The United States has 1,332 critical access hospitals located in rural communities, providing mostly acute inpatient services, ambulatory care, labor and delivery services, and general surgery. With fewer than 25 beds each and a mean daily census of 4.2 patients, these hospitals may frequently have a single registered nurse as the only healthcare professional on duty.
The article “Palliative Care in Critical Access Hospitals” uses a case report to illustrate the role that critical access hospitals play in meeting the need for high-quality palliative care in rural settings.
Palliative care provides psychological, spiritual, goal-setting and decision-making support not only to patients with life-threatening illnesses but to their families as well. The benefits of such care include early initiation of comfort-focused treatment goals, decreased length of stay, continuity of care and reduced cost of care without an increase in mortality.
Unlike hospice care, palliative care is appropriate early in the course of illness, and patients can be simultaneously treated for their condition, including therapies intended to prolong life. Millions of patients are living with serious, complex and potentially life-threatening conditions, increasing the need for palliative and end-of-life care.
Co-authors Dorothy “Dale” M. Mayer, RN, PhD, and Charlene A. Winters, PhD, APRN, ACNS-BC, are on the faculty of the College of Nursing, Montana State University, Missoula.
“As expert generalists, rural nurses are well positioned to provide support and promote quality of life close to home for patients of all ages and their families,” Mayer said. “In sparsely populated areas, nurses are not strangers to their patients, often providing care to their neighbors, friends and relatives.”
The healthcare system is increasingly moving away from the consultative model of palliative care, in which clinicians bring in specialists to advise on individual cases.
The authors advocate for a different model, in which frontline staff, including physicians, nurses, social workers and chaplains, incorporate a palliative approach into patient care, especially with patients who have complex health conditions. This approach is especially suited for rural area and critical access hospitals, in part because of an inherent sense of community between friends and neighbors.
“With limited personnel and resources, healthcare providers can no longer rely on specialized palliative care teams as the only clinicians to provide palliative care,” Winters said. “Working together, rural nurses and their urban nursing colleagues can provide palliative care across all healthcare settings to meet the needs of rural residents and their families.”
The American Association of Critical-Care Nurses, which publishes CCN, offers resources and tools to help nurses care for patients and their families at the most difficult times of their lives, including an e-learning course and a free, online self-assessment tool. For more information on palliative and end-of-life care, please visit www.aacn.org/palliativeedu.
As AACN’s bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.
Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org/.
About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high acuity, progressive and critical care settings. CCN enjoys a circulation of more than 106,000 and can be accessed at http://ccn.aacnjournals.org/.
About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than 500,000 acute and critical care nurses and includes more than 225 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. www.aacn.org; www.facebook.com/aacnface; www.twitter.com/aacnme
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