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clinical nurse specialist, palliative care, Watson's Caring-Healing Theory





Purpose: The purpose of this article was to share the experiences and knowledge gained of the clinical nurse specialist's (CNS's) role in the development and implementation of an interdisciplinary geropalliative model of care.


Background: Across healthcare settings, patients with life-threatening or life-limiting illnesses often experience unwarranted suffering and inattention to their wishes. Studies demonstrate that a palliative approach to care can provide the structure for improved symptom management and earlier identification of patients' goals of care.


Description: A palliative model of care was adopted at a 721-bed healthcare facility that encompasses long-term, subacute care, and acute care. The model incorporated a consult team into an embedded approach that provided basic palliative skills in all care. Watson's Caring-Healing Theory guided the model.


Outcome: Nursing knowledge of palliative care improved, families expressed satisfaction with care, and the staff responded that palliative care positively impacted patient/family outcomes.


Conclusion: The structure, processes, and outcomes of care can be positively impacted by the CNS during the development and implementation of a palliative model of care. This occurred through CNS activities such as direct consultation, educational initiatives, mentoring, and disseminating assessment and care planning tools.


Implications: A geropalliative model of care can be integrated into a variety of healthcare settings. Clinical support and expertise contributed to positive outcomes. Questions for research include the need to identify a symptom assessment tool that is valid, reliable, and easy to use in the chronically ill, geriatric setting, as well as discerning innovative ways to disseminate knowledge to nurses.