Recommendations to Leverage the Palliative Nursing Role During COVID-19 and Future Public Health Crises

William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN; Tamryn F. Gray, PhD, RN; Kimberly Chow, RN, ANP-BC, ACHPN; Patricia M. Davidson, PhD, RN, FAAN; J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN; Viola Karanja, BSN, RN; Judy Khanyola, MSc, RCHN; Julius D. N. Kpoeh, ASN, RN; Joseph Lusaka, BSc HM, DCM, PA; Samuel T. Matula, PhD, RN, PCNS-BC; Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN; Patricia J. Moreland, PhD, CPNP, FAAN; Shila Pandey, MSN, AGPCNP-BC, ACHPN; Amisha Parekh de Campos, PhD, MPH, CHPN; Salimah H. Meghani, PhD, MBE, RN, FAAN

Disclosures

Journal of Hospice and Palliative Nursing. 2020;22(4):260-269.

Abstract and Introduction

Abstract

With the daily number of confirmed COVID-19 cases and associated deaths rising exponentially, social fabrics on a global scale are being worn by panic, uncertainty, fear, and other consequences of the health care crisis. Comprising more than half of the global health care workforce and the highest proportion of direct patient care time than any other health professional, nurses are at the forefront of this crisis. Throughout the evolving COVID-19 pandemic, palliative nurses will increasingly exercise their expertise in symptom management, ethics, communication, and end-of-life care, among other crucial skills. The literature addressing the palliative care response to COVID-19 has surged, and yet, there is a critical gap regarding the unique contributions of palliative nurses and their essential role in mitigating the sequelae of this crisis. Thus, the primary aim herein is to provide recommendations for palliative nurses and other health care stakeholders to ensure their optimal value is realized and to promote their well-being and resilience during COVID-19 and, by extension, in anticipation of future public health crises.

Introduction

Palliative nurses play a primary and significant role in supporting the broader health care system. Right now, palliative nurses worldwide are providing an extra layer of support to nurses and care teams in emergency departments, intensive care units, skilled nursing facilities, and long-term-care environments. In the face of coronavirus disease 2019 (COVID-19), the palliative nursing workforce is delivering essential support and specialist services pertaining to symptom management, ethics and decision-making, communication, and care at the time of death, among others. As this pandemic continues to evolve, it has become clearer now more than ever that the work of the palliative nurse is indispensable as issues surrounding serious illness, dying, and death are no longer taboo but have become continuous threads of daily mainstream media, politics, and policy-making.

These authors argue that strategic and consistent investment in palliative nurses during COVID-19 and expanding their role and scope of work will strengthen the broader health system's resilience to respond effectively to COVID-19, as well as future pandemics and public health crises. While literature on the myriad health impacts of COVID-19 is rapidly emerging, the attention to palliative nurses in the broader COVID-19 discussion is a crucial gap requiring urgent attention. This article aims to address this gap. A compilation of resources and recommendations from palliative care and other key organizations for ongoing education and well-being support is also provided.

1 2 3 4 5 6

Next Section

Table 1. Advocacy and Leadership Strategies to Promote Universal Palliative Care Access During COVID-19 and Beyond
• Palliative nurses should work with organizations and policy stakeholders to align with international nursing optimization initiatives—such as the Nursing Now campaign—to actively raise the profile and status of nursing throughout the health care system and to the public. • Palliative nurses are the ideal clinicians to contextualize and adapt models of palliative care education to local needs for increased relevance to the population being served. Such education can be delivered to foster primary and specialist palliative care for multidisciplinary clinicians. • Inclusive, respectful, and mutually beneficial global health nursing and health care partnerships must be a priority for palliative nurses working across low-, middle-, and high-income nations. These collaborations emphasize knowledge exchange, skills transfer, and sustainability. • Palliative nurses must continue to advocate for full practice engagement as independent clinicians with unique contributions to interdisciplinary palliative care teams, primary team colleagues, and health organizations and systems.

