Constance Dahlin and Patrick J. Coyne
1. Lynch M , Dahlin C , Hultman T , Coakley E. Palliative care nursing—defining
the discipline? J Hospice Palliat Nurs . 2011; 13(2): 106–11.
2. Dahlin C , Lynch M. Evolution of the advanced practice nurse
in palliative care. In: Dahlin CM , Lynch MT , eds. Core Curriculum for the Advanced Practice Hospice and Palliative Registered Nurse
. 2nd ed. Pittsburgh, PA: Hospice and Palliative Nurses
3. Yale Bulletin and Calendar . American Academy Honors Three from YSN . 2001. Available
Care and the Hospice and Palliative Nurses
Association’s APRN competencies. 46 , 47
often work alongside non- nursing
providers. Whether the palliative APRN is the only nurse
on a palliative care team or the sole palliative care clinician in an oncology clinic, it is important to maintain “a nursing
orientation.” 27 (p 108) When nurses
“unconsciously use a medical or institutional model as their perspective for organizing care,” they limit their potential contribution. 48 (p 27) The key principles of advanced nursing
practice are reviewed in the following
Lisa A. Stephens and Amelia Cullinan
medication titration), using appropriate guidelines to allow him or her to practice within his or her professional nursing
scope of practice. When patients are undergoing dose titration of pain medications or require close monitoring for other reasons, the coordinating nurse
can make routine phone calls to check in with the patient, ensuring that the correct protocol is followed and optimal results are achieved. Because this registered nurse
acts as the “right hand” of the APRN, he or she should be located in the clinic to ensure optimal communication and collaboration with
Joan E. Dacher and Sherrie Murray
primary care . Available at http://www. nursingworld
.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/APRNs-as-PCPs.pdf . Published 2010. Accessed October 28, 2014.
18. Graham MC. Advocacy in practice: accountable care organizations the future of health care? Nurse
Practitioner . 2011; 36(8): 11.
19. Byock I , Twohig JS , Merriman M. Promoting excellence in end-of-life care: a report on innovative models of palliative care. J Palliat Med. 2006; 9(1): 137–52.
20. Bauer JC. Nurse
practitioner as an underutilized resource
Linda M. Gorman
Chapter 16 The Palliative Advanced Practice Registered Nurse
in the Specialty Outpatient Setting
Linda M. Gorman
◆ The palliative advanced practice registered nurse
(APRN) in a specialty practice cares for patients with chronic illnesses to manage their symptoms and address goals of care throughout the disease trajectory. This is especially important in the outpatient setting.
◆ Those with end-stage renal disease (ESRD) have a variety of uncomfortable symptoms that are often underrecognized and undertreated.
patient care needs.
The care provided by nursing
home staff can be affected when turnover occurs, potentially leading to a higher nurse-to-patient
homes may be understaffed, with a pattern of high turnover among all team members, including direct care providers as well as administrators. 3 A higher rate of turnover in these settings may be related to lower pay, more difficult work, less professional respect, and greater understaffing than in other types of healthcare facilities. 2
Education of nursing
staff is another important variable to consider
Kerstin Lea Lappen
/140307aprnpolicypaper.pdf . Accessed July 19, 2014.
9. American Nurses
Association . Available at http://www. nursingworld
.org/EspeciallyForYou/AdvancedPracticeNurses/Scope-of-Practice-2 . Accessed July 30, 2014.
10. American Nurses
Association . Nursing
: Scope and Standards of Practice . 2nd ed. Silver Spring, MD: ANA/ Nursebooks
11. Kjervik D , Brous EA. Law and Ethics in Advanced Practice Nursing
. New York, NY: Springer Publishing Company; 2010.
12. Dahlin C
Marilyn Bookbinder and Debbie Rochester-Gibbons
affiliations with nursing
schools. APRNs in exemplary organizations can hold university faculty positions and offer leadership as preceptors, and in developing curriculums for observerships, internships, residency and fellowship programs.
As health information technology leaders, APRNs can establish the linkages needed among nurses
, informatics, analytics, and patient outcomes. They can improve workflows and help reduce the barriers nurses
face in documenting routine care. These linkages are critical to capturing the data needed to populate nursing-sensitive
Rosemary Gorman and Dorothy Wholihan
patient needs and includes patient input. To provide holistic, consistent care, a PCP must provide generalist palliative care services. According to Palliative Nursing
: Scope and Standards , 6 as nurses
, all APRNs practice primary palliative care. Basic palliative care is inherent in the definition of nursing
: alleviation of suffering through the diagnosis and treatment of human response. Furthermore, all nurses
provide psychosocial and spiritual support and assist with advance care planning within the context of a patient’s cultural background. Quill and Abernethy recommend
Rikki N. Hooper
Position Statement: Nursing
Care and Do Not Resuscitate (DNR) and Allow Natural Death (AND) Decisions. March 12, 2012. Available at http://www. nursingworld
.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements.aspx . Accessed September 29, 2014.
22. Hospice and Palliative Nurses
Association . Dahlin C , ed. Competencies for Advanced Practice Hospice and Palliative Care Nurses
. Pittsburgh, PA: HPNA; 2014.
23. Dahlin C , Lynch M. Evolution of the advanced practice nurse
in palliative care. In Dahlin CM , Lynch MT , eds. Core Curriculum for the
Gretchen P. Fitzgerald, Michele A. Naugle, and Jacaline P. Wolf
palliative care do not have acute care issues that require skilled nursing
visits, nor do they technically meet the criteria of being homebound. Although additional home visits made by a registered nurse
, in addition to standard care through a medical clinic, resulted in higher patient satisfaction, it was more costly to the practice. 15 This may be attributed to the fact that registered nurses
are unable to bill for their services. One study described an interdisciplinary program in which the registered nurse
was responsible for patient education only, and the physician’s
at http://www.nhpco.org/sites/default/files/public/NDS_2012_National_Summary_20131106.pdf Accessed June 1 2015.
theories: an overview . Current Nursing
. Available at http://currentnursing.com . Updated 2012. Accessed July 13, 2014.
