Recommendations to Leverage the Palliative Nursing Role During COVID-19 and Future Public Health Crises

William E. Rosa, PhD, MBE, ACHPN, FAANP, FAAN; Tamryn F. Gray, PhD, RN; Kimberly Chow, RN, ANP-BC, ACHPN; Patricia M. Davidson, PhD, RN, FAAN; J. Nicholas Dionne-Odom, PhD, MSN, MA, ACHPN, FPCN; Viola Karanja, BSN, RN; Judy Khanyola, MSc, RCHN; Julius D. N. Kpoeh, ASN, RN; Joseph Lusaka, BSc HM, DCM, PA; Samuel T. Matula, PhD, RN, PCNS-BC; Polly Mazanec, PhD, AOCN, ACHPN, FPCN, FAAN; Patricia J. Moreland, PhD, CPNP, FAAN; Shila Pandey, MSN, AGPCNP-BC, ACHPN; Amisha Parekh de Campos, PhD, MPH, CHPN; Salimah H. Meghani, PhD, MBE, RN, FAAN


Journal of Hospice and Palliative Nursing. 2020;22(4):260-269. 

In This Article

Palliative Care in Humanitarian Crises

The contribution of palliative care providers to alleviate serious health-related suffering is of utmost importance during this pandemic. Access to safe, high-quality palliative care throughout the life span has long been deemed a fundamental human right that should be available as a component of universal health coverage for all people everywhere.[19,20] The COVID-19 crisis increases the urgency to ensure palliative care delivery for those in need. Throughout past humanitarian emergencies, palliative care services have returned dignity and reduced the suffering of individuals and communities through holistic, person-centered care and timely symptom management to optimize quality of life.

During the Ebola crisis, clinicians advocated for sustainable mechanisms of palliative care delivery and education to fill the dire gap of relevant services.[21] In the face of migration emergencies, individuals with serious illness exposed to persecution and violence have high-level and complex emotional, mental, and spiritual needs against a backdrop of physical symptoms that require palliative care input.[22] Now, during the COVID-19 pandemic, the world is seeing how racial differences[23] and social inequities[24,25] influence who gets infected, how they manage symptoms, and the impact of varying levels of access to care on associated health outcomes. No matter the level of health system strain brought about by COVID-19, all patients must be cared for through strategic planning amid the surge in palliative care needs.[26]

Resilience Amid Crisis

Palliative care professionals are exposed to death and dying on a daily basis, and this experience has become all too common during the time of COVID-19. However, their exposure to trauma may result in positive changes, such as resilience and posttraumatic growth, which they cultivate within the patients and families for whom they provide care. Positive changes resulting from secondary traumatic stress may occur in the individual's psychological functioning, including self-perception, interpersonal relationships, and philosophy of life.[27] This effect is known as vicarious posttraumatic growth.[28] To promote the perception of benefits and meaning among patients and families facing COVID-19, resilience and posttraumatic growth can be protective factors favoring adaptation and effective coping.

In the era of COVID-19, palliative nurses can help patients and families be deliberate in navigating the middle of the resilience process, the part between "getting through" and "looking back."[29] The pandemic has already shown us how dramatically and quickly the health system and the world at large can shift in its approach to population health and individual patient needs.[29] Palliative nurses are central to facilitating growth and resilience during this public health crisis as patients and families learn to be intentional about overcoming the unexpected adversity, trauma, and significant sources of stress in their daily lives.