Your FREE CHPN Flashcards 2026 – 250+ Cards

A prognosis of 6 months or less if the disease runs its normal course, certified by two physicians (or one plus the hospice medical director).

Palliative care = any stage, with curative treatment, no prognosis limit. Hospice = ≤6-month prognosis, comfort-focused, curative treatment of the terminal illness forgone.

Rates function 100% (well) to 0% (death) in 10% steps using ambulation, activity, self-care, intake, and consciousness. Lower/falling PPS = shorter prognosis.

A Karnofsky Performance Status ≤50% (needs considerable assistance) is a common functional threshold supporting hospice eligibility.

Functional Assessment Staging. Stage 7 = advanced dementia; FAST 7c (nonambulatory) plus a serious comorbidity supports hospice eligibility.

NYHA Class IV (symptoms at rest), optimally treated, often EF ≤20%, with refractory symptoms.

Disabling dyspnea at rest, disease progression (ED visits/hospitalizations), hypoxemia/hypercarbia, cor pulmonale, and unintentional weight loss.

Discontinuing or not pursuing dialysis, with creatinine clearance under 10 mL/min (under 15 with comorbidity).

INR over 1.5 and albumin under 2.5, plus ascites, SBP, hepatorenal syndrome, encephalopathy, or recurrent variceal bleeding; not a transplant candidate.

Rapid progression with critically impaired breathing capacity or critical nutritional impairment.

The patient's and family's values and priorities for treatment; they anchor the plan of care and shared decision making.

A collaborative process where the clinician shares medical information and the patient/family share values, reaching a care decision together.

An individualized, interdisciplinary plan addressing physical, psychosocial, and spiritual needs; under Medicare it is reviewed at least every 15 days.

Decreasing intake/wakefulness, cool mottled extremities, weak/irregular pulse, falling BP, low urine output, Cheyne-Stokes breathing, death rattle, terminal restlessness.

A transient rally — brief alertness or energy days before death — that should not be mistaken for recovery.

A pattern of crescendo-decrescendo breathing alternating with apneic pauses, common in the actively dying patient.

Bluish-purple skin discoloration of the extremities from poor perfusion; a sign of approaching death.

Coordinating care as the patient moves across settings/levels (home, inpatient, respite) to match changing needs.

Estimating life expectancy using functional scales (PPS, KPS), disease-specific criteria, and the trajectory of decline.

Routine home care, continuous home care, general inpatient (GIP), and inpatient respite care.

The default, most common hospice level — care delivered wherever the patient lives, with scheduled interdisciplinary-team visits.

Crisis-level care at home (≥8 hours in 24, mostly nursing) to manage an acute symptom and avoid hospitalization.

Short-term inpatient care for symptoms that cannot be controlled in other settings.

Short-term inpatient care (up to 5 consecutive days) to give the family caregiver a break.

Two 90-day periods, then unlimited 60-day periods, each requiring recertification of terminal illness (face-to-face for later periods).

The document by which a patient chooses the Medicare hospice benefit and comfort-focused care for the terminal illness.

Supporting the patient's right to define a meaningful, dignified end of life consistent with their values.

The direction and speed of decline (a falling PPS/KPS) often predicts prognosis better than a single static score.

Periodic re-certification that the patient still has a ≤6-month prognosis, required to continue the benefit; later periods require a face-to-face encounter.

Metastatic or locally advanced disease with declining function (PPS ≤ 50%) and a clinical course consistent with a ≤6-month prognosis.

Poor functional status (PPS ≤ 40%), inability to maintain hydration/nutrition, and post-stroke complications support eligibility.

FAST 7c plus a recent serious comorbidity (aspiration pneumonia, pyelonephritis, sepsis, stage 3–4 ulcers, or weight loss) strengthens eligibility.

Rates function 100% (normal) to 0% (dead) in 10% steps; KPS ≤ 50% is a common functional threshold for hospice.

Covers physical, functional, psychological, social, spiritual, and cultural domains plus goals of care — not just the disease.

Symptoms and function are reassessed regularly and whenever the condition changes, so the plan of care keeps pace with decline.

Medicare disease-specific guidelines (cardiac, pulmonary, dementia, etc.) used to support hospice prognosis and eligibility.

Prognosis combines a functional scale (PPS/KPS), disease-specific criteria, and the trajectory of decline — never a single number.

A validated tool scoring nine common symptoms 0–10 (pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, wellbeing, dyspnea).

