509718
research-article2013
NSQXXX10.1177/0894318413509718Nursing Science QuarterlyReed / Health and Public Policy
Health and Public Policy
Bridging Gaps for Policy: The DoctorallyPrepared Nurse Practitioner and End-ofLife Care
Nursing Science Quarterly 2014, Vol 27(1) 68–69 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318413509718 nsq.sagepub.com
Pamela G. Reed, RN; PhD; FAAN1 Keywords doctoral nurse practitioner, end-of-life care, nursing theory Not so long ago, nurses lacked jurisdiction over end-of-life care practice. This has changed. A major reason for the change is the doctorally-prepared nurse practitioner whose knowledge, skills, and expertise have synergistic potential for improving the care of individuals and their families facing the end-of-life. Policy plays an integral role in realizing the benefits these practitioners can bring to healthcare. End-of-life marks a critical time where policy influences nursing care. Evidence shows that while strides have been made during the past two decades, the healthcare system continues to provide inadequate care at the end-of-life (Aziz, Miller, & Curtis, 2012; Giovanni, 2012). Inadequate end-of-life care results in the many negative experiences that render lower quality of life at the ending of one’s life, including higher use of emergency services, poorer symptom and pain management, and institutional instead of home-based dying. Healthcare reform and the burgeoning aging population increase the urgency for the leadership of nurses in end-oflife care. Nurses bring not only unique knowledge and understanding of human needs at the end-of-life, but they bring a disciplinary ethic of practice that promotes quality of life during this inevitable life phase.
Nursing Knowledge and End-of-Life Care Policy that is linked to nursing knowledge, values, theories, and research findings can improve nursing practice. Nurses’ knowledge addresses the day to day health experiences that affect well-being; it is both holistic (in attending to the 24/7 complex physiological, psychosocial, and spiritual needs of individuals), and unitary (in conceptualizing the person as in process with environment in terms of having a family, a culture, and a history). The philosophical values and theoretical perspectives of nursing are congruent with the needs of individuals and families facing life-threatening illnesses. Nurses value patient and family-centered care where ideally the patient or family surrogate is regarded as leader in healthcare decisions. Nurses champion the priorities and perspectives of
patients and families. Further, nurses recognize health as a lifespan process where health experiences persist throughout aging and dying. Nursing conceptual frameworks and empirical evidence help to provide rationale for policy change and development. Nursing has robust theoretical frameworks to inform nurses about the complexity of end-of-life health experiences and care. Examples of the diversity of the theories and concepts range from managing symptoms to structuring meaning; caregiving to self-efficacy; comfort to chronic sorrow; facilitating rhythmic patterns – physiological, social and spiritual; and from hoping for the possible to human becoming in the face of illness. Theoretical frameworks may also guide development of models of care that someday become standards of practice for the interdisciplinary teams of providers needed in end-of-life care. Nurses prepared as practitioners at doctoral levels of education such as the Doctor of Nursing Practice (DNP) and Doctor of Philosophy (PhD) hold a visibly significant role in leading end-of-life healthcare practice, policy, and research initiatives. They have not only the knowledge but the scope and skills of practice to lead in the provision, investigation, and evaluation of end-of-life nursing care. They can do more than what is commonly described as filling the gap created by the physician shortage in end-of-life practice; they can bridge the gap by employing their holistic and unitary focus to engage the resources of the individual, family, and team of healthcare providers to enhance quality of life at end-of-life. Nurses can be leaders in innovative research in palliative care (Ferrell, 2010) to inform policy decisions for example, about medications and non-traditional care practices to reduce pain, ease symptoms, and enhance well-being. They also can lead in the discovery as well as implementation of
1
Professor, The University of Arizona
Contributing Editor: Pamela G. Reed, RN, PhD, FAAN, Professor, The University of Arizona College of Nursing, 1305 N. Martin St., Tucson, AZ 85721-0203 Email: [email protected]
Downloaded from nsq.sagepub.com by guest on March 29, 2015
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Reed / Health and Public Policy practices that facilitate patient and family well-being at end-of-life. With societal demand and educational preparation of doctorally-prepared nurse practitioners moving forward at a speedy pace, nurses must continue bridging other familiar gaps – among theory, research, and practice – that can impede the development of effective policy on end-of-life care. Practice-based knowledge and nursing theories are rich resources for policy development. As lead author, Dr. DuBois shares her keen insider’s view of the pragmatic policy issues that must be addressed if we are to see our philosophical perspectives and values enacted for the benefit of those facing end-of-life. Likewise, in heeding the call to practice to their “full extent,” nurse practitioners must not become untethered from the philosophical and theoretical ideas of their discipline.
Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this column.
Funding The author received no financial support for the research, authorship, and/or publication of this column.
References Aziz, N. M., Miller, J. L., & Curtis, J. R. (2012). Palliative and endof-life care research: Embracing new opportunities. Nursing Outlook, 60(6), 384-390. Ferrell, B. (2010). Palliative care research: Nursing response to emergent society needs. Nursing Science Quarterly, 23(3), 221-225. Giovanni, L.A. (2012). End-of-life care in the United States: Current reality and future promise – a policy review. Nursing Economics, 30(5), 127-135.