16. American Nurses
Association and Hospice and Palliative Nurses
Association . Palliative Nursing
: Scope and Standards—An essential resource for nurses
. 2014 . Silver Spring, MD: Nursesbooks
17. Centers for Medicare and Medicaid Services (CMS) . Medicare Hospice Benefits . Baltimore, MD: US Department
Dorothy Wholihan and Charles Tilley
Healthcare administration, clinical nurse
Adapted from American Association of Colleges of Nursing
The PhD-Prepared Palliative Nurse
There is an urgent need for PhD-prepared nurses
committed to increasing the body of knowledge within palliative nursing
. The Hospice and Palliative Nurses
Associations (HPNA) 2012–2015 Research Agenda highlights the need to integrate evidence into practice and guides nurse
researchers in prioritizing research studies
Anne Mahler and Sharon Verney
identifying and setting collaborative goals. 8 Nursing
supports the patient’s existing abilities and facilitates the use of adaptive strategies. Rehabilitation nurses
provide comprehensive and compassionate end-of-life care, including the provision of comfort and the relief of pain. 5 The advanced practice rehabilitation nurse
merges the roles of direct care provider, educator, consultant, researcher, and manager when providing care. 9 The APRN may be an 10 adult, geriatric, or family practice nurse
practitioner or clinical nurse
specialist, or a palliative and hospice
Medicaid Services, NHIC . Part B. Physician assistant, nurse
practitioner, clinical nurse
specialist, certified nurse-midwife
billing guide. Washington, DC: CMS; 2010.
16. Dahlin C. A Primer in APRN Reimbursement . Pittsburgh, PA: Hospice and Palliative Nurses
17. APRN Consensus Work Group, National Council of State Boards of Nursing
APRN Advisory Committee . Consensus Model for ARPN Regulation: Licensure, Accreditation, Certification, and Education . 2008. Available from www. nursingworld
.org/ConsensusModelforAPRN . Accessed September 28,
Betty R. Ferrell
In: Yarbro CH , Wujcik D , Gobel BH , eds. Cancer Nursing
: Principles and Practice . 7th ed. Sudbury, MA: Jones & Bartlett; 2010.
4. Taylor EJ. Religion: A Clinical Guide for Nurses
. New York, NY: Springer; 2012.
5. The Joint Commission . Spiritual assessment. 2009. Available at http://www.jointcommission.org/AccreditationPrograms/HomeCare/Standards/09_FAQs/PC/Spiritual_Assessment.htm . Accessed December 31, 2008.
6. Ferrell B , Coyle N. The Nature of Suffering and the Goals of Nursing
. New York, NY: Oxford University Press, 2008.
Cheryl Ann Thaxton and Leiann Neubauer
practices. In October 2014, three national nursing
organizations joined forces to transform the care and culture of serious illness. Together, the Hospice and Palliative Nurses
Association, the Hospice and Palliative Nurses
Foundation, and the HPCC launched a campaign aimed at (1) increasing the number of certified hospice and palliative nurses
; (2) advancing research into best practices of hospice and palliative care; (3) elevating palliative nursing
leadership at the local and national levels; and (4) enhancing nursing
competence through certification. Other groups
Patrick Callaghan, Helen Waldock, Dave Richards, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Helen Waldock, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, and Dave Richards
• Strengthen mental health nursing
Compassion in practice: the Chief Nursing
Officer’s vision and strategy for nursing
, midwifery, and care staff in England (2013)
This vision 9 identifies six qualities (six Cs) that are required of all nurses
, midwives, and care staff (see Figure 1.1 and Table 1.2 ):
• Care —put care at the heart of nursing
and all health and social care organizations. It is argued that care is the essence of mental health nursing
. Mental health nurses
can care by ‘mobilizing hope, confidence and
Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, and Patrick Callaghan
Essentials of Nursing
Research: appraising evidence for nursing
practice , 8th edn. Lippincott Williams & Wilkins: Philadelphia, PA, 2013.
5 Benton DC and Cormack DFS. Reviewing and evaluating the literature. In: DFS Cormack (ed.) The Research Process in Nursing
, 4th edn. Blackwell Science: Oxford, 2000. pp. 69–84.
6 Critical Appraisal Skills Programme (CASP) website. www.casp-uk.net
7 Callaghan P and Crawford P. Evidence-based mental health nursing
practice. In: P Callaghan , J Playle and L Cooper (eds) Mental Health Nursing
Skills . Oxford
Patrick Callaghan, Madeline O’Carroll, Richard Gray, Dan Bressington, Helen Waldock, Ben Hannigan, Peter Ryan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Madeline O’Carroll, Madeline O’Carroll, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Richard Gray, Dan Bressington, Helen Waldock, Patrick Callaghan, Patrick Callaghan, Helen Waldock, Patrick Callaghan, Patrick Callaghan, Patrick Callaghan, Ben Hannigan, and Peter Ryan
service users on inpatient mental health units who may be at risk of harm to self or others is a key component of mental health inpatient nursing
care. It is a commonly used nursing
intervention for service users, and involves the allocation of one nurse
(or sometimes two) to one person for a prescribed length of time, in order to provide intensive nursing
Definition of observation
According to the Standing Nursing
and Midwifery Advisory Committee practice guidance, ‘Safe and Supportive Observation of Patients at Risk’, 11 observation is defined as