2020 FNA Book Of Reports

2020 Florida Nurses Association
contribute and multiply the responsibilities of the nurse. Nurses require the information necessary to provide
quality care to patients and families.
Rationale
Background Information
In 2017, the National Hospice and Palliative Care Organization (NHPCO) estimated 1.5 million patients received
services from hospice and approximately 1,100,000 hospice patient deaths occurred in the United States
(NHPCO, 2017). According to the NHPCO (2017), hospice programs have increased nationally to over 4,515
programs in 2017. Hospice care is provided to patients at home, as well as in nursing homes, assisted living
facilities, inpatient units, and to patients who are homeless, regardless of their ability to pay (NHPCO, 2017).
In the 1960s, Dame Cicely Saunders established the first hospice in London, England. The interdisciplinary
approach was used to provide comprehensive end-of-life care to patients (Kinzbrunner & Policzer, 2011).
Hospice care came to the United States in the 1970s and was used mainly for cancer patients (NHPCO,
2017). In 1982, hospice care became part of the Medicare benefit, and Medicare is the largest payer source
for hospice care in the United States (NHPCO, 2017). “The introduction of hospice care in the United States
represented a paradigm shift in how the health care community viewed and treated dying patients” (Adams,
2010, p. 125).
Definitions
The hospice philosophy is to provide pain control and comfort to dying patients and their families, who have
the right to refuse services and must be consulted regarding the plan of care. It is not a requirement to have a
“Do Not Resuscitate” (DNR) in place to receive hospice care. Hospice care begins when the patient and family
accept that there are no curative treatments to consider and therefore focus on humane and compassionate
care to improve the patient’s quality of life. There are four primary levels of hospice care: routine home care,
continuous care, general inpatient care, and respite inpatient care. Routine home care is provided wherever the
patient lives: at home, in an assisted living facility, or in a nursing home. Patients on routine home care receive
visits from the interdisciplinary team including a registered nurse (RN) every 14 days or as needed. Continuous
care, also known as crisis care, is used for short periods to stabilize a patient who needs pain or symptom
management. Once stabilized, the patient will return to a routine level of care. When a patient is actively dying,
continuous care is initiated to ensure quality end-of-life care. Patients on continuous care receive daily visits
from the hospice care nurse (RN). General inpatient care is also used during a crisis and for patients who
do not want to die at home. An additional benefit offered to patient families is respite care in the inpatient
hospice unit. Patients can receive care for a maximum of 5 days to provide relief for caregivers facing stress
and burnout. These levels of care are mandated by Medicare (NHPCO, 2017).
Nursing Role / Function
The lack of research and awareness about Hospice leads to the ambiguity of the RN’s role. The role of the RN
is to ensure that the physical, emotional, spiritual, and social needs of patients and families are met. After an
assessment by an RN admissions nurse, patients are assigned to an interdisciplinary team that includes a RN
team manager, a RN hospice care nurse (case manager), a team physician, nursing assistants, a social worker,
and a chaplain. This team meets weekly to review and discuss patient care and family needs.
Legal / Ethical Considerations
“Death is a mysterious phenomenon, and though it is a normal process, it is commonly denied across the
globe. People are generally not prepared for death” (Mally et al., 2014, p. 410). The World Health Organization
(WHO), in collaboration with the Worldwide Palliative Care Alliance (WPCA), published The Global Atlas of
Palliative Care at the End of Life (2014) to highlight the need for end-of-life care globally. The atlas states, “…
it is widely acknowledged that there is still inadequate access to hospice …worldwide, and with the ageing
population who are going to be living and dying with more complex conditions, the demand for care is only
going to increase” (World Health Organization [WHO], 2014, p. 2). Globally, the WHO (2014) gives a low-level
estimate of 20 million people a year, including 6% of children, who need end-of-life palliative care.
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