Hospice/palliative care is delivered wherever the patient lives — home, assisted living, nursing facility, or inpatient unit.

A patient may revoke the hospice benefit (e.g., to pursue curative care) or be discharged if no longer terminally ill, and may re-elect later.

Under the ACA, children on Medicaid/CHIP may receive hospice AND curative treatment at the same time (concurrent care).

Early screening for spiritual distress, depression, anxiety, and social needs guides referrals to chaplaincy and social work.

Assess fall risk, home hazards, and caregiver ability as part of planning, balancing safety against the patient's goals.

Common illness trajectories — rapid (cancer), intermittent decline (organ failure), and prolonged dwindling (frailty/dementia).

Step 1: non-opioid (acetaminophen/NSAID). Step 2: weak opioid + non-opioid. Step 3: strong opioid + non-opioid. ± adjuvant at any step; move up if uncontrolled.

WHO principles: prefer the oral route, give persistent pain around-the-clock (not just PRN), and follow the ladder by severity.

Pure mu-agonist opioids (morphine, hydromorphone, oxycodone, fentanyl) have no ceiling dose — titrate to effect with acceptable side effects.

About 10–20% of the total 24-hour opioid dose, given PRN with an immediate-release form; frequent use means raise the scheduled baseline.

Scheduled dosing for persistent pain to keep a steady analgesic level, with PRN rescue doses for breakthrough flares.

Using an equianalgesic table to convert doses between opioids or routes so the new regimen gives comparable pain relief.

When rotating to a NEW opioid, reduce the calculated equianalgesic dose by about 25–50% because tolerance does not fully transfer.

Roughly 3:1 — oral morphine 30 mg is about equal to IV/subcutaneous morphine 10 mg.

Methadone has a long, variable half-life and non-linear potency; it requires specialist dosing and is not converted with a simple ratio.

Switching to a different opioid to improve the balance of analgesia and side effects (e.g., for neurotoxicity or poor control).

Drugs not primarily analgesic that relieve specific pain types — anticonvulsants, antidepressants, corticosteroids, bisphosphonates.

Gabapentin/pregabalin, TCAs (amitriptyline, nortriptyline), and SNRIs (duloxetine) for burning, shooting, or tingling nerve pain.

NSAIDs, corticosteroids (dexamethasone), bisphosphonates, and palliative radiation for painful bony metastases.

Needing a higher dose to achieve the same effect — a normal, expected pharmacologic response, not addiction.

Withdrawal symptoms on abrupt cessation or with an antagonist — expected and physiologic; managed by tapering, not addiction.

Compulsive use, loss of control, and continued use despite harm — a behavioral disease, uncommon when opioids treat pain.

Drug-seeking behavior driven by UNDER-treated pain that resolves once analgesia is adequate — not true addiction.

Cicely Saunders' concept that suffering is physical, psychological, social, and spiritual; all four must be addressed.

Pain from tissue damage — somatic (well-localized, aching) or visceral (deep, cramping, poorly localized).

Use behavioral indicators — facial grimacing, restlessness, guarding, moaning, vocalizations — and validated observational scales.

Start a stimulant laxative (senna ± docusate) with the first opioid dose; the body never develops tolerance to constipation.

Reserve for true opioid-induced respiratory depression; dilute and titrate in small aliquots to avoid precipitating severe pain and withdrawal.

Dose-related neurotoxicity (jerking movements); consider opioid rotation, hydration, or dose reduction.

Positioning, heat/cold, massage, relaxation, distraction, and palliative procedures (radiation, nerve blocks).

Reiki, hypnosis, acupressure, massage, music therapy, and pet therapy used alongside (not instead of) medical management.

Anxiety, depression, cultural, and spiritual factors can amplify the perceived intensity of pain — part of total pain.

Transdermal fentanyl is for stable, opioid-tolerant patients; it has a delayed onset/offset and is unsuitable for rapid titration of unstable pain.

Dexamethasone can relieve pain from nerve compression, raised intracranial pressure, and bowel obstruction, and also boost appetite and reduce nausea.

Give the dose needed to control the symptom; escalating an opioid to relieve pain near death is appropriate, guided by double effect.

Roughly 1.5:1 — oral morphine 30 mg ≈ oral oxycodone 20 mg (ratios vary by reference; verify locally).

Roughly 5:1 — oral morphine 30 mg ≈ oral hydromorphone 6–7.5 mg (potent; small numbers).

