1. Palliative Care:
A Concept Analysis
By Karen Davis, RN, BSN, OCN

2. What is palliative care?
Do you use palliative care in
your nursing practice?

3. History of Palliative Care
• In 1967 Dame Cicely Saunders created the first hospice program
called St. Christopher’s Hospice in the United Kingdom.
• In 1974 Florence Wald and Chaplain Ed Dobihal founded the first
U.S. hospice program in Connecticut.
• Hospice and Palliative care were considered the same until the
1980’s when hospital based palliative care programs were
developed at the Cleveland Clinic and Medical College of
Wisconsin.
• There are now over 1400 palliative care programs in the U.S.
• Over 80% of hospitals with more than 300 beds report to have a
palliative care program.

4. Definition of Palliative
• Palliative (adjective): • Palliate (verb): 1. To
Serving to palliate. reduce the violence
of (a disease) also: to
• Palliative (noun): ease (symptoms)
Something that without curing the
palliates. underlying disease. 2.
to cover by excuses
and apologies.

5. WHO Definition of
Palliative Care
• “Palliative care is an approach that
improves the quality of life of patients and
their families facing the problems
associated with life-threatening
illness, through the prevention and relief of
suffering by means of early identification
and impeccable assessments and treatment
of pain and other
problems, physical, psychosocial and
spiritual (WHO 2002, p 83)”

6. AAHPM Definition of Palliative
Care:
• “Comprehensive, specialized care provided by
an interdisciplinary team to patients and
families living with a life-threatening or severe
advanced illness expected to progress toward
dying and where care is particularly focused on
alleviating suffering and promoting quality of
life. Major concerns are pain and symptom
management, information sharing and advance
care planning, psychosocial and spiritual
support and coordination of care (AAHPM
2003)”

7. Attributes
• Individualized patient care
• Support for the family
• Interdisciplinary teamwork
• Trust
• Safety
• Effective Communication

8. Individualized
Patient Care
Effective Support for the
Communication Family
Interdisciplinary
Safety
Teamwork
Trust

9. Individualized Patient
Care
• Individualized patient care focuses on the
physical, emotional, social and spiritual needs
for that particular patient.
• It focuses on all aspects of the patient
care, rather then just controlling the
symptoms.
• Patients and their family members are asked
to contribute to their specific goals of care.
• Care is focused on the patient and their idea
of quality of life.

10. Support for the Family
• Palliative care does not focus solely on the
patient, but rather encompasses both the
patient and family as units of care.
• Family support is incredibly important to the
patient at end-of-life.
• Palliative care and resources can offer
opportunities for families to heal relationships,
provide professional support in terms of
counseling, respite care, financial counseling
and bereavement support.

11. Interdisciplinary
Teamwork
• Many different health care professionals
are involved in palliative care programs:
physicians, nurses, social workers,
chaplains, nurse aides, dieticians and
volunteers.
• All members of the palliative care team
work together, along with the patient and
family, to create the best goals of care for
the patient.

12. Trust
• Patients must be able to trust the judgment of the
team in that they will provide the best care available.
• It is crucial for the palliative care team to create a
trusting relationship with the patient and family in
order for the patient to received the most beneficial
care available to them
• Patients and family members must also be able to trust
in the treatments given.
• It is up to the medical team to properly educate the
patient and family about the treatments the patient
will be receiving and why they are important.

13. Safety
• Continuity of Care: • Competence of Care:
• By maintaining • Patients and family
continuity of care, members have a feeling
patients and family of safety when they
members have a feeling believe that competent
of safety. They are able care is being provided.
to build trusting
relationships with team
members, and do not
have to worry about
new team members
that may not know the
patient’s goals of care,
needs or wants.

14. Effective
Communication
• Communication is vitally important in
palliative care. It allows the patient, family
and care team to have open conversations
about advanced care planning and prognosis.
• Palliative Care allows patients and family
members to get involved in the care and to
help create goals of care.
• Team members must maintain open
communication with the patient and family in
order to continually develop and change the
care plan.

15. Antecedents
• Acute or Chronic • Terminal or
Illness. Potentially Terminal
Illness.
• Examples: COPD, CHF,
Dementia, • Examples:
Respiratory Failure, Cancer, Stroke, Brain
Acute or Chronic Injuries.
Renal Failure.

