Nursing Care for HIV - Palliative Care for Nurses

Authors: Julia Downing, PhD, RGN; Liz Gwyther, MB ChB, FCFP, MSc Pall Med
Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA); Stacie Stender, MSN, MSc ID, FNP (More Info)

Last Reviewed: July 8, 2016 (What's New)

Credit Information

inPractice® Africa’s Continuing Education Unit (CEU) provider, the South African Medical Association, offers physicians 3 CPD points on a 70% pass rate for completing this individual module. Nonphysicians who successfully complete the module will receive a participation certificate. To learn more on CPD credits and participation certificates, click here.

Introduction: What Is Palliative Care?

  • The overall goal of palliative care is to promote quality of life in people with advanced disease[Twycross 2003; Pennel 2001]
  • Primary aims are to
    • Maximise a person’s ability to continue functioning for as long as possible
    • Support the patient’s family and friends
  • The concept of palliative care is complex and continues to evolve to meet the changing and differing needs around the world
  • The major focus of palliative care is the relief of suffering
    • This suffering is described by the patients themselves
    • Palliative care practitioners develop a care plan to respond to patients’ needs
  • Palliative care was described by the World Health Organisation (WHO) in 2002 as “an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering, the early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” (Table 1)[WHO 2002]
    • In the setting of HIV infection, management of antiretroviral therapy (including adherence support and adverse event management) and treatment of opportunistic infections constitute critical components of palliative care[Defilippi 2009]

Table 1. Aims of Palliative Care According to WHO[WHO 2002]

  • Provide relief from pain and other distressing symptoms
  • Affirm life and treat dying as a normal process without intending to hasten or postpone death
  • Integrate psychological and spiritual aspects of patient care
  • Offer support system using team approach to help patient live as actively as possible until death and to help family cope during patient’s illness and their bereavement
  • Enhance quality of life and positively influence the course of illness
  • Is applicable early in the course of illness, in conjunction with other therapies implemented to prolong life (eg, chemotherapy, radiation), and includes investigations needed to better understand and manage distressing clinical complications

  • Although palliative care can be provided by general practitioners within the context of a multidisciplinary team (additional details later in this chapter), there has been increasing recognition worldwide of the key role for nurses who have speciality training focused on palliative care
    • The Hospice Palliative Care Association of South Africa supports multiple Centres for Palliative Learning that provide training for staff of hospices, community partners, formal healthcare facilities, and tertiary-care institutions[Defilippi 2009]
    • A donor-funded Hospice & Palliative Care Association programme is providing training in palliative care for nurses in Africa[Defilippi 2009]
    • A link – nurse programme in Uganda has shown that training nurses throughout hospitals in palliative care can increase access to palliative care[Downing 2016]
    • The World Health Organisation has published guidelines for first-level facility health workers in dealing with symptom management and end-of-life care[WHO Palliative 2004]
  • This module provides detailed information on how nurse clinicians can provide effective, palliative care to persons living with HIV within their specific clinic setting