Palliative & End-of-Life Care

Palliative Care in the Acute & Critical Care Setting

The goal of palliative care is to address the impact of serious illness by managing symptoms, providing emotional support and ensuring that the plan of care aligns with patient and family goals. Under usual circumstances, there is a lot of overlap between nursing basics — interaction between person and disease — and palliative care.

During a pandemic, we need to consider patient goals and preferences in the context of limited resources. In crisis situations, demand for resources exceeds supply and triage protocols may be implemented that emphasize doing the greatest good for the greatest number of patients over individual preferences. This type of shift is challenging for all members of the healthcare team. To learn more about palliative care during a pandemic, explore resources offered by ELNEC (End-of-Life Nursing Education Consortium), and access additional resources related to communicating with patients and their families through the Center to Advance Palliative Care and the Vital Talk program.

AACN offers resources to support nurses as they care for patients infected with coronavirus, as well as education for staff members who don’t normally provide this kind of care. Visit our coronavirus page to learn more.

Facts & Figures

Financial Impact

The Center to Advance Palliative Care estimates six million people in the U.S. could benefit from palliative care and if it were fully available at U.S. hospitals, $6 billion could be saved each year.

Primary Palliative Care

Less than two-thirds of hospitals with more than 50 beds have a specialty palliative care resource, which means that the primary team caring for the patient is the best resource to provide this care.

Inpatients with Serious Illness

According to an AHRQ report, one in four Americans has multiple chronic conditions and hospital admission for patients with more than one chronic disease is increasing.

Training Makes a Difference

A study of 438 bedside nurses examined outcomes from live workshops and educational rounds and found significant increases in nurses’ confidence in their communication skills.

Remember that (palliative care) can be offered simultaneously with curative, aggressive, lifesaving treatments. People do not have to wait. They do not have to choose.
Clareen Wiencek, PhD, RN, ACHPN, ACNP, AACN past president

What’s the Difference?

There are sometimes subtle distinctions between palliative, end-of-life and hospice care, including patient prognosis, goals of care and insurance reimbursement.

Palliative Care

Palliative care is appropriate at any time in the trajectory of serious illness or injury and does not replace curative interventions.
Palliative care communication skills can be used to explain prognosis or uncertainty about prognosis and to elicit patient and family perspectives even if a change in the plan of care does not occur.
Insurance reimburses for specialty palliative care in the same way other consultative services are paid for and does not depend on a specific prognosis.
In some instances, palliative care is delivered by the primary care team instead of as an additional service. This is called primary palliative care.
Palliative care is given in many settings, including ICU, PCU, acute care or outpatient.

End-of-Life Care & Hospice

End-of-life care generally refers to patient care before death, either while undergoing curative treatment or after deciding to focus on comfort rather than cure.
With some serious illnesses, prognosis is uncertain and it is unclear if the care provided is end-of-life or life sustaining.
When patients have a prognosis of six months or less, they are eligible to enroll in hospice through their insurance coverage.
Hospice organizations provide a comprehensive set of services aimed at promoting comfort, and providing emotional support and education on what to expect during the dying process.
Hospice services can be delivered to patients at home, in a skilled nursing facility or in a hospital.

For more information on the difference between palliative and end-of-life care, consider watching a recorded NTI session on the topic.

Key Resources

Communication skills and education can increase your confidence when discussing goals of care with patients and families. Keep up with the latest developments in palliative care with this selection of AACN resources, intended to help you deliver the best evidence-based care.

Palliative Care Resources for Nurses During COVID-19

Review a case based blog with links to information that supports nurses in providing palliative and end of life care during COVID 19.

Explore

Palliative Care and Moral Distress: An institutional Survey of Critical Care Nurses

Do you or your colleagues experience moral distress providing curative treatment to patients with a poor prognosis? Read this journal article to learn about the association between palliative care skills and moral distress.

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A Passion for Palliative Care

Palliative care nurse practitioner and AACN past president Clareen Wiencek answers common questions about the intersection of palliative and critical care in this Q&A article. Consider how her insights and expertise from four decades of nursing could apply to your practice.

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AACN Position Statement: Ethical Triage and End-of-Life Care

AACN’s position statement gives specific actions for nurses and organizations when triage guidelines apply to the allocation of scarce resource.

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Additional Resources

Access AACN’s complete library of programs and publications on palliative & end-of-life care. This compilation of resources includes journal articles, webinars and CE activities to improve your understanding of palliative & end-of-life care and enhance your practice.