16. Consequences
• Patient Consequences: • Family Consequences:
• Advanced Care Planning • Effective Closure
• Increased Coping • Improved Bereavement
Outcomes
• Increased Quality of Life
• Healing of Relationships
• Relief of Suffering and
Symptoms • Decreased Guilt
• Enhancement of Human • Decreased Psychological
Dignity Distress
• Effective Closure • Improved Coping

17. Advanced
Care
Planning
Effective Increased
Closure Coping
Patient
Consequences
Enhancement Increased
of Human Quality of
Dignity Life
Relief of
Suffering and
Symptoms

18. Improved
Coping
Decreased
Effective
Psychological
Closure
Distress
Family
Consequences
Healing Decreased
Relationships Guilt
Improved
Bereavement
Outcomes

19. Barriers to Palliative
Care:
• There are 3 main categories of obstacles
for patients to receive palliative care:
• Family members creating obstacles
• Health professionals creating obstacles
• Conflict between ideal care and patient’s
wishes

20. Families Creating
Obstacles
• Lack of openness of communication between
family members and patient and between family
members and health care team.
• Forbid the health care team to discuss the
patient’s diagnosis and prognosis with the patient.
• Demand complete control over the patient’s goals
of care.
• Want to continue treatment that is futile to the
patient.
• Limit medications or care delivered to the patient.

21. Health Professionals
Creating Obstacles
• Double Effect
• Active Euthanasia
• Own Fear of Dying
• Medicare Laws
• Opioid Prescribing Laws
• Lack of Knowledge about Palliative Care

22. Conflict Between Ideal Care
and Patient Wishes
• Patient may want to stay at home, even
when symptoms are too great to be treated
at home.
• Fear of hospitalization
• Wish to maintain their autonomy
• Loss of control

23. Importance of Concept
to Nursing Practice
• Understanding of the palliative care concept will help
to enhance patients’ quality of life.
• In order for palliative care to benefit the patient, it
must be used to the best of its abilities.
• It is an evolving concept, nurses must continually stay
educated on any changes made to the palliative care
concept
• Nurses must know when to introduce to topic of
palliative care to patients and their family.
• Must not be afraid to bring up the topic of palliative
care, or to suggest it to a physician.

24. SUPPORT Study
• SUPPORT study (Study • Development of new
to Understand vocabulary to describe
Prognoses and the time before end-
Preferences for of-life when palliative
Outcomes and Risks of care should begin.
Treatments) • Access to palliative
care and hospice care
• Conducted in the U.S. has less to do with the
to learn how to patient’s decisions and
improve the care of more to do with the
the dying patient systems of care and
within our healthcare how they function.
system.
• Indicated the need for
earlier intervention in
planning with patients
and families.

25. Government and
Palliative Care
• Patient Protection and Affordable Care Act
• Signed by President Obama in March of 2010.
• Act seeks to expand the palliative care system in the
U.S.
• Health Care Financing Administration
• Regulates amount of reimbursement from Medicare
and Medicaid to palliative care programs
• Joint Commission Standards
• Set of standards that each hospital with a palliative
care program must abide by in order to maintain
their certification

26. References
• Brenner, Paul R. (2000). Palliative care and hospice: One approach. American Journal of Hospice and
Palliative Medicine, 17, 241-244. doi:10.1177/104990910001700409
• Meghani, Salimah H. (2003). A concept analysis of palliative care in the United States. Journal of
Advanced Nursing, 46(2), 152-161.
• Meier, Diane E., Morrison, R. Sean, Cassel, Christine. (1997). Improving palliative care. Annals of
Internal Medicine, 127(3), 225-230.
• Kaur, Judith S. (2000). Palliative care and hospice programs. Mayo Clinic Proceedings, 75(2), 181-184.
• Philip, Jennifer A.M., Komesaroff, Paul. (2006). Ideals and compromises in palliative care. Journal of
Palliative Medicine, 9(6), 1339-1347.
• Reb, Anne M. (2003). Palliative and end-of-life care: Policy analysis. Oncology Nursing Forum, 30(1),
35-50
• Werkander Harstade, Carina., Andershed, Birgitta. (2004). Good palliative care: how and where?.
Journal of Hospice and Palliative Nursing, 6(1), 27-35.