SOUTHERN LUZON STATE UNIVERSITY

COLLEGE OF ALLIED MEDICINE

[ An Introduction to Hospice
and Palliative Care]
HOSPICE CARE NURSING/
History

MODULE 1

This course includes concepts, principles, theories of hospice palliative

care. This will enable the students to apply nursing interventions and
strategies for the management of patients with debilitating, chronic,
terminal illnesses to provide an alternative to hospitalization during
the final stage of life and includes consideration and support for the
family.

Mondays 10-11 AM Section A

11-12 AM Section B

Dear Students,

As we go along the way, may you have a big heart in dealing with them. As we
intervene in their sufferings, have your strategies and techniques, book-based
and own approaches in dealing with them. Good luck everyone.

67 Quezon Avenue
Lucban, Quezon 4328

09761439535

HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023

 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

jdsabas@slsu.edu.ph

[Your Google classroom

link]

Overview

Hospice is a type of healthcare dedicated to alleviating suffering in terminally ill patients. It has
been in place in the United States for several decades. A large part of hospice care is the
palliation of distressing symptoms. Palliative care has been strongly associated with hospice,
but has taken on its own identity in American healthcare. It is now considered a specialty
distinct from hospice care. Although these 2 types of care are closely related, they are not the
same. The similarities and differences will be reviewed.

HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023

 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

Learning objectives

After reading, the nurse will be able to:

1. Specify how hospice and palliative care differ.

2. Identify unique features of hospice care and palliative care.
3. Discuss hospice and palliative care as unique but interrelated specialty areas.

Discussion

Hospice is specialized care for terminally ill patients and their families that primarily takes
place in the home. It can be provided in assisted living facilities, nursing homes, group
homes and even within a hospital setting. (National Institute on Aging 2017). The goal of
hospice care is symptom management and support throughout the disease process. The
patient and family/caregivers are considered to be the unit of care, and their needs are
addressed by members of the hospice interdisciplinary team. An interdisciplinary approach
is used “to deliver medical, nursing, social, psychological, emotional and spiritual services
through a collaboration of professionals and other caregivers, with the goal of making the
beneficiary as physically and emotionally comfortable as possible. Hospice is compassionate
beneficiary and family/caregiver-centered care for those who are terminally ill” (Centers for
Medicare and Medicaid Services, 2018. p. 38624.

HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023

 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

Fast Facts:

American Nurses Association (ANA)

End-of-Life Nursing Education Consortium (ELNEC)

Hospice & Palliative Credentialing Center (HPCC)

Hospice & Palliative Nurses Association (HPNA

National Hospice & Palliative Care Organization (NHPCO)

The City of Hope

Characteristics of Hospice Care:

HC is associated with terminality, and there is often fear on the part of patients and families
when the term is used. This fear is primarily related to the misperception that hospice care is
provided only when a patient is clearly nearing death. Patients and families may also fear
choosing HC means that all hope is lost or that the patient will give up the will to live.
Even when a patient and family recognize that hospice would be an appropriate
form of care, fears regarding whether the hospice team will be able to provide physical
comfort, dignity, and support are pervasive. Perhaps most importantly, the patient may fear
his/her actual death, and the family may fear the loss of their loved one. (El-Jawahri et al.
2017)

Hospice care differs from other specialties in that the hospice team specifically focuses on
physical, emotional and spiritual comfort of terminally ill patients through the interventions
developed by the interdisciplinary team. Hospice nurses must have expertise in symptom
management and be well versed in how each disease trajectory typically evolves. When a
patient chooses hospice care,

Care is specifically tailored to address issues related to the terminal illness,

The patient agrees to forgo curative treatments,

Services are covered by the Medicare Hospice Benefit (if the patient is Medicare eligible)

All end-of-life concerns are addressed in a holistic manner,

Patients receive skilled palliative care interventions to ensure comfort and

Care is mainly provided in the home (which may include facilities, if this is where the patient
resides; (Coyle, 2015)

Hospice care is generally provided for patients who have a life expectancy of 6 months or
less without life-sustaining treatment. Beyond the 6-month time frame, a patient may
continue to receive services provided that recertification requirements are met. Hospice

HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023

 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

care continues through the disease process, during the dying process, and even after the
patient’s death in the form of bereavement support for the patient’s family and caregivers.

