright & Clark, 2012). This outlook remains the bedrock for hospice nursing. However, over time, the development of scope and standards for hospice nursing has helped clarify and delineate the role of the hospice nurse. After reading this chapter, you will be able to: ■ Define the role of the nurse in hospice and palliative care ■ Explain how patient care differs in the hospice setting ■ Identify resources for hospice and palliative nurses NURSING AND THE RELIEF OF HUMAN SUFFERING The nurse has always been a central figure in the care of dying patients. But, over the past 40 years, the role of the hospice nurse in the United States has evolved considerably. Today, the hospice nurse is expected to have demonstrable expertise not only in the nursing care of patients who are actively dying, but also in palliative interventions. Thus, the expertise of the hospice nurse is in alleviating symptoms, which aligns closely with the original goal of nursing as stated by Florence Nightingale (1860) and has been reaffirmed by the American Nurses Association (ANA) in the following statement: “the aims of nursing actions (also nursing interventions) are to protect, promote, and optimize health; to prevent illness and injury; to alleviate suffering; and to advocate for individuals, families, communities, and populations” (2010a, p. 11). HOSPICE NURSING AS A SPECIALTY AREA In 1987, the first American organization for hospice nurses, the Hospice Nurses Association (HNA), was formed. This organization later created the National Board for Certification of Hospice Nurses (NBCHN) to develop a certification process for hospice nurses (Hospice and Palliative Nurses Association, 2004). Fast Facts in a Nutshell “The goal of hospice and palliative nursing is to promote and improve the patient’s quality of life through the relief of suffering along the course of illness, through the death of the patient, and into the bereavement period for the family” (American Nurses Association/Hospice and Palliative Nurses Association, 2007, p. 1). In 1994, the first certification exam for hospice nurses was offered. Those who passed this test earned the credential CRNH (Certified Registered Nurse Hospice; Hospice and Palliative Credentialing Center, 2014a). In 1997, the HNA conducted a role delineation study and found that palliative care expertise was required of hospice nurses. Thus, in 1999, the NCBHN recognized this competency and offered the credential of CHPN (Certified Hospice and Palliative Nurse) to those who successfully completed the exam (Hospice and Palliative Nurses Association, 2004). The CRNH was retired in 2002, the same year that the credential CHPN was awarded accreditation by the American Board of Nursing Specialties (Hospice and Palliative Credentialing Center, 2014a). To more accurately represent the goals of these organizations, the HNA was renamed the Hospice and Palliative Nurses Association. Question: Why should nurses become certified in hospice and palliative care? Answer: Certification helps nurses: ■ Demonstrate competency in pain and symptom management ■ Improve end-of-life outcomes ■ Validate nursing expertise ■ Demonstrate a personal commitment to quality end-of-life care (Hospice and Palliative Credentialing Center, 2014b)
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