Hospice nursing. Present perspectives and future directives.

The specialty of hospice nursing calls for a highly skilled and knowledgeable practitioner. Four categories emerge to define and describe a specialist in hospice/palliative care nursing as one who practices: (a) intensive "caring"--the management of physical, psychological, social, and spiritual problems of dying persons and their families; (b) collaborative sharing--the coordinated and collaborated efforts of the extended and expanded components of hospice care services; (c) continuous knowing--the acquisition of the counseling, managing, instructing, "caring," and communicating skills/knowledge required for the specialty of hospice nursing; and (d) continuous giving--the balance of the hospice nurse's own self-care needs with the complexities and intensities of death and dying. To provide skilled, competent hospice nursing, two levels of hospice education are proposed, and descriptions are given for (a) the "hospice nurse certified (HNC)" who delivers competent, expert, and continuous patient/family care; and (c) the "hospice nurse advanced (HNA)" who provides educational needs and administers hospice care programs. Within the expanded and extended components of hospice care, the nurse works with an interdisciplinary team to provide care that is humanistic and supportive, and that is continuous and comprehensive.