Palliative Care Fast Facts:

Palliative care nursing should be integrated into the nursing care of older adults and those
with chronic illness to improve quality of life and to promote physical, spiritual and
emotional comfort (Ferrell, 2019)

The National Institute on Aging (2017, defines palliative care as “a resource for anyone living
with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer,
dementia, PD, and others. Palliative care can be helpful at any stage of illness and is best
provided from the point of diagnosis. Palliative care can be provided along with curative
treatment and does not depend on prognosis.” Palliative care includes the management of
symptoms, such as pain, dyspnea, nausea and vomiting, fatigue and others that interfere
with the patient’s ability to be comfortable. Palliative care can take place in various
healthcare settings, such as clinic, hospital, long-term care facility, and others. Palliative care
is distinguished from other medical specialties by its foci on:

Incorporation of an interdisciplinary team to address spiritual, psychosocial, and cultural

needs of patients and families,

Integration with curative treatments,

Symptom management in early stages of disease and throughout the disease process and

Patient and family involvement in the plan of care (WHO, 2019).

THE PALLIATIVE CARE NURSE

Fast facts: although palliative care is not specified as Medicare benefit, Medicare Part B may
cover some treatments and services that are considered palliative.

Palliative care nurses have expertise in managing symptoms that disrupt patients’ and
families’ quality of life. Both pharmacologic and nonpharmacologic measures are used to
alleviate suffering whether the plan of care involves curative or strictly the promotion of
comfort within the confines of the life-limiting disease. Since nurses are usually the 1 st health
care professionals to identify end-of-life concerns among patients, palliative care skills are
essential for developing a trusting therapeutic relationship with the patient and conveying
the patient’s needs to the interdisciplinary team (Dahlin and Wittenberg, 2019)

PROVISION OF PALLIATIVE CARE SERVICES

Unlike hospice services that are provided through an accredited hospice agency, palliative
services may or may not be fully covered by Medicare or other health insurance plans.
However, palliative care services are becoming more accepted and integrated into the
continuum of care, and coverage options are changing rapidly. Medicare remunerates
providers for advance care planning activities as a medically necessary service (under Part B)
or as part of an annual examination (Centers for Medicare & Medicaid Services, 2018)

HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023

 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

In addition, clinicians providing care in hospital based palliative care programs can receive
payment as consultants through Medicare Part B and some private insurance plans.
However, other members of the interdisciplinary team, such as chaplains and social workers,
cannot receive a service intensity add-on payment for palliative services despite the
advanced knowledge, skills and time that are required for such patient encounters. No clear
defined palliative care reimbursement system currently exists, hospital-based palliative care
programs are typically supported by the hospital’s operating budget, which disadvantages
smaller community hospitals (Sullender & Selenich, 2016).

Nonetheless, some hospitals have embraced the need for palliative services and have gained
certification through The Joint Commission. This type of certification recognizes that an
organization:

Has a full-time palliative care program in place that serves the entire patient population

Is led by an interdisciplinary team with advanced training in palliative care,

Has leadership that endorses and supports the palliative program,

Implements strategies to promote family engagement,

Has internal processes that foster interdisciplinary communication, and

Uses national, evidence-based guidelines to develop protocols for patient care (The Joint
Commission, 2020)

FF: For those interested in starting palliative care programs within organizations, the Center
to Advance Palliative Care offers training, assistance and tools. Find more information at
www.capc.org.

Summary of differences: Hospice Care :Palliative Care

Type of care:

Bereavement services:

Care is primarily delivered in:

Patient chooses to forego what treatment:

Covered by the Hospice Medicare Benefit:

Life expectancy of patient:

HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023

 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

[SAMPLE ONLY]
Test Your Knowledge

The following …………………………………………………………………………………

A. ……………………..
B. …………………………
C. ………………………
D. ………………….

Evaluation

HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023

 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

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Activity 2
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 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

Activity 3

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HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023
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 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

Activity 4

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HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023
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 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

Activity 5

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HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023
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 SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE

References

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HCN 00 HOSPICE CARE NURSING, JESSICA A. SABAS, 2022-2023