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The Hospice Nurse as a Member of the Interdisciplinary Team
Hospice care is a holistic approach to the care of terminally ill patients and their families. Patients who are facing end-of-life issues have multidimensional needs and require the expertise of a team of professionals who work together to develop an individualized, comprehensive plan of care. This chapter reviews the roles of members of the hospice team and discusses the role of nurse as a team member.
After reading this chapter, you will be able to:
■ Identify members of the interdisciplinary team and their functions
■ Explain how the hospice team collaborates to develop a plan of care
■ Discuss the role of the nurse within the interdisciplinary team
WHO’S ON THE TEAM?
First and foremost, the patient and family are the captains of the team. In every situation, the patient determines which care options are most in line with his or her end-of-life wishes. Within this context, the professionals on the hospice team, taking their lead from the patient and family, develop a plan of care that is specifically tailored to each patient. The Centers for Medicare & Medicaid Services (2015) outlined the services covered by members of the hospice team, including:
■ Nursing care: These services “require the skills of a registered nurse (RN), or a licensed practical nurse (LPN) or a licensed vocational nurse (LVN), under the supervision of an RN, and must be reasonable and necessary for the palliation and management of the patient’s terminal illness and related conditions” (p. 19).
■ Medical social services: These services include assessment of the social and emotional factors related to the patient’s terminal condition; assessment of the patient’s medical and nursing needs, home situation, financial resources, and community resources; counseling services; and short-term social services for family members or caregivers with the goal of removing impediments to the provision of effective end-of-life care.
■ Physician services: Within the interdisciplinary team, the hospice medical director must be prepared as either a doctor of osteopathic medicine (DO) or a medical doctor (MD). The hospice medical director must verify the patient’s terminality and oversee medical care. The hospice medical director may complete the face-to-face visits intended to verify continued eligibility for hospice. The medical director may also serve as the attending physician for a hospice patient. The attending physician has “the most significant role in the determination and delivery of the individual’s medical care” (p. 21). In some cases, a nurse practitioner may serve as the attending physician. The nurse practitioner must be employed by the hospice and the patient must have the option to receive care from a physician or a nurse practitioner. Nurse practitioners cannot certify or recertify terminality or prognosis.
■ Counseling services: These services include the provision of emotional, psychosocial, and spiritual support for the patient and family. Bereavement counseling is also provided for the family for up to 1 year following the death of the patient.
■ Hospice aide and homemaker services: Hospice aides provide personal care services as well as household services as needed to maintain a safe and clean environment for the patient. The hospice aide is assigned and supervised by the RN.
■ Physical therapy, occupational therapy, and speech therapy: These services are “provided for purposes of symptom control or to enable the individual to maintain activities of daily living and basic functional skills” (p. 25).
Fast Facts in a Nutshell
The hospice interdisciplinary team addresses the biomedical, psychosocial, and spiritual care of the patient (Moore, Bastian, & Apenteng, 2015).
THE ROLE OF THE NURSE ON THE TEAM
Nursing education prepares nurses to work primarily in acute care settings and many hospices require a nurse to have at least 1 year of acute care experience prior to employment. Acute care experience is beneficial because, in hospice care, the nurse is alone in the patient’s home and is expected to make decisions quickly and autonomously. However, working closely with all members of the interdisciplinary team on each case may be an adjustment for some nurses who have transitioned from the acute care environment.
Fast Facts in a Nutshell
