Historical Review in Understanding Burnout, Professional Compassion Fatigue, and Secondary Traumatic Stress Disorder From a Hospice and Palliative Nursing Perspective

Christina S. Melvin, MS, PHCNS, BC, CHPN


Journal of Hospice and Palliative Nursing. 2015;17(1):66-72. 

In This Article


Historically, hospice and palliative care nursing has been recognized as encompassing the true essence of nursing. Dame Cecily Saunders, founder of the modern-day hospice movement, identified in 1967 that the needs of dying people are unique.[1] It has been through her work and that of Dr Elizabeth Kubler-Ross that the specific needs of dying people were addressed (physical, psychological, social, and spiritual). Dr Florence Wald, a nursing pioneer, led an interdisciplinary team to create the first hospice in the United States in the mid-1970s.[1]

The National Consensus Project for Quality Palliative Care defined palliative care as the following:

Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice. [2]

This definition broadens the scope of palliative care to care that encompasses those needs before end-of-life care and suggests that palliative care be integrated with life-prolonging therapy that subsequently is enhanced as death nears.[1] The goal is to change the standard of practice of palliative care to avoid "too little, too late."[1] Hospice care is described as a program through which palliative care is intensified as a patient moves closer to death. Ideally, a patient living with chronic, debilitating, or progressive disease receives palliative care throughout the course of that disease, and as death approaches, services are seamlessly increased to meet the patient's individual needs.[1]

This article will address the specific stressors that predispose hospice and palliative care nurses to PCF and/or STSD and differentiate these terms from burnout.