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Discussion of completed service learning project:

My selected health concern focus is timely access to high quality palliative and/or hospice care
based on patients and families needs to promote improved patient-centered outcomes.

My plan for my service learning project is to present the data I have researched in a PowerPoint
presentation with a recorded voice-over.

For my service-learning project, I narrated an oral discussion of the role of palliative and

hospice care in end-of-life care. Palliative care is often confused with hospice care. I will explore

their similarities and differences and discuss what each has to offer patients and families.

Many times, when people hear the word hospice, they automatically associate it with

death and do not wish to discuss it as a treatment option. However, hospice is not about dying

but about living. If only we can get the general public (as well as all health care professionals) to

understand this, it would help tremendously in providing excellent end-of-life care (Galicia-

Castillo, 2011, p. 2219). Hospice care is a part of palliative medicine and is usually delivered

within the last six months of life when curative treatments are no longer being pursued. Studies

have shown that people in hospice care live longer than patients getting curative treatment for

the same illness (For hospice care, sooner is better, 2014).

The focus of palliative care is on symptom management and improving quality of life in

patients with a terminal illness. Palliative care, according to Dr. Galicia-Castillo, a geriatrician

board certified in hospice and palliative medicine, can be delivered concomitantly with curative

medicine and can occur at any time during a disease process (2011, p. 2219). The goal of

palliative care is to manage end-of-life symptoms while optimizing the quality of life

throughout the dying process (Rome, Luminais, Bourgeois, & Blais, 2011, p. 349).
The most important thing that palliative care and hospice care have in common is taking

care of people who are dying. Generally, a person is eligible for hospice services are eligible for

hospice service when there is a terminal prognosis is made with a life expectancy of less than six

months. Eligibility for palliative care has no such time constraint and, in fact, the earlier it is

started the better.

Evaluation of selected intervention:

Possible nursing interventions include:


1. Managing pain and other symptoms to provide best quality of life possible
2. Encouraging patient to identify end of life choices
3. Assist patient and family in anticipatory grieving process

My selected intervention was encouraging patients to identify desired end of life choices

based on increased understanding of the role of palliative care versus hospice care. Advance care

planning is a communication process wherein people plan for a time when they cannot make

decisions for themselves. It includes reflection, deliberation, and determination of a persons

values and wishes or preferences for treatments at the end-of-life ("Improving end-of-life

communication and decision making," 2015)

Goal #1: Create a shared understanding among patients, families, and healthcare

providers regarding what care choices are important to patients. Patients with long-term and/or

terminal illnesses have often lost control over many things. Advance care planning gives patients

back some control over their life how they want to be treated when seriously ill. It lets them

plan how they want to be treated when faced with a terminal prognosis.
Goal #2: Identify a healthcare proxy (HCP) who will make healthcare decisions if the

patient becomes unable to do so. It is important that the patient select someone they trust to make

significant decisions based on his or her understanding of the patients values, beliefs, and

desires. If a patient has not named a HCP, most states a default hierarchy that is used to identify

who can make decisions if the patient is unable; for example, if married, then the spouse would

become the HCP by default.

Discuss how this project contributed to professional collaboration & community

engagement: (Two well-developed paragraphs)

As I chose to give an oral presentation on my topic, no specific project was done.

However, in considering professional collaboration and community engagement, I would like to

explore a program that would address my nursing intervention and meet the two goals I

identified. Again, my intervention was to encourage patients to identify end of life choices. It is

not necessary for patients to be at end of life before deciding what kind of care they want.

Rather, the earlier advance care planning is addressed, the better prepared the patient, family, and

healthcare providers are to ensure the patients desires are accomplished.

Consider the following statistics:

60% of Americans report that they want their wishes respected at the end
of life

70% of those Americans have not completed an advance directive

80% of those diagnosed with a terminal illness want to have an end-of-life


conversation with their physician (Five Wishes [PDF], 2011).

Bridging the gap between the percentage of people who want their wishes respected at end of life

and those who actually have taken steps to make sure that happens is an important task for
healthcare providers. Starting the discussion is not always easy, even for those in the healthcare

field. One program that makes this process easier and simpler is Five Wishes, created by the

nonprofit organization Aging With Dignity. It is an easy to use advance directive tool that asks

simple questions written in plain, easy to understand language that help a person think about

important end-of-life issues. It is often called the living will with a heart and soul (Aging with

Dignity, 2017).

Five Wishes simplifies advance care planning by dividing the process into five steps, or

wishes. Each wish addresses a different aspect of care planning. When it is completed,

patients desires for how they want their healthcare to be addressed are clearly addressed and a

healthcare proxy is identified. Once the Five Wishes document is signed and witnessed, it

becomes legally binding and supersedes any previous documents. It meets state requirements in

42 states, including Maryland (Five Wishes [PDF], 2011).

Advance care planning can involve more than just the patient. Families, doctors, lawyers,

financial planners and even friends can participate in helping a patient make important decisions

about care options. It is best to start advance care planning before you actually need it. This will

help ensure that quality healthcare continues until the very end of life.

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