Roughly 5:1 — oral hydromorphone is about one-fifth as potent as IV; convert carefully because the drug is potent.

Total the 24-hour requirement, divide for the scheduled dose, and set the breakthrough dose at ~10–20% of the 24-hour total.

Adjuvants (steroids, anticonvulsants, antidepressants, bisphosphonates) can be added at ANY step, not only at the top.

Deep, cramping, poorly localized pain from organs (e.g., bowel obstruction, hepatic capsule); opioids ± antispasmodics/steroids.

Well-localized, aching pain from skin, muscle, or bone; responds to opioids, NSAIDs, and acetaminophen.

Self-report scales (0–10 numeric, Wong-Baker FACES) are the gold standard when the patient can communicate.

A behavioral pain scale for advanced dementia scoring breathing, vocalization, facial expression, body language, and consolability.

Acetaminophen has analgesic benefit but a dose ceiling (hepatotoxicity); useful as a non-opioid co-analgesic.

GI bleeding, renal impairment, and fluid retention limit NSAIDs, especially in the frail and renally impaired.

For STABLE, opioid-tolerant pain only; ~12 hours to onset and offset — never use for rapid titration of unstable pain.

When oral and IV access are lost, subcutaneous infusion/injection delivers opioids and other comfort meds at home.

Methadone's NMDA-antagonist action helps neuropathic pain but its variable, long half-life makes dosing specialist-only.

Lowers the seizure threshold and carries serotonin-syndrome risk; a weak opioid with a dose ceiling — limited in severe pain.

Avoid meperidine (Demerol) in palliative care — its metabolite normeperidine accumulates and causes neurotoxicity/seizures.

Lets the patient self-administer rescue doses within set limits; useful for rapidly changing or severe pain.

Epidural/intrathecal opioids, nerve blocks, and palliative radiation for pain refractory to systemic medication.

Because tolerance to opioid constipation never develops, a bowel regimen is started prophylactically with every opioid.

Myoclonus, hyperalgesia, delirium, and seizures from metabolite accumulation; treat with rotation, hydration, or dose reduction.

After any dose change or new analgesic, reassess pain and function to confirm benefit and detect toxicity.

Beliefs about pain, stoicism, and the meaning of suffering shape reporting and acceptance of treatment.

Acceptable comfort at rest and with activity, balanced against tolerable side effects — defined with the patient.

Pain from nerve/cord compression, raised intracranial pressure, capsular stretch, or bowel obstruction often responds to dexamethasone.

Low-dose opioids reduce the sensation of breathlessness (air hunger). Oxygen only if hypoxic; a fan to the face helps even without hypoxia.

Like pain, dyspnea is what the patient says it is; a normal pulse oximetry reading does not rule it out.

Noisy breathing from pooled secretions in the actively dying patient — usually more distressing to family than to the patient.

Reposition and give an antimuscarinic (glycopyrrolate, scopolamine, atropine, hyoscyamine). Avoid deep suctioning. Reassure the family.

Acute, fluctuating confusion common near death; assess reversible causes (meds, infection, pain, retention, hypoxia, metabolic).

Haloperidol is first-line for agitation, plus non-pharmacologic measures — reorientation, calm environment, family presence.

Chemoreceptor trigger zone nausea (opioids, metabolic) responds to haloperidol, metoclopramide, or ondansetron.

Treat with the prokinetic metoclopramide to improve gastric emptying.

Treat with antihistamines or anticholinergics (scopolamine, meclizine).

Octreotide, anticholinergics, and corticosteroids reduce secretions and colic when surgery is not appropriate.

Stimulant ± osmotic laxative; avoid bulk-forming fiber in opioid-induced constipation. PAMORAs (methylnaltrexone) for refractory cases.

Always exclude fecal impaction and bowel obstruction before increasing laxatives.

A natural part of advanced dying; artificial nutrition/hydration usually does not prolong life or improve comfort and can worsen symptoms.

Reassure family that reduced appetite and intake are normal at the end of life; offer small amounts of preferred food for pleasure.

The most common symptom in advanced illness; treat reversible contributors (anemia, depression, meds) and pace activities.

Agitation in the actively dying; rule out reversible causes (pain, retention, dyspnea) then treat for comfort, sometimes with sedatives.

Itching from opioids, cholestasis, or uremia; treat the cause and use antihistamines or, for cholestatic itch, other agents.

Can cause agitation/restlessness in a dying patient; assess the bladder and consider catheterization for comfort.

