Nursing in Hospice and Terminal Care

Research and Practice

Barbara Petrosino, David M Dush

• Editorial: Routledge
• Año: 2021
• ISBN:
  9781317941453
• Edición: 1
• Categoría: Médecine
• Categoría: Théorie, pratique et référence de la médecine

A unique volume reflecting the state of the art in hospice nursing, Nursing in Hospice and Terminal Care addresses the special concerns of nurses--the primary professional caregivers in a hospice--in caring for terminally ill patients and in comforting their families. Experts highlight the major components of hospice nursing and address the enormous need for research that will help hospice nurses improve the quality of nursing care they are able to provide. Each valuable chapter is presented from a scientific base and offers practical applicability to nursing in various health care settings.

Patterns of Hospice Care—The RN Role

Nancy Burns
Kim Carney

Kim Carney received her Ph.D. in economics from Southern Methodist University in 1968. She joined the faculty of the University of Texas at Arlington in 1967, becoming full professor in 1975. During leaves of absence she has served as a faculty fellow in the Department of Health, Education, and Welfare (1973-74), a senior Fulbright lecturer at Osmania University in Hyderabad, India (1975-76), and a fellow of the American Research Center in Egypt (1983-84). Her published research includes: “Hospice Care: Some Insights on Nature, Demand, and Cost” (with N. Burns) in Hospice Handbook, Aspen Press, 1985; “Health in Egypt,” Journal of Public Health Policy, March 1984; “The Economics of Philanthropy,” Atlantic Economic Review, Fall 1976, and “Developments in Trading Patterns in the Common Market and EFTA,” Journal of the American Statistical Association, December 1970.

Nancy Burns received her Ph.D. in nursing from Texas Woman’s University in 1981. She joined the faculty of the University of Texas at Arlington in 1974, becoming Associate Professor in 1982. She is a Clinical Nurse Specialist in Oncology and has published a text on cancer nursing: Nursing and Cancer, Saunders Publishing Co., 1982. She is currently co-authoring a text on Nursing Research with Saunders Publishing Co. which will be published in 1987. Her published research includes: “The Caring Aspect of Hospice: An Economic and Nursing Analysis (with Kim Carney) in Hospice Handbook, Aspen Press, 1985; “Development of the Burns’ Cancer Beliefs Scales” Proceedings of the American Cancer Society Third West Coast Cancer Nursing Research Conference, and “Chronic Illness and Disability in the Hospice Setting,” The American Journal of Hospice Care, 2:37-41 (with Kim Carney).

This study is being funded by Grant #PBR-14 from the American Cancer Society.

ABSTRACT. The detailed recording of hospice care has made it possible to delineate the RN role which may lead to increased insight into all nursing care. The present study is part of a longitudinal study. The conceptual framework is a composite of economic and nursing theory and Carney & Burns (1985) model of health services. The sample (n = 360) is patients who died in a single hospice over four years. Data analyses include ordinary least squares multiple regression. Examining minutes of care by week, RN time was high the week of admission and the week of death, but dropped in other weeks, forming a U shaped curve. This curve contrasts markedly from that of other staff. Regression models were specified with two definitions of intensity of RN care: (1) total RN minutes and (2) RN minutes/day. The first estimates startup costs and the second relates the explanatory variables to amount of daily care. Startup time was well above 10 hours. Significant explanatory variables in equation (1) were patient age, patient/family calls, race, social class, and diagnosis. Significant variables in equation (2) included patient/ family calls, one week survival, two week survival, and diagnosis. Almost 2/3 of the variance of RN time can be explained by the equations. The findings can be used to develop acuity indices. Also, the equations illustrate the inadequacy of present methods of reimbursement which do not consider startup time.

The intuitive appeal of hospice care has attracted a broad range of supporters and generated considerable rhetoric. However, hospice has considerable significance beyond its positive emotional appeal. Not only is the hospice concept significant for the provision of humane and affordable care for dying patients but its care patterns and techniques have relevance for the rest of the health care system.

Although current research is documenting hospice care patterns and techniques, additional work is needed. This work requires three stages: First, it is necessary to provide detailed descriptions of the care in a fashion that makes it possible to measure. Secondly, it is desirable to identify as far as possible the determinants of the quantity and type of care provided. Thirdly, it is important to examine care as it relates to outcomes. From these insights two types of predictions are possible: the types and amounts of care likely to be needed for individual patient/family units, and probable outcomes as a consequence of variations in care. These insights can aid the hospice administrator in several ways. Ascertaining the determinants of hospice care contributes to the understanding of staffing needs. Relating care to outcomes provides insight on quality of care and assists the administrator in determining the mix and intensity of care that is least costly.

Among the various characteristics of hospice care that have been identified in the literature, one that is particularly important for this paper is that hospice care has been developed using an interdisciplinary model, perhaps to an extent not previously achieved in health care. A central purpose of this paper is to explore the care provided by the hospice with particular reference to the role of the nurse in the provision of this care. This paper is perceived as a step in meeting the first two research needs identified earlier: describing and measuring hospice care, and identifying determinants of that care. Examination is aided by the careful documentation generally practiced by hospices.

The procedure in this study is to consider the following: (1) a brief review of the literature on nursing within hospice care, (2) a description of the overall hospice research program of which this study is a part, and (3) outcome data pertaining to nursing care.

REVIEW OF THE LITERATURE

Although numerous articles have been published on hospice care, much of the literature is anecdotal, evangelical, or of a “how-to-do-it” nature. To date relatively little research or scholarly literature has been published on the role of the RN in hospice care. Where the RN role is discussed, it is usually in the context of some other discussion, such as the cost of hospice care. A computer search of studies dealing with nursing care within hospice published between 1980 and 1985 yielded sparse results. Most of these dealt with the RN role only cursorily. Those studies from this five year period which examined nursing in hospice addressed four perspectives: (1) the centrality of nursing within the multidisciplinary team by which hospice care is provided, (2) the intensity of nursing care in hospice as contrasted with nursing care for similar patients receiving nonhospice home care, (3) determinants of the intensity of nursing care in hospice, and (4) the quality of nursing care in hospice.

Centrality of Nursing Care

It is frequently observed by researchers that within hospice the role of the nurse and nursing care is central. This thesis is supported in various ways, such as observation of staffing patterns, services provided, and attitudes of patients and providers toward hospice services. Buckingham and Lupu (1982) found that 22 out of 24 hospices responding to their survey indicated the presence of an RN on the hospice staff. The only staff person reported more frequently than the RN was a secretary, present in 23 hospices. However, the mean number of hours per week worked by RNs was reported to be 150.9, almost three times as many hours as those worked by secretaries.

An example of the use of “services provided” to support the thesis of the centrality of nursing care within hospice are studies reported by Lack and Buckingham (1978) and Burns and Carney (1985). Lack and Buckingham (1978) compared activities performed by various staff of the hospice (LPN, RN, MD, social worker, and volunteer) using average hours per month per person devoted in a particular activity. The comparison indicated that with respect to the total number of visits, total visit hours, travel time and total time, RNs were surpassed only by the volunteer. RNs invested more time than other providers in initial assessment visits (2.4 hours), ongoing assessment visits (23.9 hours), direct physical care visits (9.1 hours), physical care—treatment visits (3.4 hours), physical care—medication visits (3.9 hours), supportive care—counseling (11.3 hours), supportive care—teaching visits (7.4 hours), supportive care—befriending (8.6 hours), volunteer supervision visits (5.0 hours), bereavement visits (4.4 hours), death pronouncements (1.3 hours), and discharges (1.7 hours).

Burns and Carney (1985) used a nursing process frame...