Palliative Care Nursing: Reducing Psychological Distress at End of Life
This paper examines the role of palliative care nurses in minimizing psychological distress for patients and their families during the end-of-life period. Drawing on the American Association of Colleges of Nursing's fifteen core competencies, the paper outlines the knowledge and skills nurses must possess to provide high-quality end-of-life care. It also explores the psychological challenges associated with neurodegenerative diseases such as Parkinson's, multiple sclerosis, Huntington's, and Alzheimer's, emphasizing how communication breakdowns, mood disturbances, and caregiver stress compound patient suffering. The paper concludes that anticipatory communication planning between nurses, patients, and families is essential to fulfilling these competencies and ensuring the best possible quality of life.
- Introduction: Growing need for palliative care and psychological preparation
- Palliative Care Nursing Competencies: AACN's fifteen core end-of-life nursing competencies
- Psychological Stress and End-of-Life Factors: Psychological challenges in neurodegenerative and terminal diseases
- Summary and Conclusion: Communication planning as key to minimizing distress
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What makes this paper effective
- It anchors its argument in an authoritative, enumerated list of nursing competencies from the American Association of Colleges of Nursing, giving the paper a concrete policy foundation.
- It connects abstract competency requirements to specific disease examples (Parkinson's, MS, Huntington's, Alzheimer's), making the clinical stakes tangible and specific.
- The conclusion ties the argument together by explaining how a single failure point — communication breakdown — can undermine every listed competency, demonstrating logical cohesion.
Key academic technique demonstrated
The paper demonstrates competency-based analysis: it introduces a formal framework (the fifteen AACN competencies), then uses secondary literature on neurodegenerative diseases to show where real-world care falls short of those standards. This technique of setting a normative benchmark and then stress-testing it against clinical evidence is common in nursing and health policy writing.
Structure breakdown
The paper follows a three-part structure. The introduction establishes the growing need for palliative care and frames the thesis around psychological distress. The body is divided into two substantive sections: the first catalogs the AACN's competency framework, and the second surveys the psychological and communicative challenges posed by specific neurodegenerative diseases. The conclusion synthesizes both sections by arguing that anticipatory communication planning is the linchpin of effective palliative nursing care.
Introduction
There was little in earlier centuries that health care professionals could actually do to help patients during the end-of-life period, except attempt to ease the pain and suffering experienced by the individual. However, recent research has identified specific competencies and best practices for nurses caring for patients during this transition period. Since people live longer in today's world and the elderly population continues to grow, more people with chronic illness are in need of palliative care.
Ferrell and Coyle (2002) relate that the way individuals die in today's world has changed: "Patterns of dying include the unexpected death; a steady decline with a short terminal phase; or a slower decline that often includes several crises before death occurs. In each case, patients at the end of life and their families will depend on expert nursing care to meet their needs." The world's population now includes more elderly individuals than ever before in history. Because of this, palliative care must extend beyond end-of-life care for trauma victims and those with terminal disease; it must ensure the best possible quality of life for every patient.
This can only be achieved by addressing not only physical needs such as pain relief, but also the psychological dimensions of care. Unmet psychological needs increase anxiety levels in both patients and their families and are likely to compound depression during a period already characterized by grief. It is therefore essential that the nurse prepare not only for their own professional role, but also prepare the patient and their family in order to minimize psychological distress during the end-of-life period.
Palliative Care Nursing Competencies
According to Ferrell and Coyle (2002), there is still room for improvement in palliative care. They note that nurses spend more time with patients and their families "than do any other health care professionals and are intimately involved in all aspects of end-of-life care. Thus, expert nursing care has the potential to greatly reduce the distress these patients and families feel." Ferrell and Coyle also point out that recent research has identified major deficiencies in nursing education pertaining to end-of-life care.
The American Association of Colleges of Nursing has identified fifteen specific competencies necessary for nurses providing high-quality care to patients and families during the end-of-life stage. Those competencies are:
(1) Recognize dynamic changes in population demographics, health care economics, and service delivery that necessitate improved professional preparation for end-of-life care; (2) Promote the provision of comfort care to the dying as an active, desirable, and important skill, and an integral component of nursing care; (3) Communicate effectively and compassionately with the patient, family, and health care team members about end-of-life issues; (4) Recognize one's own attitudes, feelings, values, and expectations about death, and the individual, cultural, and spiritual diversity existing in these beliefs and customs; (5) Demonstrate respect for the patient's views and wishes during end-of-life care; (6) Collaborate with interdisciplinary team members while implementing the nursing role in end-of-life care; (7) Use scientifically based standardized tools to assess symptoms — such as pain, dyspnea (breathlessness), constipation, anxiety, fatigue, nausea/vomiting, and altered cognition — experienced by patients at the end of life; (8) Use data from symptom assessment to plan and intervene in symptom management using state-of-the-art traditional and complementary approaches; (9) Evaluate the impact of traditional, complementary, and technological therapies on patient-centered outcomes; (10) Assess and treat multiple dimensions, including physical, psychological, social, and spiritual needs, to improve quality at the end of life; (11) Assist the patient, family, colleagues, and oneself to cope with suffering, grief, loss, and bereavement in end-of-life care; (12) Apply legal and ethical principles in the analysis of complex issues in end-of-life care, recognizing the influence of personal values, professional codes, and patient preferences; (13) Identify barriers and facilitators to patients' and caregivers' effective use of resources; (14) Demonstrate skill at implementing a plan for improved end-of-life care within a dynamic and complex health care delivery system; and (15) Apply knowledge gained from palliative care research to end-of-life education and care. (American Association of Colleges of Nursing, 1998)
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