The Paradox of Nursing Visibility in Community-Based Palliative Care

The Paradox of Nursing Visibility in Community-Based Palliative Care

– Ms. Anu Savio Thelly, Abu Dhabi

Despite being the backbone of community-based palliative care, nurses remain largely invisible in global advocacy and discourse, particularly in low- and middle-income countries (LMICs). While nurses are often the primary providers of palliative care at the grassroots level, policy discussions and leadership positions in the field continue to be dominated by physicians, economists, and policymakers. This disconnect between front-line reality and international representation is striking, especially when considering foundational models such as Kerala, where early documentation highlighted the crucial role of nursing in home care (Kumar 2007 ^[6]) — yet subsequent research has largely failed to map or spotlight these contributions.

Cicily Saunders, the founder of the modern hospice movement, long ago articulated the need to blend scientific knowledge with the art of compassionate presence at the bedside, urging practitioners to “combine the art and science of palliative care” (Saunders 2003 ^[11]). Despite this guiding ethos, in the provision of end of life care crucial psychosocial needs—such as loneliness or social abandonment often go unaddressed while the systems focuses primarily on physical symptoms alone (Rosenberg 2011 ^[10]). For palliative care to truly improve the quality of the last months of life, it must be delivered equitably and strategically, bridging the divide between health and social care (House of Commons – Health – Fourth Report{no date} ^[5]). High-quality, compassionate nursing is universally recognised as a primary means of alleviating serious health-related suffering (Rosa et al. 2020 ^[9]).

The patient and family experience is most successful when interdisciplinary collaboration begins in the patient’s home, supported by competent, experienced teams and regular mentorship (Danielsen et al. 2018 ^[4]). Nurses, in particular, are described as blending “knowledge, skills, and compassion in equal measure,” bringing sensitivity, hope, and dynamic engagement to every encounter (Becker 2016 ^[2]). Still, landmark reports, have underrepresented the vital role of nurses, primarily due to a lack of robust evidence on their specific assessments, interventions, and outcomes (Moran et al. 2024 ^[8]). Recent reviews, however, confirm that nurses drive person-centred care, demonstrate strong interpersonal skills, and provide direct clinical support. Their leadership, environmental management, and commitment to evidence-based practice underpin a bio-psychosocial-educational approach that enhances therapy adherence, symptom control, quality of life, access to care, and even reduces healthcare costs (Bassah et al. 2023 ^[1]; Benson et al. 2023 ^[3]).

In LMICs, nurse-led palliative care is still evolving but shows significant promise. To maximise impact, it is imperative to expand advanced nursing roles, invest in targeted training, and prioritise research that both maps barriers and identifies enabling factors unique to these contexts. Nurses are not only caregivers but also community mobilisers, educators, and connectors—often acting as the linchpin between patients, families, volunteers, and the broader healthcare team. In many settings, they fill critical gaps such as care coordination and capacity-building, particularly where no formal roles exist.

Recognising and investing in the unique contributions of nurses is critical to building resilient, equitable, and high-quality palliative care systems worldwide (Mathew et al. 2022 ^[7]). Only by addressing this paradox of visibility can we ensure that palliative care delivers on its promise of dignity, relief, and hope for all.

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References

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