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Helping patients recover from their illnesses or medical conditions is one of the major goals of health care. Unfortunately, not all patients will recover. Some conditions are chronic and long-term, while others are fatal over a given period of time. In those cases, the protection of the patient's quality of life becomes the goal. This process, called palliative care, attempts to make patients comfortable and minimize or postpone the effect of their condition. Advanced practice nurses are often front-line caregivers in this field.
Evaluation and Planning
A detailed assessment of each new patient's condition, a sort of medical "you are here," is the first step for a palliative care nurse. The assessment includes a number of steps, including a review of the patient's medical records, consultation and collaboration with the patient's doctors, and often, a physical examination. In most states, the advanced practice nurse will have the authority to order laboratory tests or diagnostic images from the radiology lab. Once the assessment is complete, the nurse creates a treatment plan either independently, or in conjunction with physicians.
Once a plan is in place, the advanced practice nurse is responsible for monitoring and recording the patient's condition, and adapting care to meet the patient's needs. Depending on the patient's condition, that might include drug therapies, physical therapy, occupational therapy, or appropriate use of prosthetics and wheelchairs. Pain management often plays a significant role in treatment, allowing the chronically ill to function at higher levels. Nurses in long-term care facilities might primarily treat elderly patients as their physical state deteriorates. Others treat children with chronic illnesses, helping them to lead as normal a life as possible. A third career option is end-of-life care.
Palliative care nurses in nursing homes, oncology departments and other settings are frequently responsible for patients who are close to death. It's a stressful time for both patients and their family members, and palliative care nurses are often required to act as their counselors and educators. Patients close to death sometimes require especially high levels of painkillers, and nurses must be mindful of the potential for conflicts with other medications. Keeping patients pain-free but lucid enough to interact with family requires a high level of expertise.
Training and Practice
Advanced practice palliative care nurses are RNs who have several years' clinical experience, and have earned a graduate nursing degree from an accredited university. After practicing in palliative care for at least 500 hours as either a nurse practitioner or a clinical nurse specialist, nurses are eligible to take a certification exam through the National Board for Certification of Hospice and Palliative Nurses. A certified advance practice nurse's responsibilities will vary between states. In some, nurses can order tests, diagnose illnesses and prescribe medications on their own authority. In others, they must collaborate with a doctor or be supervised by one.
Fred Decker is a trained chef and certified food-safety trainer. Decker wrote for the Saint John, New Brunswick Telegraph-Journal, and has been published in Canada's Hospitality and Foodservice magazine. He's held positions selling computers, insurance and mutual funds, and was educated at Memorial University of Newfoundland and the Northern Alberta Institute of Technology.
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