Nursing Research Paper

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Title: End-of-life and hospice care


End-of-life patients deserve to be taken care of like everybody else. To address their emotional and spiritual needs, these patients should be provided with extensive palliative care. This type of care can best be provided in hospices, where physicians can focus on improving the quality of their lives. In hospice care, the physicians also have the mandate of ensuring that the terminally ill patients die in safe and comfortable conditions. Pain management is a major component of hospice care because pain increases since in most cases pain intensifies as the terminally ill patient nears death.

This paper sought to examine whether hospice care enhances the end-of-life circumstances of a terminally ill patient especially in respect of pain management in nursing homes. In address this issue, the paper contains two sections. The first one highlights the importance of hospice care among terminally ill patients while the second one examines the role of hospice care in pain management. The paper concluded that hospice care brings about numerous improvements in the way pain is managed by creating collaborative opportunities for hospices and nursing homes to offer intensive palliative services to end-of-life residents



Abstract 2

Introduction. 3

The importance of hospice care among terminally ill patients. 3

The role of hospice care in pain management 5

Conclusion. 7

References. 8



Hospice care is normally provided to patients especially those who are terminally ill. It focuses a lot on palliation, whereby attention is on easing the pain or the disease without necessarily removing its cause (Higginson, 2003). It is based on the philosophy of care that entails addressing the spiritual and emotional needs of seriously ill or terminally ill patients. This type of care is today being provided in nursing homes as well in patients’ homes. In the United States, hospice care was introduced in nursing homes in 1985 following the extension of Medicare hospice benefit to Medicare beneficiaries receiving care in nursing homes (Miller & Gozalo, 2001).

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Today, a lot has been done to investigate the relevance of hospice care in end-of-life situations. It has been found out that in nursing homes, hospice care offers a unique opportunity where hospices can provide palliative services to residents who are faced with end-of-life situations (Miller, et al, 2002). A major component of this care is the management of pain. However, the debate on whether this type of care leads to an improvement in the way pain is managed in nursing homes is ongoing (Earle, 2004). The aim of this paper is to contribute to this debate by investigating the relevance of hospice care in bringing about improvements in the way pain is managed to enhance the end-of-life circumstances among terminally ill patients.

The importance of hospice care among terminally ill patients

Hospice care is essential for terminally ill patients. Such patients require a lot of attention in terms of both emotional and spiritual aspects. Those residing in nursing homes need even more attention because of the fact that they may be far away from their family members. In end-of-life situations, hospices must focus on the management of symptoms and pain. They must also pay special attention to the emotional and spiritual needs of the patients. Increased emphasis on these two aspects is the main factor that distinguishes hospice care from non-hospice care.

During the end-of-life phase of a patient, enrolment in a hospital-based hospice becomes one of the most appropriate courses of action. According to Teno (2004), this move is normally motivated by the assumption that patients who receive hospice care are less likely to endure persistent severe pain compared to those who rely on conventional care. Although this assumption has not been confirmed to be the reality through research findings, it continues to influence the decisions by relatives of terminally ill patients to facilitate the delivery of hospice care for their loved ones.

After hospice enrolment, many benefits are likely to be realized in terms of symptom management. This is primarily because of the specialized hospice care that end-of-life patients receive in these settings. It may be logical to argue that in hospice settings, patients have a better opportunity to receive better end-of-life care particularly in the context of nursing homes. This is because hospices are the only places where the most desired outcome is comfortable and safe dying. Moreover, hospices make concerted efforts to provide pain management services that are either poor or inaccessible in conventional environments that offer long-term care. This is one their core duties because it is the one that sets them apart from conventional long-term care facilities.

In many situations, end-of-life patients are normally taken to healthcare facilities where service providers are routinely torn between addressing the causes of the disease and managing the end-of-life realities of the patient. In such situations, the service providers normally fail to achieve the best outcomes either way. On the one hand, they end up failing to reverse the course of the disease. On the other hand, they give false hope to patients who later on feel desperate that their end-of-life situation has not been successfully reversed. In hospice care, the primary objective is always to ensure that all symptoms are being properly managed and that the terminally-ill patient is as comfortable as possible.

The objectives that hospices seek to achieve through analgesic management differ remarkably from those of conventional non-hospice environments. This is normally demonstrated in the prescribing practices of hospice personnel. However, this does not mean that these care providers should flout all the guidelines on pain management that have been put in place. Instead, the objective should be to ensure that as many end-of-life patients as possible are receiving analgesic treatment on a need basis. The targeted outcomes of such treatment should be designed in such a way that they enable the patient to live  for as long as possible and to endure the least pain during this time.