Downloaded from nsq.sagepub.com by guest on March 29, 2015
research-article2013
NSQXXX10.1177/0894318413509718Nursing Science QuarterlyReed / Health and Public Policy
Health and Public Policy
Bridging Gaps for Policy: The DoctorallyPrepared Nurse Practitioner and End-ofLife Care
Nursing Science Quarterly 2014, Vol 27(1) 68–69 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318413509718 nsq.sagepub.com
Pamela G. Reed, RN; PhD; FAAN1 Keywords doctoral nurse practitioner, end-of-life care, nursing theory Not so long ago, nurses lacked jurisdiction over end-of-life care practice. This has changed. A major reason for the change is the doctorally-prepared nurse practitioner whose knowledge, skills, and expertise have synergistic potential for improving the care of individuals and their families facing the end-of-life. Policy plays an integral role in realizing the benefits these practitioners can bring to healthcare. End-of-life marks a critical time where policy influences nursing care. Evidence shows that while strides have been made during the past two decades, the healthcare system continues to provide inadequate care at the end-of-life (Aziz, Miller, & Curtis, 2012; Giovanni, 2012). Inadequate end-of-life care results in the many negative experiences that render lower quality of life at the ending of one’s life, including higher use of emergency services, poorer symptom and pain management, and institutional instead of home-based dying. Healthcare reform and the burgeoning aging population increase the urgency for the leadership of nurses in end-oflife care. Nurses bring not only unique knowledge and understanding of human needs at the end-of-life, but they bring a disciplinary ethic of practice that promotes quality of life during this inevitable life phase.
Nursing Knowledge and End-of-Life Care Policy that is linked to nursing knowledge, values, theories, and research findings can improve nursing practice. Nurses’ knowledge addresses the day to day health experiences that affect well-being; it is both holistic (in attending to the 24/7 complex physiological, psychosocial, and spiritual needs of individuals), and unitary (in conceptualizing the person as in process with environment in terms of having a family, a culture, and a history). The philosophical values and theoretical perspectives of nursing are congruent with the needs of individuals and families facing life-threatening illnesses. Nurses value patient and family-centered care where ideally the patient or family surrogate is regarded as leader in healthcare decisions. Nurses champion the priorities and perspectives of
patients and families. Further, nurses recognize health as a lifespan process where health experiences persist throughout aging and dying. Nursing conceptual frameworks and empirical evidence help to provide rationale for policy change and development. Nursing has robust theoretical frameworks to inform nurses about the complexity of end-of-life health experiences and care. Examples of the diversity of the theories and concepts range from managing symptoms to structuring meaning; caregiving to self-efficacy; comfort to chronic sorrow; facilitating rhythmic patterns – physiological, social and spiritual; and from hoping for the possible to human becoming in the face of illness. Theoretical frameworks may also guide development of models of care that someday become standards of practice for the interdisciplinary teams of providers needed in end-of-life care. Nurses prepared as practitioners at doctoral levels of education such as the Doctor of Nursing Practice (DNP) and Doctor of Philosophy (PhD) hold a visibly significant role in leading end-of-life healthcare practice, policy, and research initiatives. They have not only the knowledge but the scope and skills of practice to lead in the provision, investigation, and evaluation of end-of-life nursing care. They can do more than what is commonly described as filling the gap created by the physician shortage in end-of-life practice; they can bridge the gap by employing their holistic and unitary focus to engage the resources of the individual, family, and team of healthcare providers to enhance quality of life at end-of-life. Nurses can be leaders in innovative research in palliative care (Ferrell, 2010) to inform policy decisions for example, about medications and non-traditional care practices to reduce pain, ease symptoms, and enhance well-being. They also can lead in the discovery as well as implementation of
1
Professor, The University of Arizona
Contributing Editor: Pamela G. Reed, RN, PhD, FAAN, Professor, The University of Arizona College of Nursing, 1305 N. Martin St., Tucson, AZ 85721-0203 Email: [email protected]
Downloaded from nsq.sagepub.com by guest on March 29, 2015
69
Reed / Health and Public Policy practices that facilitate patient and family well-being at end-of-life. With societal demand and educational preparation of doctorally-prepared nurse practitioners moving forward at a speedy pace, nurses must continue bridging other familiar gaps – among theory, research, and practice – that can impede the development of effective policy on end-of-life care. Practice-based knowledge and nursing theories are rich resources for policy development. As lead author, Dr. DuBois shares her keen insider’s view of the pragmatic policy issues that must be addressed if we are to see our philosophical perspectives and values enacted for the benefit of those facing end-of-life. Likewise, in heeding the call to practice to their “full extent,” nurse practitioners must not become untethered from the philosophical and theoretical ideas of their discipline.
Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this column.
Funding The author received no financial support for the research, authorship, and/or publication of this column.
References Aziz, N. M., Miller, J. L., & Curtis, J. R. (2012). Palliative and endof-life care research: Embracing new opportunities. Nursing Outlook, 60(6), 384-390. Ferrell, B. (2010). Palliative care research: Nursing response to emergent society needs. Nursing Science Quarterly, 23(3), 221-225. Giovanni, L.A. (2012). End-of-life care in the United States: Current reality and future promise – a policy review. Nursing Economics, 30(5), 127-135.
Downloaded from nsq.sagepub.com by guest on March 29, 2015
