Position Statement

THE ROLE OF THE NURSE IN PALLIATIVE CARE

Introduction
Palliative care is defined as: “… a concept of care which provides a coordinated medical, nursing and allied
health service for people with progressive incurable illnesses, delivered where possible in the environment of
the person’s choice, and which provides physical, emotional and spiritual support for patients, for families
and for friends. The provision of palliative care service includes grief and bereavement support for the
family and other carers during the life of the patient and continuing after death.’1

Palliative care is proactive care which seeks to maximise quality of life for people and families facing life
threatening illnesses. Dying and death are recognised as a part of life where opportunities remain for
personal growth and social contributions. Care aims to be responsive to, rather than directive of, the needs of
each person and their family.

Although it has a major focus on interventions for the relief of symptoms, palliation is recognised as more
than a physical experience. The influence of social, cultural, psychological and spiritual factors on the
experience of symptoms and dying demands a style of care that does not focus on death as a medical event.
In recognition of this, a multidisciplinary approach is an essential feature in the delivery of palliative care.
Multidisciplinary in this context means nursing, medical, allied health practitioners and volunteers working
together to meet the complex needs of the individual and their family.

While care of individuals in the palliative care phase of an illness has always had a place in Australian health
care, palliative care has emerged as a distinct specialisation over the last 20 years.

Specialist palliative care nurses bring a unique set of skills and qualities that enhance the care and support
provided to people facing the end of life and to the families and communities that support them. These skills
and qualities are developed through many years of interdisciplinary clinical practice and continuing
education and they are informed by the founding philosophies of palliative care.

Specialist palliative care nurses demonstrate leadership in autonomous and collaborative practice, in
modelling end of life care, and in providing mentorship and education to other nurses and health care
professionals. They have extensive knowledge and experience in the management of pain and complex
symptoms associated with terminal illness. Specialist palliative care nurses work collectively and with other
professional groups to advance the body of knowledge about end of life care, initiating and conducting
research and incorporating research findings where appropriate. They work collectively and with others to
advocate for change and provide policy advice to Government and professional organisations regarding a
wide range of clinical, professional and service related issues.

Specialist palliative care nurses’ knowledge of end of life issues, combined with a strong commitment to the
palliative care ethic, usually extends the work of the specialist nurses beyond the bedside to advocating the
need for palliative care on the sociopolitical level, and to promoting optimal well-being at the end of life
regardless of a patient’s location or financial position.

Specialist palliative care nurses are also advocates for the families and friends of palliative care patients, and
by promoting and teaching positive approaches to grieving they extend the benefit of palliative care to bring
health to the wider community.

While the contribution of all nurses to the care of people at the end of life is important, palliative care is
extended and strengthened by the knowledge and advocacy work of specialist palliative care nurses.
Royal College of Nursing, Australia believes that:
• Palliative care services are an integral and essential part of the health and community service system,
providing support for people who are facing their own deaths and to those who support these
individuals.
• Palliative care nursing is a key component in the multidisciplinary approach to care necessary to
meet the complex needs of individuals and their families/carers facing life threatening illnesses.
Care is directed towards easing the symptoms associated with end stage illnesses and the fears,
anxieties, grief and concerns of both clients and their families/carers.
• The central concerns for nurses in care of individuals in the palliative care phase of an illness are the
improvement of quality of life, the promotion of comfort and the preservation of dignity and choice.
• The community’s mandate to care for the individual with a life threatening and incurable illness
must be reflected by governments in the allocation of adequate resources sufficient to ensure that
palliative care is available when and where it is needed, for as long as it is needed. As integrated and
collaborative approach to the delivery of services is necessary as it is recognised that not all
palliative care is delivered within specialist palliative care services.
• Support and education should be made available for nurses care for the terminally ill and dying in all
settings.

Rational
Nursing is a discipline which has a fundamental concern with the human condition and the totality of human
experience including the end of life. Palliative care is an emerging specialisation of nursing and is
developing a body of knowledge and skills specifically focused on the care of people facing the end of life.

Nursing has a role in palliative care that is sanctioned and valued by the community. The continued
development of nursing knowledge and skills in this area, through the development of specialist palliative
care nursing, is a legitimate activity for nurses. Nurses recognise the diversity if services that may be needed
by individuals and their families or carers and acknowledge and value the multidisciplinary context in which
palliative care is delivered. The promotion of effective care for individuals in the palliative care phase of
their illness and their families and carers is a priority concern of nurses. Nursing care of individuals in the
palliative care phase of their illness occurs in a variety of clinical and geographical settings.

Royal College of Nursing, Australia recommends that:

• The recommendations of the Report to the Palliative Care Program Review Stage 12 be implemented
particularly in relation to the provision of adequate funding, the removal of barriers that inhibit the
integration of service delivery and performance measures.
• All nurses required to provide palliative care have access to specialist palliative care nursing
knowledge and skills.
• The Commonwealth retain funding for national palliative care programs, in recognition of the
developmental stage of palliative care in Australia.
• The multidisciplinary nature of palliative care continue to be acknowledged and supported.

Royal College of Nursing, Australia resolves to:

• Continue to support the education of nursed in palliative care.
• Encourage the development and recognition of palliative care as an area of speciality practice in
nursing.
• Work with other professional bodies in the promotion of multidisciplinary palliative care.
• Support efforts to acquire appropriate funding for palliative care services.

References:
1 Standards For Hospice and Palliative Care Provision, 1994 Australian Association for Hospic and Palliative Care,
Melbourne
2 Kasap D, 1996 Report to the Palliative Care Program Review Stage 2, Public Affairs, Parliamentary and Access ranch,
Commonwealth Department oof Health and Family Services publication No. 1833 Canberra.
 Authorised by Council of Royal College of Nursing, Australia
Date of issue: April 1998 Dated revised: April 2000 Date to be revised : November 2004