The role of hospice care in pain management

A disturbing situation has continued to exist whereby many end-of-life patients residing in nursing homes continue to languish in unrelieved pain. This is not how things should be. Although a patient may be terminally ill, the end-of-life situation should not be a reason enough to let him or her die in the most uncomfortable circumstances. In many situations, many terminally ill patients may be expected to live for several months or even years. It would be inhuman to condemn them to a live of unrelieved pain, however short that life might be perceived to be by the rest of humanity.

Lorenz & Lynn (2008) point out that for terminally ill patients, pain tends to intensify as death nears. This means that by providing hospice care to such patients, hospices are essentially giving the necessary attention to the end-of-life patients at the time when they need it most. End-of-life care cannot be said to be of high quality if the patient has been condemned into a life of pain. In some cases, it is possible for hospices to effectively treat this pain. For example, with an adequate level of commitment and proper specialized attention, it might is possible to treat pain affecting most cancer patients (Earle, 2008). In these situations, terminal sedation should be regarded as the option of last resort.

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Hospice care provides a unique opportunity for nursing home physicians to identify pain as a serious problem as far as end-of-life care is concerned. Failure to identify it as a problem leads to complacency among these physicians. In fact, this perception has greatly contributed to a negative mindset regarding pain and ways of dealing with it in hospice care. This may explain why many end-of-life patients are not being given the attention that they deserve in terms of pain management. A change of mindset will enable physicians to follow through with analgesic prescriptions and to provide adequate pharmacological treatment to all end-of-life patients regardless of the extent of disease progression.

The problem of inadequacy in regards to pain management is mainly prevalent among older adults. This situation in terms of demographics is one that is to be expected given the fact that most nursing homes are inhabited by older adults. However, the problem of improper pain management should not be tolerated even if it involved older adults. The medications used should never be allowed to exhibit inconsistency with pain management guidelines that have been put in place especially for these older individuals. The fact that an older person is terminally ill is not reason enough to flout existing guidelines on analgesic prescriptions and recommended pain management.

The American Medical Directors Association (AMDA) has even recognized the need to improve pain management among end-of-life patients residing in nursing homes (Miller, et al, 2002). The Association has gone to the extent of publishing guidelines on how chronic pain should be managed among terminally ill patients (Miller, et al, 2002). This is an indication of the importance of hospice care in contemporary medical practice. By providing guidelines on the medications that are recommended for populations residing in nursing homes, the AMDA has made a very important contribution to the ongoing debate on the importance of making hospice care accessible in nursing homes. Through this move, the Association has contributed to the shaping-up of the debate on the need to create collaborative opportunities for hospices and nursing homes to offer intensive palliative services to end-of-life residents.


Based on the discussion presented in this paper, it is difficult for anyone to deny that hospice care is essential to end-of-life patients. Such patients endure severe pain, which intensifies as they approach their date of death. Hospice care providers are the only people who can identify safe and comfortable dying as one of the best outcomes. Yet this is the one outcome that dying patients need most. Terminally ill patients need to be relived of pain like everybody else. In hospice settings, it is easy to evaluate whether the pain management practices are in line with the existing regulations on analgesic treatment. Therefore, this paper concludes that hospice care brings about numerous improvements in the way pain is managed by creating collaborative opportunities for hospices and nursing homes to offer intensive palliative services to end-of-life residents.



Earle, C. (2004). Trends in the Aggressiveness of Cancer Care Near the End of Life. Journal of Clinical Oncology, 22(2), 315-321.

Earle, C. (2008). Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue? Journal of Clinical Oncology, 26(23), 3860-3866.

Higginson, I. (2003). Is There Evidence That Palliative Care Teams Alter End-of-Life Experiences of Patients and Their Caregivers? Journal of Pain and Symptom Management, 25(2), 150-168.

Lorenz, K. & Lynn, J. (2008). Evidence for Improving Palliative Care at the End of Life: A Systematic Review. Annals of Internal Medicine, 148(2), 147-159.

Miller, S. & Gozalo, P. (2001). Hospice enrollment and hospitalization of dying nursing home patients. The American Journal of Medicine, 111(1), 38–44.

Miller, S., Mor, V., Wu, N., Gozalo, P. & Lapane, K. (2002). Does Receipt of Hospice Care in Nursing Homes Improve the Management of Pain at the End of Life? Journal of the American Geriatrics Society, 50, 507–515.

Teno, J. (2004). Family Perspectives on End-of-Life Care at the Last Place of Care. Journal of the American Medical Association, 291(1), 88-93.


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