Reposition, protect skin, and manage moisture; near death the goal shifts to comfort rather than aggressive turning if it causes distress.

Frequent moisturizing and oral care relieve dry mouth in patients with low intake and mouth breathing — a key comfort measure.

Benzodiazepines (e.g., rectal or buccal midazolam/lorazepam) are used when the oral route is lost.

Persistent hiccups may respond to chlorpromazine, baclofen, or metoclopramide; treat reversible causes.

Suffering related to meaning, hope, or faith; distinct from depression — involve chaplaincy and use a spiritual assessment.

Benzodiazepines for acute anxiety; address fears and unmet psychosocial/spiritual needs alongside medication.

A catastrophic bleed; have dark towels and a fast-acting sedative ready, stay with the patient, and support the family.

Manage for comfort — positioning, gentle diuretics if helpful, and avoiding over-hydration that worsens fluid overload.

Hearing is thought to remain until close to death; encourage family to keep talking to the patient.

Opioids can suppress a distressing dry cough in advanced illness when other measures fail.

Oxygen relieves dyspnea only when the patient is hypoxic; for non-hypoxic air hunger, airflow and opioids are more effective.

Treat reversible causes; use low-dose opioids first-line, a fan to the face, positioning, and benzodiazepines for associated anxiety.

Start a low dose of an immediate-release opioid (e.g., morphine 2.5–5 mg PO) and titrate to comfort.

Match the drug to the pathway: CTZ (haloperidol), gut/stasis (metoclopramide), vestibular (anticholinergic/antihistamine), cortical (benzodiazepine).

A 5-HT3 antagonist useful for chemotherapy/radiation-related nausea; may worsen constipation.

Manage medically with octreotide, anticholinergics, antiemetics, and corticosteroids; a venting gastrostomy if needed.

Treat the cause; loperamide for symptom control; review laxatives and rule out overflow around an impaction.

Corticosteroids (short-term) or megestrol may transiently improve appetite; neither reverses cachexia or prolongs life.

Tube feeding/IV fluids generally do not prolong life or improve comfort at the very end and can worsen secretions and edema.

Screen for and treat reversible causes (medications, infection, pain, urinary retention, hypoxia, metabolic) before sedating.

Quiet, withdrawn confusion that is easily missed; manage reversible causes and minimize deliriogenic drugs.

Antimuscarinics work best when started early, before large volumes pool; they dry new secretions but not existing pooled fluid.

Turning the patient to a lateral or semi-prone position helps drain pooled secretions and reduce the death rattle.

Treat for comfort (antipyretics, cooling); antibiotics are used only when they improve comfort, consistent with goals of care.

Address pain, anxiety, and environment first; use sleep aids judiciously, as they can worsen confusion in the frail.

Persistent hopelessness, worthlessness, and anhedonia suggest depression (treatable), distinct from normal anticipatory grief.

The most common and distressing symptom; treat reversible causes, pace activity, and consider a psychostimulant in selected patients.

Manage with skin care, compression, and gentle exercise; treat associated discomfort and infection risk.

Topical metronidazole, charcoal dressings, and odor control improve comfort and dignity with malodorous fungating wounds.

Painful oral inflammation from cancer therapy; manage with oral care, topical analgesics, and systemic analgesia.

Confusion, constipation, nausea, polyuria, and weakness; treat with hydration and bisphosphonates if consistent with goals.

An oncologic emergency — back pain with weakness/sensory loss; give dexamethasone urgently and consider radiation.

Facial/arm swelling and dyspnea from SVC obstruction; treat with steroids, head elevation, and oncologic therapy or stenting.

A full bladder or impacted stool is a common, reversible cause of terminal restlessness — check before sedating.

Near death, interventions (turning, vitals, labs) are continued only if they add comfort, not by routine.

A legal document — a living will (treatment preferences) plus a durable power of attorney (names a health care surrogate) — for future incapacity.

A written statement of a person's treatment preferences if they lose decision-making capacity.

A document naming a surrogate (proxy) to make medical decisions if the patient cannot.

Portable, actionable medical orders signed by a clinician for a seriously ill patient — code status, intubation, nutrition — that travel across settings.

An advance directive guides future care; a POLST is an immediately actionable clinician order for current care.

Requires facilities to ask patients about advance directives and inform them of their right to accept or refuse treatment.

Covers care related to the terminal diagnosis — IDT visits, medications, DME/supplies — and bereavement support for up to 13 months after death.

