A Review of Clinical Practice Guidelines for Palliative Nursing (FR457-B)

Abstract

•Recognize and locate at least three clinical guidelines that are relevant to palliative nursing.•Identify domains of quality palliative care that are in need of nursing clinical practice guidelines. Clinical practice guidelines are meant to provide evidence-based recommendations that can optimize care. While the National Consensus Guidelines for Quality Palliative Care have provided an excellent foundation of understanding for the interdisciplinary practice of palliative care, clear practice guidelines for nurses can improve patient and family outcomes and guide nursing education. Practice guidelines concerning palliative care have been developed by various organizations and groups, but it has not been clear which of these are relevant to the clinical practice of palliative nursing. The aims of this review were to (1) Identify existing clinical practice guidelines with relevance to the practice of palliative nursing and (2) Identify gaps in the existing guidelines that require additional research or guideline development. Searches were conducted in the National Guidelines Clearinghouse, PubMed, and websites of professional nursing organizations using terms including palliative, nursing, symptoms, end-of-life, and hospice. Inclusion criteria included guidelines that were (a) specifically directed at nursing practice or that included nursing as one of multiple disciplines, (b) published, (c) evidence-based, and (d) included references. There were 25 appropriate guidelines, including the Oncology Nursing Society’s Putting Evidence Into Practice, which includes 20 topics. The National Consensus Guidelines for Quality Palliative Care were used as an organizing framework. The quality of the guidelines was assessed using AGREE II. Some excellent, evidence-based guidelines are available that give clear direction for nurses’ clinical practice. The domains best represented include physical aspects of care, psychological and psychiatric aspects of care, social aspects of care, and structure and processes of care. There is a need for guidelines concerning spiritual, religious, and existential aspects of care; cultural aspects of care; care of the patient at the end of life; and ethical and legal aspects of care. Additional guidelines are also needed on specific aspects of some domains, including some common symptoms that are not represented and anticipatory grief.