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Editorial: Caring Versus Curing
For quite some time now, palliative care has been an important cornerstone of nursing practice. As a concept, it has evolved and is now envisioned as a gold standard for patients with progressive life-threatening illnesses, but it is also an essential complementary approach to aggressive, life- prolonging, and cure-oriented conventional therapies (Gilleck, 2005; Himelstein, 2005). The newly revised World Health Organization’s definition of palliative care is as follows: “an approach that improves quality of life of patients and their families facing problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual” (World Health Organization, 2006). Although not stated here, it is critically important to recognize that palliative care for children has supplementary components that should be reviewed when specifically working with that patient population. Moreover, palliative care is not limited to only a hospice setting and does not exclude patients who seek aggressive potentially curative treatment.
As a mode of care delivery, palliative care is applicable to all age groups and should be applied 24/7 to patients suffering from a myriad of acute, chronic, and disabling conditions (e.g., human immunodeficiency virus, heart failure, cancer, peripheral vascular disease, and diabetes). However, the common thread is caring versus curing. The focus should be on the patient’s quality of life and ability to live with dignity regardless of age, gender, race, ethnicity, or health status. In many of today’s healthcare settings, lengths of stay are increasingly being shortened. As a result, healthcare professionals are frequently neither witnessing nor being adequately educated to address the multiple palliative care issues (e.g., importance of early initiation, symptom management, scientific evidence to support its efficacy, and cost savings or coverage by private insurance or Medicare) experienced by patients and family members, not only in the acute care setting, but also in the long-term care and home settings.
More than 50% of Americans with serious illnesses within the United States, die in an acute care hospital (www.cdc.gov/nchs/pressroom/98facts/93nmfs.htm). However, data reveal that the greatest prevalence of palliative care programs are in larger hospitals, academic medical centers, and non-profit, or VA hospitals compared with other institutions (Morrison, Maroney-Galin, Kralovec, & Meier, 2005). This finding highlights the need to develop additional strategies to stimulate growth of palliative care programs in smaller community hospitals, as well as to develop alternative program structures that reach beyond the hospital setting.
We inevitably must consider how all of this relates to rehabilitation nursing. What are the ramifications of palliative care on our practice? A comparison of palliative versus rehabilitation care reveals that both share similar goals and approaches to promote the highest level of function, independence, comfort, and quality of life for patients. Moreover, for each approach an interdisciplinary team is pivotal to the successful accomplishment of patients’ long- and short-term outcomes. Yet, as practitioners, we must also continually expand our knowledge of current palliative care aspects and standards of care.
Take an important step in that direction and read the articles in this issue of Rehabilitation Nursing. These articles describe some of the essential aspects in the care of chronically ill patients whose quality of life we, as rehabilitation nurses, can improve. In addition, reviewing the Scope and Standards of Hospice and Palliative Nursing Practice approved by the Hospice and Palliative Nurses Association and American Nurses Association is another important action. Because nurses are often the patient’s greatest care advocates, early inclusion of palliative care elements should occur in patients’ plans of care whenever appropriate.
With the aging of our population and increased numbers of survivors of acute and chronic illnesses, palliative care promises to gain even greater prominence. In this stimulating period of innovative treatment regimens, technological advances, and the ability to traverse distances in seconds, healthcare providers and consumers should be receptive to creative new palliative care strategies. For instance, telehealth could increase the availability and uniformity of care elements. In addition, palliative care could be universally mandated as a standard of care, and online or virtual reality educational offerings could be consistently provided for healthcare professionals, patients, and family members alike to optimize care delivery and resource utilization (e.g., distinguishing traditional care from palliative and hospice care, advocacy and decision making, symptom management). Palliative care is an emerging frontier demanding creativity, energy, tenacity, and collaboration among healthcare professionals, patients, and their family members. Quality of life and ability to live with dignity is maximized when care versus cure is a priority.
Gillick, M. R., (2005). Rethinking the central dogma of palliative care. Journal of Palliative Medicine, 8, 909–913.
Himelstein, B. P., Hilden, J. M., Boldt, A. M., & Weissman, D. (2004). Pediatric palliative care. New England Journal of Medicine, 2350, 1752–1762.
Hospice and Palliative Nurses Association and American Nurses Association. (2002). Scope and Standards of Hospice and Palliative Nursing Practice. Silver Springs, MD: American Nurses Association.
Morrison, R. S., Maroney-Galin, C., Kralovec, P. D., & Meier, D. E. (2005). The growth of palliative care programs in U.S. hospitals. Journal of Palliative Medicine, 8, 1127–1134.
World Health Organization. (2006). Retrieved July 6, 2006 from www.who.int/cancer/palliative/definition/en/.
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