Integrating a Palliative Approach Hospice Care Begins Historically, care of the dying was the responsibility of the family and the community. People died in their own homes. In the mid-1900s, with medical advances and the building of acute care hospitals, care of the dying was moved to the hospitals. People lived their last months, weeks, or days under the care of physicians, nurses, and other health care providers (HCPs). It was in a busy acute care hospital that Cicely Saunders, a social worker and former nurse, met David Tasma. Tasma was living alone in London, England. He was dying. They talked for hours about the challenges that dying in an acute care hospital presented, and envisioned a place and philosophy of care designed specifically to address the needs of the dying person and their family—care that would relieve suffering and improve quality of life. Following Tasma’s death, Saunders spoke with a surgeon colleague about her dream. He suggested that she would be better able to make changes to care of the dying if she was a physician. Saunders then returned to study and earned a medical degree. With the holistic perspective of a nurse, a social worker, and now a medical doctor, she saw and understood the “total pain” that people experienced. In fact, she coined that term to describe the various types of pain—emotional, spiritual, physical, bureaucratic, and so on—that people might experience in the dying process. In 1967, Saunders opened St Christopher’s Hospice out- side of London, England. In 1979, Queen Elizabeth II hon- ored her with the title “Dame Commander of the Order of the British Empire” for her contributions to hospice and palliative care. Thereafter she was known as Dame Cicely Saunders. Ethics Touchstone Principle 4 Licensed Practical Nurses develop and maintain positive, collaborative rela- tionships with nursing colleagues and other health professionals. Code of Ethics for Licensed and Registered Practical Nurses (CCPNR, 2013) Reflect on this principle and consider how nurses providing holistic hospice and palliative care can bring these concepts to life in their practice. 2