Grief support the hospice provides to the family for up to 13 months after the patient's death.

Grief experienced before the death by patient and family as they anticipate the loss; a normal response.

Persistent, impairing grief lasting well beyond the expected period; a clinical concern warranting referral.

Grief = internal response to loss; mourning = outward/cultural expression; bereavement = the state of having lost someone.

Denial, anger, bargaining, depression, acceptance — DESCRIPTIVE, not linear, universal, or required; a framework, not a checklist.

Breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary.

Empathic responses to emotion: Name, Understand, Respect, Support, Explore.

Assess what the patient knows/wants, give information in small chunks, then check understanding.

A structured conversation to share information and align goals of care among patient, family, and the team.

An ongoing stance of openness and self-reflection — ask rather than assume about beliefs on disclosure, decisions, and rituals.

Faith, Importance, Community, and Address in care — a tool to explore a patient's spirituality.

When a patient expresses strong emotion, address it (empathy) before giving more medical information.

Pausing after bad news or emotion gives the patient space to process and respond.

Promoting rest, support, and respite for family caregivers to prevent burnout and sustain caregiving.

Train caregivers in medication administration, symptom recognition, what to expect when dying, DME use, and whom to call.

Teach families secure storage and proper disposal of opioids to prevent diversion and accidental harm.

Address family fears that opioids cause addiction or hasten death; correct misconceptions so pain is treated adequately.

Respectful care of the body after death, honoring cultural/religious practices, and supporting the family's presence and rituals.

Being present, explaining what is happening, normalizing the process, and supporting the family through the moment of death.

Assess environmental, physical, and socioemotional risks — fall hazards, medication safety, caregiver capacity.

Some cultures favor protecting the patient from a terminal diagnosis; clarify who should receive information and how.

Help patients shift hope from cure to achievable goals — comfort, time with family, dignity, life closure.

A DNR/AND order directs that CPR not be attempted; clarify it is separate from, and does not stop, comfort care.

Preferred framing over 'DNR' — emphasizes allowing a natural death and continuing comfort, not withdrawing care.

If no health-care proxy is named, most states follow a statutory order (spouse, adult child, parent, sibling) for the surrogate.

The surrogate decides as the patient WOULD have decided, based on the patient's known values — not on the surrogate's own wishes.

Used when the patient's wishes are unknown — decisions are made in the patient's overall best interest.

Capacity is a clinical, decision-specific judgment; competence is a legal determination by a court.

Tailor teaching to the patient's literacy — plain language, teach-back, and written/visual aids improve understanding.

Ask the patient/caregiver to restate instructions in their own words to confirm understanding.

Some families prefer to shield the patient from a terminal diagnosis; clarify the patient's own disclosure wishes respectfully.

Representing and protecting the patient's preferences, dignity, and access to needed care across the team and system.

Support children's grief with honest, age-appropriate language; avoid euphemisms like 'gone to sleep.'

Identify family at higher risk for complicated grief (sudden loss, prior losses, poor support) for targeted follow-up.

Healthy grieving oscillates between loss-oriented and restoration-oriented coping over time.

Maintaining a healthy ongoing connection to the deceased (memories, rituals) is part of normal grieving, not pathology.

Helping patients create legacy (letters, recordings, life review) supports meaning and dignity near the end of life.

Connect families to community resources — financial, respite, equipment, support groups, spiritual care.

Teach families the signs of approaching death so changes feel anticipated rather than alarming.

Assess and address the physical, emotional, and financial strain on caregivers as part of the unit of care.

Elicit the patient's values, hopes, and fears, then align recommendations and treatment with them.

Provide balanced information so the patient/family can make informed choices; do not coerce a decision.

Spirituality (meaning, hope, connection) is broader than religion and applies even to non-religious patients.

Facilitate and support family presence, normalize the process, and honor their cultural and religious rituals.

Record advance directives, code status, and goals so they travel with the patient and guide all team members.

Acknowledge emotion, allow silence, and respond to feelings before adding more medical detail.

The ethical principle respecting a patient's right to self-determination and informed choices about their own care.

The ethical duty to act for the patient's good.

The ethical duty to do no harm.

The ethical principle of fairness in the distribution of care and resources.

Fidelity = keeping commitments to the patient; veracity = truth-telling.

An act with a good intended effect (relief of suffering) is permissible despite a foreseen, unintended harm if intent is good, dose proportionate, and harm not the means.

