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Care for the Dying.

In September 2000, CBS aired, "On Our Own Terms: Moyers on Dying," a four-part series that focused on the controversial issues of how our society and health care systems care for people at the end of life (EOL). This program documented the last months, days, and hours of several men and women as they struggled to balance their quality of life, which included comfort and dignity, with medical interventions.

Nurses provide care to the dying and chronically ill across the life span and in all settings. Nurses play a vital role in promoting responsible, competent, compassionate, appropriate, and ethically sound care (American Association of Critical Care Nurses, 1999). The quality of care provided to persons with a chronic, progressive illness and to persons near the end of life is of utmost concern to nurses and other health care providers. Nurses have an obligation to provide comprehensive and compassionate EOL and palliative care, which includes promoting comfort and pain relief, and at times, forgoing life-sustaining treatments (ANA, 1998).

There is documented widespread dissatisfaction from the U.S. public with care at the end of life. The Institute of Medicine (IOM) conducted and published a study, "Approaching Death: Improving Care at the End of Life" (Field & Cassel, 1997). The committee that developed the report proposed that "people should be able to expect and achieve a decent or good death: a death that is free from avoidable distress and suffering for patients, families, and care givers; is in general accord with patients' and families' wishes; and is reasonably consistent with clinical, cultural, and ethical standards." The IOM made several recommendations for achieving a compassionate care system. These include: (a) People with advanced, potentially fatal illnesses and those close to them should be able to expect and receive reliable, skillful, and supportive care; (b) Physicians, nurses, social workers, and other health professionals must commit themselves to improving care for dying patients and to using existing knowledge effectively to prevent and relieve pain and other symptoms; (c) Changes should be initiated in the undergraduate, graduate, and continuing education programs to ensure that practitioners have relevant attitudes, knowledge, and skills to care for dying patients; and (d) Palliative care should become a defined area of expertise, education, and research.

Improving Palliative Care

The nursing community has developed several initiatives to improve the public's perception of the profession's concern for palliative care. These varied and numerous initiatives are evidence of the nursing profession's commitment to EOL/palliative care. One of these initiatives is the Nursing Leadership Consortium on EOL Care at Johns Hopkins. The Nursing Leadership Consortium was developed to advance the nursing profession's commitment and efforts to improve EOL/palliative care. The Nursing Leadership Consortium was funded by the Open Society Institute through its Project on Death in America. The 4-day conference that Marcia Kucler, AMSN North Central Regional Director, and I attended was designed to assist nursing leaders to develop programs on EOL/palliative care within their specialty nursing organizations.

The 22 specialty nursing organizations were asked to submit an action plan on how they intend to integrate EOL/palliative care into their organization. The main points to the AMSN action plan are:

* Medical-surgical nurses do not provide the level of care that is optimal for patients and families experiencing EOL.

* Medical-surgical nurses are not educated in EOL/palliative care.

* AMSN is committed to educating its membership regarding clinical issues that impact our patients such as EOL/palliative care.

One recommendation in the action plan included the endorsement by the AMSN Board of Directors of the following statement that was developed by the 22 nursing organizations attending the Nursing Leadership Consortium.

Nursing's Commitment to Palliative Care

"We the undersigned, come together to express our commitment to the advancement of palliative care across the life span, and in all settings. We commit that our organization will seek opportunities to collaborate within the nursing profession and beyond in an effort to ensure the quality of care rendered to individuals, families, and communities.

"We have endorsed the Precepts of Palliative Care, developed by the Last Acts Palliative Care Task Force (December 1997), and we commit to participate in the translation and application of these Precepts for the area of nursing in which our membership is engaged."

The AMSN Board of Directors agreed to endorse this statement at its board meeting in October 2000. For additional information on the Last Acts and the Precepts visit

AMSN's Action Plan

AMSN has set forth the following action plan that will be implemented and revised as needed over the next 2 years: (a) Incorporate EOL/palliative care into AMSN's strategic plan, and (b) Form an ad hoc committee to develop and implement the educational plan, including: developing practice guidelines and position statements on EOL/palliative care, providing EOL/palliative care topics at the national convention, keeping our membership informed about EOL/palliative care issues via our Website; newsletter, AMSN News; and journal, MEDSURG Nursing.

The AMSN Board of Directors welcomes your comments and ideas regarding this very important aspect of patient and family education and care.


American Association of Critical Care Nurses. (1999, November). Designing an agenda for the nursing profession on end-of-life care: Report of the Nursing Leadership Consortium on End-off Life Care. AACN: Aliso Viejo, CA.

American Nurses Association (1998). Postion Statement on assisted suicide. Washington, DC: American Nurses Publishing.

Field, M.J. & Cassel, C.K. (Eds.). (1997). Approaching death: Improving care at the end-off-life. (Report of the Institute of Medicine Task Force). Washington, DC: National Academy Press.

Last Acts. (1997, December). Precepts of palliative care. (Task Force on Palliative Care). Princeton, NJ: Robert Wood Johnson Foundation.
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Title Annotation:planning palliative care
Author:Roman, Marlene
Publication:MedSurg Nursing
Article Type:Brief Article
Geographic Code:1USA
Date:Feb 1, 2001
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