The Role of the Advance Practice Nurse in Palliative and Hospice Care
What is the difference be hospice and palliative care? What is the role of the
Advance Practice Nurse in both hospice and palliative care? Are Advance Practice Nurses
reimbursed for Hospice and Palliative care?
Please review the following Web resources:
Hospice Referral and Care: Practical Guidance for Clinicians
End-of-Life Care: Improving Communication Skills to Enhance Palliative Care
Principles of Effective Pain Management at the End of Life
A National Framework and Preferred Practices for Palliative and Hospice Care Quality
How Do I Bill Commercial Insurers for Palliative Care Consultations?
Palliative and hospice care
Palliative care is a type of care that mainly deals with relieving symptoms that are
associated with chronic illnesses such as cancer. On the other hand, hospice care is a special type
of care that focuses on supporting a patient with his/her family while at the same time focusing
on relieving symptoms in the patient and providing comfort from various aspects such as pain
and fatigue. Both palliative and hospice care aim at administering to patients a number of aspects
such as medications, quality care and symptom relieving through a single program. However,
there is some difference in the two types of care.
The number of hospice care programs is more than that of palliative care programs.
Hospice care, which usually relies upon the family caregiver and a visiting hospice nurse, is
administered at home and is overseen by hospice professionals. This happens after the patient is
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referred from the primary care physician. Palliative care on the other hand is made up of doctors,
nurses and other practitioners in the medical care giving field. It is usually offered at the at the
health facility where the patient receives first treatment and such facilities include hospitals,
nursing homes and extended care facilities. (Wolfe, Hinds & Sourkes, 2011, pg 190)
For one to be put under hospice care, he/she must be in a condition that makes him/her
considered being at a terminal stage. However, there are no time restrictions in palliative care
and the patient can receive this treatment at any stage of illness. (Wolfe, Hinds & Sourkes, 2011,
Hospice programs focus more on availing care that provides comfort to their patients than
aggressive disease abatement. In comparison, the treatment offered in palliative care is aimed at
prolonging life. (Wolfe, Hinds & Sourkes, 2011, pg 189)
Advance practice nurses play a pivotal role when it comes to providing both palliative
and hospice care. In providing palliative care, the role of advanced practice nurses extends
beyond their wide knowledge in care giving and evidence based practice to improved
communication skills that enhance the providing of quality palliative care to patients through the
process of making critical decisions that are informed. Their roles also include facilitating
education programs to both the patients and their families and providing psychosocial-spiritual
care. In general the presence of advance practice nurses enhances the access to palliative care.
(In Ferrell, In Coyle & In Paice, 2015, pg 1084) In hospice care, the main role of advance
practice nurse is to ensure that the day-to-day welfare of the patients are met and such can
include things such as ensuring that all the patients are provided with their meals and medication
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and they leave in hygienic conditions. Advanced practice nurses are also expected to ensure that
the nurses in hospice programs provide a conducive environment to their patients since most of
them are usually in a vulnerable state. It is also the work of advance practice nurses to ensure
that the family members of patients are educated on how to ensure that the patients live
comfortably. (DeNisco & Barker, 2013. pg 81)
Over the recent years, many healthcare facilities have been adopting the palliative care
programs despite the fact that most insurance companies do not cover for these services. In such
facilities, advanced practice nurses have continued to provide palliative care although they are
not reimbursed for these services since the insurance companies do not cover these services.
However, organizations such as Center to Advance Palliative Care (CAPC) are working to
overcome this challenge by sourcing for funds to oversee the delivering of palliative care. Health
facilities that have received these funds have been able to reimburse their advance practice
nurses. In the case of hospice care, the nurses receive reimbursements. (Cowen & Moorhead,
2014, pg 203)
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Cowen, P. S., & Moorhead, S. (2014). Current Issues In Nursing. London: Elsevier
DeNisco, S., & Barker, A. M. (2013). Advanced practice nursing: Evolving roles for the
transformation of the profession. Burlington, Mass: Jones & Bartlett Learning.
In Ferrell, B., In Coyle, N., & In Paice, J. A. (2015). Oxford textbook of palliative
Wolfe, J., Hinds, P. S., & Sourkes, B. M. (2011). Textbook of interdisciplinary pediatric
palliative care. Philadelphia: Elsevier/Saunders.