Journey along the palliative care bridge to hospice

by tammysmithlvn

4,618 Views | 7 Comments

The importance of Palliative care discussions upon diagnosis of a life threatning disease.

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    Palliative care services are a very important resource for those patients who have been recently diagnosed with a terminal illness. Care needs fluctuate throughout the course of any life-limiting disease. No longer are patients required to terminate aggressive treatment, and possibly give up all hope in order to receive much needed services. These Palliative care services may include:

    • Help navigating the healthcare system.
    • Multiple symptom and pain management.
    • Guidance with difficult and complex treatment choices.
    • Emotional and spiritual supportive counseling.


    Patient and family open communication. Unfortunately, there continues to be a lack of knowledge and understanding among many Physicians, who are resistant to the idea of Palliative care. They continue to have the idea that if their patient considers Palliative care services, that the patient is actually giving up and is ready to die. But that is simply not the case. According to the American Nurses Association, Palliative Care is recommended for:

    • Any stage of illness.
    • Used in conjunction with treatment.
    • Helps with the transition from curative care to Hospice.


    These patients can continue with their aggressive disease- oriented treatment, as ordered by their Physician, while receiving much needed services. The network of support from the entire Palliative care team, may even aid the patient in continuing with their treatment.

    Palliative Care is beneficial, not only for the seriously ill patient, but their families as well. This also makes for a much smoother transition or “bridge” to elective Hospice services at a later time. This bridge provides for the movement of the pre-hospice patient, on to full hospice services, without an actual crisis. This new Hospice patient admission can now be a direct result of a tranquil, peaceful, and an elected personal choice.

    It is important that all healthcare team members have an understanding of the aspects of Palliative care services. Detailed information and a referral about these important services should be initiated at the actual diagnosis point with the Physician. The Journal of Hospice and Palliative Nursing explains, that although the Physician makes the initial diagnosis, it is the important universal communicative role of the Nurse, which takes on special importance during such intense times such as serious illness and end-of-life care. It is the Nurse who provides accurate information so that individuals can make informed decisions following the shock of such a diagnosis.

    As our vastly educated population ages, the planning of our own personal end of life journey will become increasingly important. No longer will patients be faced with the “treat or not to treat” decision following a diagnosis of a life-limiting disease. As Physicians become more informed, and learn the importance of Palliative care services for their patients, this transition will become a peaceful and tranquil experience. There are so many advantages to the patient as they receive Palliative Care services and then bridge peacefully on the Hospice Services. End of Life should be respected, and all resources should be offered and provided to the patient and their families at the point of diagnosis. All treatment options as well as a referral to Palliative care services should be initiated in order to assist the individual with the most beneficial and personally detailed plan of care.
    Last edit by Joe V on May 3, '11 : Reason: formatting for easier reading
    kwyattmd, nola1202, and Need2Wings like this.
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  4. About tammysmithlvn

    tammysmithlvn joined Mar '10 - from 'Conroe, Texas'. tammysmithlvn has '5' year(s) of experience and specializes in 'LTC, SKILLED, LTAC, HOSPICE'. Posts: 13 Likes: 38; Learn more about tammysmithlvn by visiting their allnursesPage


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    7 Comments so far...

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    I work in long term care and am discouraged by peoples lack of knowledge re palliative care, for instance, if someone gets a fever at end of life most nurses will ask for antibiotics, well my dad is and old country md who still makes housecalls and he would let families know that pneumonia at this point is a "gentlemans friend", nurses are mostly wanting to start iv fluids,clysis,and not allow natural death, they are pressing the aides to encourage food , then want to suction them when they choke!Oh yeah and lets do alot of vitals and count respirations while we are at it, it makes me cry. Dying in america is brutal.
    tralalaRN, bethann27, and Need2Wings like this.
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    You are right, dying in America is brutal. I just started my first job as a new grad at a ltc facility. Ultimately, I want to go into hospice. I am just learning the ropes at the facility, but I have to wonder at the treatment philosophy for some of the residents, and who is deciding. It certainly isn't the resident in many cases, as they can't make the decisions due to dementia or Alzheimer's. If a person appears dehydrated or malnourished, it seems the facility can be accused of neglect. So the facility, even against the patient's wishes (if they don't want to eat, they must not know what they are talking about and are incapable of making a rational decision) and so they just keep encouraging food, meds, etc.

    I think that culturally, we see death as a failure and we must succeed at all costs.
    tyvin and wowensue like this.
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    Dying in America can be brutal! It makes me very sad to see what can be a dignified death botched by those who don't get it. Unfortunately some of the blame is with hospice organizations that have gotten so big that they've lost the essence of hospice care altogether.

    Our physicians & nurses at all levels need to be educated on the benefits for the patient, family and the healthcare system of choosing hospice.
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    I believe that some have forgotten that death is a natural part of life - regardless of the age - sometimes at 98, sometimes at birth. We've become so terrified of it. I wish there were more education on palliative care and hospice in nursing schools. Thank you for an excellent article.
  9. 0
    Here Here!
  10. 0
    Quote from jlynn2303
    You are right, dying in America is brutal. I just started my first job as a new grad at a ltc facility. Ultimately, I want to go into hospice. I am just learning the ropes at the facility, but I have to wonder at the treatment philosophy for some of the residents, and who is deciding. It certainly isn't the resident in many cases, as they can't make the decisions due to dementia or Alzheimer's. If a person appears dehydrated or malnourished, it seems the facility can be accused of neglect. So the facility, even against the patient's wishes (if they don't want to eat, they must not know what they are talking about and are incapable of making a rational decision) and so they just keep encouraging food, meds, etc.

    I think that culturally, we see death as a failure and we must succeed at all costs.
    I retired about 3 years ago so if I'm mistaken please correct me. The facility can be sited for "withholding food" and "forced feeding" was outlawed some time ago. If the patient is on Pallaitive Care they can refuse to eat. It must be covered in the Patients Care Plan and it must be documented in the Nurse's Notes.
    Last edit by timetoshine on May 9, '11 : Reason: spelling
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    I so agree with your article. As a retired hospice physician I see the huge need for more palliative care in the US and, of course, for more open discussion. As a society we are death-phobic and chase after futile cures and promises of immortality because we don't understand this: the fact that we will all die someday is exactly what makes our lives so precious and meaningful.
    Last edit by madwife2002 on Dec 1, '11 : Reason: Removing link


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