Palliative Care in Critical Rural Settings

Abstract

The United States has 1332 critical access hospitals. These hospitals have fewer than 25 beds each and a mean daily census of 4.2 patients. Critical access hospitals are located in rural areas and provide acute inpatient services, ambulatory care, labor and delivery services, and general surgery. Some, but not all, critical access hospitals offer home care services; a few have palliative care programs. Because of the millions of patients living with serious and life-threatening conditions, the need for palliative care is increasing. As expert generalists, rural nurses are well positioned to provide care close to home for patients of all ages and the patients' families. A case report illustrates the role that nurses and critical access hospitals play in meeting the need for highquality palliative care in rural settings. Palliative Care in Critical Access Hospitals T he media frequently portray hospitals as large facilities filled with health care professionals, including physicians, nurses, respiratory therapists, and others, who perform lifesaving interventions and surgeries in emergency departments and critical care units on a daily basis. Although this depiction of large teaching hospitals located in urban cities across the United States is true, it is not an accurate portrayal of hospitals located in rural communities, where 1 registered nurse might be the only health care professional on duty at a hospital with fewer than 25 beds and a mean daily census of 4.2 patients.

Role of the Nurse in the Palliative Care Community

“…Millions of patients around the globe are living with serious and life-threatening conditions, requiring palliative care. Nurses can close this gap in rural and remote areas [25]. Diligent pain and symptom management, communication with the physician and other team members, communication about advanced directives and goals of care, education about self-care, and emotional support are all important roles of the community health nurse.…”

Management of Extracorporeal Membrane Oxygenation for Obstetric Patients: Concerns for Critical Care Nurses

“…32 Unfortunately, not all hospitals offer palliative care services. 33 The palliative care team can identify goals to optimize patient care and enhance communication between the patient, family, and all members of the health care team. 32 Enhanced communication and coordination of care can help to mitigate anxiety related to current clinical outcomes and potential death.…”

The Impact Of Palliative Care Course On Nursing Students’ Knowledge

“…Derste bu konuların yer almasının öğrencilerin palyatif bakıma ilişkin bilgi ve uygulamalarının gelişimine katkı sağlayacağı düşünülmektedir. Ülkemizde yapılan bir çalışmada, ulaşılan 111 üniversitenin yalnızca 11'inin hemşirelik eğitim müfredatında palyatif bakım dersi olduğu saptanmıştır (13) . Ülkemizde palyatif bakım merkezlerinin yeni olması nedeniyle klinik hemşirelerin, öğretim üyelerinin, palyatif bakım hastasıyla ilgili deneyimleri sınırlı düzeyde kalmaktadır.…”

“…Ülkemizde palyatif bakım merkezlerinin yeni olması nedeniyle klinik hemşirelerin, öğretim üyelerinin, palyatif bakım hastasıyla ilgili deneyimleri sınırlı düzeyde kalmaktadır. Aynı zamanda temel hemşirelik eğitiminde palyatif bakıma ilişkin herhangi bir ders/ünite bulunmaması ya da çok az bulunması nedeniyle gerek lisans düzeyinde gerekse hizmet içi eğitimle palyatif bakım alanında hizmet verecek teorik donanıma sahip hemşirelerin yetiştirilmesine gereksinim duyulmaktadır (13)(14)(15) . İlgili literatür incelendiğinde, ülkemizde sağlık profesyonellerinin palyatif bakıma olan ilgisinin gün geçtikçe arttığı ancak çalışma sayısının sınırlı sayıda olduğu görülmektedir (16)(17)(18) .…”