Titrating sedation to relieve refractory, intolerable symptoms in an imminently dying patient; the intent is symptom relief — ethically and legally accepted.

Intentionally causing a patient's death — distinct from palliative sedation in both intent and act.

A clinician provides the means for a patient to end their own life; distinct from euthanasia and from palliative sedation.

Nurse, physician/medical director, social worker, chaplain, hospice aide, bereavement counselor, and volunteers — with patient and family at the center.

Medicare requires the interdisciplinary team to review and update the plan of care at least every 15 days.

The NCP Clinical Practice Guidelines for Quality Palliative Care — the national standards for palliative care practice.

Federal requirements a hospice must meet to receive Medicare payment, covering the IDT, plan of care, and quality.

Physician certification that the patient has a ≤6-month prognosis; required at admission and at each benefit period.

A required visit by a physician or nurse practitioner before the third and later hospice benefit periods to recertify eligibility.

The federal law protecting the privacy and security of patients' health information.

The federal agency setting workplace-safety standards, including bloodborne-pathogen and hazard protections for nurses.

Maintaining a therapeutic, not personal, relationship with patients and families to protect both parties.

Emotional and physical exhaustion from caring for the suffering, reducing empathy over time; an occupational risk in hospice.

Chronic work-related exhaustion, cynicism, and reduced efficacy; mitigated by boundaries, support, and self-care.

The distress that arises when a nurse knows the right action but is constrained from taking it.

Stress from repeated exposure to others' trauma and suffering; addressed through debriefing and peer support.

Reflective practice, debriefing, boundaries, peer support, and resilience practices — explicitly part of the Practice Issues domain.

Hospices must run a data-driven QAPI program to monitor and improve care quality and safety.

Follow DEA and facility rules for prescribing, counting, wasting, and disposing of opioids and other controlled drugs.

Verify the patient meets hospice criteria — a ≤6-month prognosis and election of comfort-focused care — before admission.

Contributing to the professional development of peers and students as an educator, preceptor, or mentor.

Staying current on legislation, policy, reimbursement, and health-care delivery changes that affect hospice and palliative care.

Recognized standards and guidelines (NHPCO, NCP) that define quality hospice and palliative nursing practice.

(1) the act is good/neutral, (2) intent is the good effect, (3) the bad effect is not the means, (4) proportionality.

Sedation is titrated to the lowest level that relieves the refractory symptom — only as deep as needed for comfort.

A symptom that cannot be adequately controlled despite aggressive, tolerable treatment — the threshold for palliative sedation.

Ethically equivalent — there is no moral difference between not starting and stopping a treatment that no longer serves goals.

Voluntarily stopping eating and drinking — a capacitated patient's legal choice; the team provides comfort care and support.

Legal only in some states under strict criteria; distinct from euthanasia (patient self-administers); know your jurisdiction's law.

A nurse may decline to participate in certain acts on moral grounds but must not abandon the patient and must ensure continuity.

Nurses do not abandon patients who express a wish to hasten death — they assess suffering and engage the team.

A resource to help resolve value conflicts and complex end-of-life decisions among patient, family, and team.

Voluntary agreement to treatment after disclosure of risks, benefits, and alternatives by a capacitated patient.

Protect health information; disclose only with consent or where law requires (e.g., safety, mandated reporting).

Provides direct care, coordinates the plan, communicates observations, and educates patient, family, and team.

Certifies terminal illness, oversees the medical component of care, and supports the IDT.

Medicare requires hospices to use trained volunteers (≥5% of patient-care hours) for companionship and support.

The Hospice and Palliative Nurses Association — the professional organization providing standards and education for the specialty.

The Hospice and Palliative Credentialing Center — the body that administers the CHPN and related certifications.

HPNA/ANA standards defining competent hospice and palliative nursing practice and professional responsibilities.

Integrating best evidence, clinical expertise, and patient values to guide hospice and palliative interventions.

The Hospice Quality Reporting Program — outcome and experience measures hospices report to Medicare.

Building resilience through reflection, debriefing, boundaries, and support sustains the nurse and prevents burnout.

Team debriefing and remembrance practices help staff process cumulative loss and prevent compassion fatigue.

Delegate appropriately to aides/LPNs within scope while retaining accountability for assessment and the plan of care.

Practicing with humility and respect for diverse beliefs about death, decision-making, and rituals.

Influencing policy, access, and resources to improve hospice and palliative care beyond the individual patient.