Palliative & End-of-Life Care

Palliative Care in Acute & Critical Care Settings

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

AACN offers resources to support nurses as they care for patients with serious illnesses and those nearing the end of their lives, as well as education for staff members who don’t usually provide this kind of care. In addition, several respected organizations offer widely recognized resources on these topics, including the End-of-Life Nursing Education Consortium/ELNEC (palliative care training), Center to Advance Palliative Care (toolkits) and Vital Talk program (communication skills).

Facts & Figures

Financial Impact

The Center to Advance Palliative Care estimates 6 million people in the U.S. could benefit from palliative care. If it were fully available at all 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 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 admissions for patients with more than one chronic disease are 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.

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, designed to help you deliver the best possible evidence-based care.

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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Palliative Care in the ICU

Examine end-of-life patterns in chronically and critically ill patients, and identify the pharmacologic methods for providing comfort in this recorded session.

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Providing Primary Palliative Care in the ICU

Learn key skills every critical care nurse should have to talk with patients about palliative care and collaborate with the team for family meetings.

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Palliative Care in the ICU: Communication Skills in Practice

View videos demonstrating essential communication skills for providing primary palliative care in this interactive case-based webinar.

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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 and end-of-life care. This compilation of resources includes journal articles, webinars and CE activities to improve your understanding of palliative and end-of-life care, and enhance your practice.