1. Ferrell, Betty PhD, RN, MA, FAAN, FPCN, CHPN

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Every month of our practice in palliative care, we move the field 1 step forward. We improve some aspect of care, take on a new patient population, or extend our care to a new setting. And yes, there are some months where we take 2 steps backward. But then, we get up and move forward again.


But some months, we take a big step. This is one of those months. In October 2018, the National Consensus Project, a coalition of 16 palliative care organizations, will release the fourth edition of the national clinical practice guidelines for our field. It has been 5 years since the National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care was updated. Since then, palliative care has expanded into new settings and is being offered by diverse types of organizations, such as health systems, office practices, cancer centers, dialysis units, home health agencies, hospices, long-term-care settings, and more.


The goal of the fourth edition is to improve access to quality palliative care for all people with serious illness, regardless of setting, diagnosis, prognosis, or age, by encouraging organizations and clinicians across the care continuum to integrate palliative care principles and best practices into their routine assessment and care of their patients.


The collaboration and consensus process for developing the fourth edition were significantly expanded from the third edition process. Leadership included representatives from every major organization in our field, including the following:


* American Academy of Home Care Medicine


* American Academy of Hospice and Palliative Medicine


* American Health Care Association


* American Medical Group Association


* Association of Professional Chaplains


* Center to Advance Palliative Care


* HealthCare Chaplaincy Network


* Hospice and Palliative Nurses Association


* Long-Term Quality Alliance


* National Association of Home Care and Hospice


* National Hospice and Palliative Care Organization


* National Palliative Care Research Center


* National Pediatric Hospice and Palliative Care Collaboration


* National Quality Forum


* Physician Assistants in Hospice and Palliative Medicine


* Social Work Hospice and Palliative Care Network



The fourth edition specifically focuses on 2 key elements:


1. Palliative care is inclusive of all people with serious illness, regardless of setting, diagnosis, prognosis, or age. As a result, language specific to the care of neonates, children, and adolescents was added throughout the guidelines.


2. Palliative care is the responsibility of all clinicians and disciplines caring for the seriously ill, including primary care practices, specialist care practices (such as oncology or neurology), hospitalists, nursing home staff, and palliative care specialist teams including hospice, hospital, and community-based palliative care teams.



In addition, 6 key themes were added to each domain:


* The elements of a comprehensive assessment are described.


* Family caregiver assessment, support, and education are referenced in numerous domains.


* The essential role of care coordination, especially during care transitions, is emphasized.


* Culturally inclusive care is referenced in all the domains and expanded in the Cultural Aspects of Care domain.


* Communication (within the palliative care team, with patients and families, with other clinicians, and with community resource providers) is prerequisite for delivery of quality care for the seriously ill and is emphasized throughout.



A new addition to the fourth edition is a systematic review with a formal grading of the evidence.


Palliative care nurses should celebrate these guidelines. Nurses have led the way from pioneering hospice care in America, developing the specialty field, and the Hospice and Palliative Nurses Association has led as an organization for the National Consensus Project. The Hospice and Palliative Nurses Association as an organization has been a driving force and led the way for other disciplines and organizations as they have joined this national movement, which has challenged the health care system and been a major force in transforming the care of the seriously ill.


To access the fourth edition of the guidelines, visit Read the guidelines. Use them to guide your practice. Challenge your organization to improve the quality of care set forward in these guidelines. Be proud that you are a part of this field and be very proud that you are a palliative care nurse.