Hospice Nursing: Quality of Life in Death

The origins of hospice can be traced back to the early 11th century A.D., describing a specific kind of lodging for traveling pilgrims. The term itself, hospes, meant hosts, as in hospitality. In the year 1095, Pope Urban ll called for the first holy crusade, resulting in thousands of European warriors and pilgrims heading to the holy land. The early hospes were actually lodging houses built to accommodate these weary travelers. As the journey to the holy land was dangerous, the focus within the hospes lodges quickly turned to caring for the sick and dying. The goal of this care was to comfort the ill until their death or recovery. The concept of (modern-day) hospice was born during these difficult times.

In the 1950’s, a physician named Cicely Saunders changed the way we think about the terminally ill. Speaking from her first-hand patient care experiences, she exposed the inadequacies of a hospice setting as a form of end-of-life care. She held a strong belief that physicians, rather than the currently used volunteers and nuns, should be the ones to treat hospice patients.  She was also instrumental in championing the notion that opioids should be used for pain management in a hospice setting, using such drugs to improve the quality of life for these patients.  Currently, an estimated one-third of Americans who are terminally ill are in hospice – a figure that is growing each year.

Hospice has been credited with saving Medicare money. Approximately one-third of Medicare costs are spent on end-of-life services. Hospice services significantly reduce those costs by eliminating needless, often costly treatments, and limiting the repetitive misuse of emergency room visits.  In addition, a hospice program offers a more holistic approach to care, offering an array of services, including pain management, grief counseling, patient and family services; these services are not traditionally offered at primary care offices or emergency department visits.

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Upon completion of this course, the participant will be able to:

  1. Discuss the need for hospice care in the United States (as it relates to the cost of medical care at end of life).
  2. Describe services available through the Medicare hospice program benefit. 
  3. Discuss differences palliative care versus hospice care.
  4. Verbalize understanding of the roles/responsibilities of hospice care team members. 
  5. Discuss the importance of living wills, durable powers of attorney (health care proxy). 
  6. Discuss various pain management protocols available under hospice care.
  7. Describe various spiritual, psychological and family issues that may occur in hospice care.
  8. Identify signs and symptoms of an “actively dying” hospice patient.
  9. Discuss self-care practices for hospice providers at risk for compassion fatigue/ moral distress.


Chapter 1: End-of-Life Care in America - Quantity Versus Quality

Chapter 2: Hospice Care and Medicare

Chapter 3: Palliative Care Versus Hospice Care

Chapter 4: Roles and Responsibilities

Chapter 5: Living Wills and Durable Powers of Attorney

Chapter 6: Pain Management in Hospice

Chapter 7: Spiritual, Psychological, and Family Issues

Chapter 8: Signs and Symptoms in the “Actively Dying”

Chapter 9: Compassion Fatigue and Moral Distress

Chapter 10: Case Study

Chapter 11: Additional Hospice Nursing Resources

Chapter 12: References

Price: $24.00

Contact Hours: 2

Course Author

Maureen Sullivan-Tevault

Maureen graduated nursing school in 1981 and has spent her years in the Emergency and Trauma field, including nursing positions as the Emergency Department Manager, Director of Staff Education, Trauma Coordinator, Cardiology Nurse Navigator, and Stroke Program Manager.

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