For patients who are chronically or terminally ill, palliative care is often interpreted as end-of-life care and imminent death. The stigma makes palliative care difficult for many patients to accept and healthcare providers to prescribe.
Palliative care is intended to treat all patients suffering in pain or stress to improve medical outcomes and patient satisfaction. Palliative care is used to assist patients through life-limiting illnesses but is also often used in conjunction with curative treatments. These types of treatments address nutritional deficiencies, nausea, fatigue, pain, depression, and mental confusion, among others.
With the aging of the U.S. population and the expected increase in the incidence of serious illnesses, the use of palliative care is projected to increase in the coming years. Healthcare leaders say family nurse practitioners (FNPs) are suited to providing palliative care because many serve as primary caregivers, working independently of licensed physicians and legally permitted to prescribe pain medications.
“Nurse practitioners (NPs) in all fields care for people with serious or potentially life-threatening illness. With the stated aim of palliative care to prevent and relieve suffering, NPs have an opportunity to offer primary palliative care in all practice settings,” Mary S. Wheeler, FNP-BC, wrote in The Journal for Nurse Practitioners. “Primary palliative care involves using basic palliative care skills and should be practiced by all NPs.”
Moving Past The Stigma Of Palliative Care
Since its earliest years, palliative care has been linked to terminal illness and hospice, a specialized care intended for patients who have a life expectancy of six months or less. All hospice patients receive palliative care for physical, mental, and spiritual comfort, but not all palliative care patients qualify for hospice.
Researchers have found that palliative care is helpful in all aspects of disease treatment and can be provided at all stages of a disease. Medical professionals now say the early integration of palliative care is useful for disease and symptom management.
To remove the palliative care stigma, healthcare organizations worldwide have been redefining palliative care. In 2002, the World Health Organization (WHO) redefined palliative care from “active total care of patients whose disease is not responsive to curative treatment” to “an approach that improves the quality of life.”
Despite the efforts, many patients still face barriers to accessing palliative care.
Barriers To Accessing Palliative Care
Researchers have found the United States has stalled in its efforts to improve access to and attitudes about palliative care. In a 2015 report, the Center to Advance Palliative Care said the nation had improved access to care in the past decade, but more work needs to be completed.
The center, which has been collecting data about access to palliative care since 2008, found one-third of the nation’s hospitals with fifty or more beds have no palliative care services. Researchers found one-third of the states received a grade of C or D, which indicates poor access to palliative services.
The center also found palliative care is not widely available in the United States to patients with serious chronic illnesses, such as chronic lung disease, multiple sclerosis, heart or kidney failure, and amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease).
Overall researchers found barriers to receiving palliative care include the following:
Not enough resources to meet the need
An average of 3.4 percent of hospital admissions receive palliative care services, but estimates place the need between 7.5 and 8 percent. Up to 1.8 million patients admitted to hospitals annually could benefit from palliative services but are not receiving it, the center found.
Varied availability by region
Less than one-third of hospitals in Alabama, Arkansas, Mississippi and other Southeast and South Central states have palliative teams. At the same time, the Northeast and Northwest regions of the United States have almost universal access.
Reluctance to refer palliative care to patients
Some providers, particularly those who do not have specialist designations, may be ill-equipped to identify patients who can benefit from palliative services. Other documented reasons include fear of upsetting patients, not wanting to abandon patients, and not understanding the benefits of such care.
Problematic insurance coverage
Medicare, Medicaid, and many private health insurers provide full palliative care coverage for patients in hospice or the hospital. However, for patients who have chronic conditions but are not hospice eligible, the coverage is less extensive.
FNPs And Palliative Care
Medical professionals say an important factor in overcoming barriers to palliative care access is FNPs who are trained to alleviate suffering across the spectrum of healthcare.
As advanced practice registered nurses (APRNs), FNPs have masters-level degrees with coursework that applies to clinical practice in a primary care setting. FNPs may work either collaboratively with a physician or autonomously in private practice, depending on local and state regulations. An FNP’s advanced training allows them to serve as primary-care providers to treat acute and chronic conditions.
For patients in need of pain relief and palliative care, FNPs act as teacher, counselor, caregiver, and advocate. For FNPs, working in palliative care can mean working with other healthcare providers as part of a team effort for patient wellbeing. FNPs monitor medical and pain symptoms to ensure patients are given proper care. They also help patients follow medication procedures and schedules to improve quality of life.
Registered nurses (RNs) who have already earned a Master of Science in Nursing (MSN) degree have the opportunity to advance their education and career by earning an FNP Post-Master’s Certificate. Most states require FNP candidates to pass the American Association of Nurse Practitioners Certification Program (AANPCP) exam or the American Nurses Credentialing Center (ANCC) Family Nurse Practitioner exam.
An FNP Post-Master’s Certificate provides pathways to helping patients in need of palliative care for life-threatening, chronic, and acute illnesses.
About Duquesne University’s Online Post-Master’s Certificates
As a leader in online nursing education, Duquesne University has helped scores of APRNs successfully complete testing for AANPCP and ANCC certifications as FNPs. The university’s Family (Individual Across the Lifespan) Nurse Practitionerprogram prepares APRNs for a career helping individuals as primary care providers.
U.S. News and World Report has recognized Duquesne University as a 2017 Best Online Graduate Nursing Program and among the Top 10 Best Online Graduate Nursing Programs for Veterans.
The University also offers two other areas of Post-Master’s Certificate specializations—Forensic Nursing or Nurse Education and Faculty Role—for comprehensive career options.