Hospice nursing: the specialty

The purpose of this study was to identify and delineate what experienced hospice nurses perceive as the knowledge and skills base essential to their practice of hospice nursing as a specialty. Little of this specialty is taught in basic nursing programs, so another purpose was to determine the methods hospice nurses use for knowledge and skills acquisition. The qualitative study method of focused ethnography was used. This method allowed the researcher to examine hospice nurses in the context of their own community-based agency, enter the research arena with specific questions, describe the topic from the viewpoint of the participants, use multiple data sources, and begin data analysis concurrently with data collection, which continued until saturation was reached. During data analysis, 11 categories emerged. Four of these categories involved skills: (a) assessment skills, (b) communication skills, (c) technical skills, and (d) management skills; and seven categories primarily involved knowledge: (a) end-stage disease process, (b) signs of impending death, (c) palliative therapeutics, (d) collaboration between disciplines, (e) advocacy, (f) philosophy and ethics of hospice care, and (g) family dynamics. Of these 11 categories, the one discussed and observed most often was that of assessment skills. It was found that the hospice nurses learned their specialty by doing it. However, the need for graduate education in hospice nursing became apparent.