Providing Service and Support at Every Stage of Illness

In palliative nursing, delivering compassionate, high-quality care to people facing terminal or chronic illnesses is a responsibility, and a privilege. Nurses like Marina Sargin, BSN, RN, who specialize in the field, explain it as humbling, rewarding and purposeful.

“When people learn that I work in palliative care, a common reaction is, ‘that must be so sad,’” says Sargin, a care coordinator for Cleveland Clinic’s Department of Palliative & Supportive Care. “While it can be heavy, it’s also an honor to be there for people during some of the most difficult times in their lives. It’s a calling that brings purpose and fulfillment.”

Sargin was drawn to palliative care almost immediately after graduating from nursing school. Her first job was in inpatient oncology and palliative care at Cleveland Clinic Hillcrest Hospital. “I quickly fell in love,” she says.

Specialized care tailored to patient needs

Different from hospice care, which is end-of-life care for those who have less than six months to live, palliative care can benefit people of any age, at any stage of illness, and for however long it is warranted.

Based on patients’ needs — not prognosis — the goal of palliative care is to improve quality of life through symptom relief, comfort and support. People with a wide variety of medical conditions can benefit from it, including those with heart, kidney, liver and lung diseases, amyotrophic lateral sclerosis (ALS), Alzheimer’s and Parkinson’s diseases, multiple sclerosis, cancer and more. It enhances care coordination, helps avoid unnecessary hospitalizations and addresses the physical, psychosocial, emotional, social and spiritual needs of patients and their families.

“Palliative care is for anyone who has a chronic condition that interferes with their quality of life,” says Sargin. “It can and should be offered to patients with serious or advanced illness who are concurrently receiving curative or life-prolonging therapies. There are no prognostic limitations to receiving palliative care like there are with hospice.”

At Cleveland Clinic, interdisciplinary palliative care teams include physicians, nurse practitioners, physician assistants, RN care coordinators, social workers and chaplains. Palliative caregivers work alongside patients’ primary care teams to provide an extra layer of support.

“While primary care focuses on prevention, diagnosis and management of chronic conditions, palliative care aims to improve quality of life through advanced symptom management, emotional and spiritual support,” explains Sargin.

Patients can receive palliative care in clinic, hospital, home or assisted living settings. Cleveland Clinic’s department is embedded within the Taussig Cancer Institute and includes a community-based palliative care (CBPC) program that encompasses nine regional clinics, virtual and home care.

“When we’re not seeing patients in clinic, our nurses spend a lot of time on the phone triaging those who call in with new or worsening symptoms,” she explains. “We also make follow up calls to patients who had a recent therapy or medication change, or who we know are going through a difficult time. This allows us to provide more meaningful, trusting and individualized care.”

Comprehensive, holistic nursing

Personalized and holistic, palliative nursing encompasses physical care, medication and pain management, pain relief, mental and physical health assessments, and emotional, spiritual and cultural support. “We don’t just treat illness, we treat the whole person,” says Sargin.

Palliative nurses collaborate daily with physicians and other specialists — sharing insights on patient care preferences and goals, disseminating important information and advocating for patient needs. They frequently coordinate with social workers to ensure patients receive services like talk therapy, counseling, financial or housing assistance, and advance directives planning.

Having worked in the outpatient setting for the past five years, Sargin says the ideal palliative care nurse offers a combination of strong clinical knowledge, good communication skills, active listening and a deep sense of empathy.

“We partner with patients and families to ensure care provided aligns with their values and preferences,” says Sargin. “We take the time to build trust and rapport and we strive to provide clear, compassionate communication, which helps them feel more comfortable.”

Education and communication are important to help people better understand their conditions and the type of treatments they’d like to pursue.

“You follow your patients throughout much of their healthcare journey and you develop meaningful, trusting relationships,” she explains. “You offer a compassionate presence during times of grief and suffering, and you are leaned on to discuss difficult topics like end-of-life goals and planning.”

Palliative care can be just as crucial for caretakers and families. If offers many resources to help them navigate the added stress and responsibilities that can accompany serious illnesses.

“My job is to support patients and families in whatever way they need,” admits Sargin. “Nurses are often the first to triage symptomatic patients, but we’re also the first to receive gratitude from a family member when a treatment modification relieved suffering and improved their loved one’s quality of life.”

In addition to impact on quality of life, research has shown that palliative care enhances patient satisfaction, can extend one’s life expectancy and more. “Palliative care nurses make a real difference in our patients’ lives,” adds Sargin.