Adapted from Rosa et al.³¹

Table 2. Resources to Support Palliative Nurses' Education, Practice, and Well-Being
Organization	Description	Website
• African Palliative Care Association	• Resources to guide palliative care practice in Africa and resource-constrained settings	• https://www.africanpalliativecare.org/articles/covid-19-resources/
• American Academy of Hospice and Palliative Medicine	• Tools, networks, and resources to guide self-care and patient education	• http://aahpm.org/education/covid-19-resources
• American Academy of Nursing	• Detailed timeline of policy advocacy to protect the public and nurses; links to multiple resources	• https://www.aannet.org/news/coronavirus
• American Association of Critical-Care Nurses	• Updates and resources for those in the critical care field, including technical information and content on moral distress in times of crisis	• https://www.aacn.org/clinical-resources/covid-19
• American Association of Nurse Practitioners	• Policy and practice updates for nurse practitioners working across settings	• https://www.aanp.org/advocacy/advocacyresource/coronavirus-disease-2019-covid-19-policy-updates
• American Holistic Nurses Association	• Holistic self-care strategies including meditation, movement, nutrition, and other modalities	• https://www.ahna.org/Home/Resources/Coronavirus-COVID-19
• American Nurses Association	• Crisis standards of care; nurse preparedness for advocacy, policy, safety, and self, patient, family, and community education	• https://www.nursingworld.org/practicepolicy/work-environment/health-safety/disaster-preparedness/coronavirus/
• American Organization for Nursing Leadership	• Resources to provide health system and hospital resources, webinars, and education	• https://www.aonl.org/updates-andresources-novel-coronavirus-covid-19
• American Psychiatric Nurses Association	• Tips and resources to support all impacted by COVID-19 and strategies for self-coping	• https://www.apna.org/i4a/pages/index.cfm?pageid=6686
• Ariadne Labs	• Serious illness care program COVID-19 response toolkit for communication and conversation needs	• https://www.ariadnelabs.org/coronavirus/clinical-resources/covid-conversations/
• Center to Advance Palliative Care	• Response resources for symptom management, communication, telehealth, among others	• https://www.capc.org/toolkits/covid-19-response-resources/
• End-of-Life Nursing Education Consortium (ELNEC)	• ELNEC free resources including training modules, materials to support staff, and other links	• https://www.aacnnursing.org/ELNEC/COVID-19
• European Association for Palliative Care	• Updates and resources on the European palliative care response to COVID-19 management	• https://www.eapcnet.eu/publications/coronavirus-and-the-palliative-care-response
• Coalition to Transform Advanced Care	• Resources for providers, patients, family caregivers, policy-makers, faith leaders, and foundations	• https://www.thectac.org/coronavirus/
• Hospice and Palliative Nurses Association	• Compilation of helpful resources to support both nurse and patient safety and well-being	• https://advancingexpertcare.org
• International Association for Hospice & Palliative Care	• Resources relevant for global palliative care in the context of COVID-19	• http://globalpalliativecare.org/covid-19/
• International Council of Nurses	• Global platform to share nurses' experiences, learnings, and advice from the frontlines	• https://www.2020yearofthenurse.org
• National Academy of Medicine	• Strategies to support the health and well-being of clinicians during COVID-19	• https://nam.edu/initiatives/clinician-resilience-and-well-being/clinician-well-being-strategies-during-covid-19/
• National Hospice and Palliative Care Organization	• Shared decision-making tool while considering likelihood of survival, preexisting conditions, and symptoms	• https://www.nhpco.org/wp-content/uploads/COVID-19-Shared-Decision-Making-Tool.pdf
• Robert Wood Johnson Foundation	• Updates, guidance, and information on ensuring health equity and supporting a culture of health throughout COVID-19	• https://www.rwjf.org/en/library/collections/coronavirus-disease-2019-covid-19.html
• Sigma Theta Tau International Honor Society of Nursing	• Relevant free continuing education and series of free expert webinars	• https://www.sigmanursing.org/sigma-is-here-for-you
• VitalTalk	• Communication guide and playbook for difficult conversations during COVID-19	• https://www.vitaltalk.org/guides/covid-19-communication-skills/
• Worldwide Hospice Palliative Care Alliance	• Internationally based resources for the public, health care professionals, and those working in resource-constrained settings	• http://www.thewhpca.org/covid-19

Authors and Disclosures

William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN
William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN, is Robert Wood Johnson Foundation Future of Nursing Scholar, University of Pennsylvania School of Nursing, Philadelphia.

Tamryn F. Gray, PhD, RN
Tamryn F. Gray, PhD, RN, is research fellow, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.

Kimberly Chow, RN, ANP-BC, ACHPN
Kimberly Chow, RN, ANP-BC, ACHPN, is nurse practitioner, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York.

Patricia M. Davidson, PhD, RN, FAAN
Patricia M. Davidson, PhD, RN, FAAN, is dean and professor, Johns Hopkins University School of Nursing, Baltimore, Maryland.

J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN
J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN, is assistant professor, University of Alabama at Birmingham School of Nursing; and codirector, Caregiver and Bereavement Support Services, UAB Center for Palliative and Supportive Care.

Viola Karanja, BSN, RN
Viola Karanja, BSN, RN, is deputy executive director, Partners in Health Liberia, Harper.

Judy Khanyola, MSc, RCHN
Judy Khanyola, MSc, RCHN, is Chair, Nursing and Mid wifery, University of Global Health Equity, Butaro, Rwanda.

Julius D. N. Kpoeh, ASN, RN
Julius D. N. Kpoeh, ASN, RN, is senior clinical mentor, Partners in Health Liberia, Harper.

Joseph Lusaka, BSc HM, DCM, PA
Joseph Lusaka, BSc HM, DCM, PA, is clinical manager, Pleebo Health Centre, Liberia.

Samuel T. Matula, PhD, RN, PCNS-BC
Samuel T. Matula, PhD, RN, PCNS-BC, is lecturer, University of Botswana, Gaborone.

Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN
Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN, is research associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio.

Patricia J. Moreland, PhD, CPNP, FAAN
Patricia J. Moreland, PhD, CPNP, FAAN, is assistant clinical professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

Shila Pandey, MSN, AGPCNP-BC, ACHPN
Shila Pandey, MSN, AGPCNP-BC, ACHPN, is nurse practitioner, Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York.

Amisha Parekh de Campos, PhD, MPH, CHPN
Amisha Parekh de Campos, PhD, MPH, CHPN, Robert Wood Johnson Foundation Future of Nursing Scholar, University of Connecticut, Storrs; quality and education coordinator, Hospice Program, Middlesex Health, Connecticut.

Salimah H. Meghani, PhD, MBE, RN, FAAN
Salimah H. Meghani, PhD, MBE, RN, FAAN, is professor and term chair of Palliative Care, University of Pennsylvania School of Nursing, Philadelphia.

Address correspondence to
William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN, University of Pennsylvania School of Nursing, 418 Curie Blvd, Claire Fagin Hall, Philadelphia, PA 19104 (wrosa@nursing.upenn.edu).

The authors have no conflicts of interest to disclose.