Critical access hospitals help meet need for high-quality palliative care in rural communities

Nurses at critical access hospitals are well positioned to provide high-quality palliative care close to home for millions of Americans in rural communities, according to an article in the February issue of Critical Care Nurse (CCN).

The United States has 1,332 critical access hospitals located in rural communities, providing mostly acute inpatient services, ambulatory care, labor and delivery services, and general surgery. With fewer than 25 beds each and a mean daily census of 4.2 patients, these hospitals may frequently have a single registered nurse as the only healthcare professional on duty.

The article "Palliative Care in Critical Access Hospitals" uses a case report to illustrate the role that critical access hospitals play in meeting the need for high-quality palliative care in rural settings.

Palliative care provides psychological, spiritual, goal-setting and decision-making support not only to patients with life-threatening illnesses but to their families as well. The benefits of such care include early initiation of comfort-focused treatment goals, decreased length of stay, continuity of care and reduced cost of care without an increase in mortality.

Unlike hospice care, palliative care is appropriate early in the course of illness, and patients can be simultaneously treated for their condition, including therapies intended to prolong life. Millions of patients are living with serious, complex and potentially life-threatening conditions, increasing the need for palliative and end-of-life care.

Co-authors Dorothy "Dale" M. Mayer, RN, PhD, and Charlene A. Winters, PhD, APRN, ACNS-BC, are on the faculty of the College of Nursing, Montana State University, Missoula.

"As expert generalists, rural nurses are well positioned to provide support and promote quality of life close to home for patients of all ages and their families," Mayer said. "In sparsely populated areas, nurses are not strangers to their patients, often providing care to their neighbors, friends and relatives."

The healthcare system is increasingly moving away from the consultative model of palliative care, in which clinicians bring in specialists to advise on individual cases.

The authors advocate for a different model, in which frontline staff, including physicians, nurses, social workers and chaplains, incorporate a palliative approach into patient care, especially with patients who have complex health conditions. This approach is especially suited for rural area and critical access hospitals, in part because of an inherent sense of community between friends and neighbors.

"With limited personnel and resources, healthcare providers can no longer rely on specialized palliative care teams as the only clinicians to provide palliative care," Winters said. "Working together, rural nurses and their urban nursing colleagues can provide palliative care across all healthcare settings to meet the needs of rural residents and their families."