This reflective essay chronicles my experience as a fourth-year medical student during a clinical rotation in a hospital ward. Initially overwhelmed by the sensory intensity and surrounding suffering, I developed an unexpected stillness-not born of indifference, but of necessity. Grappling with death as an inevitable reality, I reframed my presence at the bedside as an act of witness rather than a battle against the incurable. Through observing physicians and nurses, I absorbed not only clinical skills but the art of delivering difficult news with compassion. The essay explores the tension between empathy and emotional detachment, concluding that the quiet I cultivated was the only way to remain useful. Stepping outside the hospital, I realized the psychological distance I had built within the ward did not travel with me-leaving the outside world feeling strangely unguarded. This piece reflects on the hidden curriculum of medical training: learning to carry reverence for life alongside the discipline to act.
Purpose Patients with Life-Limiting Illnesses (LLI) require palliative care, yet access remains limited in rural areas. Community Health Center nurses play a key role in Home-Based Palliative Care (HBPC), but their readiness to provide such care remains poorly understood. This study aimed to explore nurses’ readiness to provide HBPC for patients with LLI in rural areas. Methods A qualitative study with a descriptive phenomenological approach was conducted from June to July 2026 through semi-structured interviews at four Community Health Centers in Indonesia. A total of 18 participants were purposively selected, comprising Community Health Center nurses with experience caring for patients with LLI. The data were analyzed using thematic analysis. Results Four themes with 19 subthemes were identified in this study: (1) nurses’ capacity readiness to provide HBPC, highlighting perceived competency gaps and the need for further training; (2) readiness of the service system and governance, reflecting the lack of specific regulations, structured programs, and adequate financial support; (3) resource and service access readiness in rural areas, highlighting limited nursing staff and heavy workloads; and (4) strengthening collaboration and family empowerment for continuity of care, emphasizing the roles of interprofessional coordination and family education in supporting care continuity. Conclusions Nurses expressed willingness to provide HBPC, although their readiness depended on adequate training, clear regulations, sufficient resources, and organizational support. These findings may inform the Banyumas Regency Health Office in strengthening local HBPC services. Further research across regions is needed to support broader policy development.
Background Pruritus is a common and often distressing symptom in palliative care, affecting a significant fraction of patients and significantly impairing sleep, mood, and quality of life. Common etiologies include chronic kidney disease, cholestatic liver disease, hematologic malignancies, solid tumors, medication-related syndromes, and paraneoplastic processes. Conventional treatments, including antihistamines, antidepressants, gabapentinoids, ondansetron, and ultraviolet-B phototherapy, are frequently limited by adverse effects, cost, or practicality in seriously ill patients. Objective To review the pathophysiology of pruritus relevant to palliative care and evaluate the emerging role of naltrexone as a therapeutic option for refractory pruritus. Methods Narrative review of the literature addressing the mechanisms of pruritus, current treatment approaches, and clinical evidence supporting the use of naltrexone across various pruritic conditions encountered in palliative medicine. Results Increasing evidence implicates dysregulation of the endogenous opioid system in the pathogenesis of several forms of chronic pruritus. As a competitive opioid receptor antagonist, naltrexone may mitigate “itch” through μ-opioid receptor blockade and restoration of opioid signaling balance. The strongest evidence supports its use in cholestatic pruritus, where randomized placebo-controlled trials demonstrated significant reductions in symptom severity with 50 mg daily dosing. Evidence in uremic pruritus is mixed, with some studies showing benefit and others finding no superiority over placebo. Case reports and small series suggest potential efficacy in malignancy-associated pruritus, polycythemia vera, and selected dermatologic disorders. Limitations include contraindication in patients receiving opioid therapy, potential precipitation of withdrawal, and adverse effects such as nausea, gastrointestinal distress, dizziness, fatigue, and sleep disturbance. Conclusions Naltrexone represents a mechanistically rational and potentially effective option for selected patients with refractory pruritus in palliative care. Current evidence is most compelling for cholestatic pruritus, while data for other etiologies remain limited and heterogeneous. Larger prospective studies are needed to define optimal dosing strategies, identify patients most likely to benefit, and better characterize its role in opioid-exposed palliative care populations.
Alzheimer's Disease and Related Dementias (ADRD) disproportionately affect Americans who identify as Hispanic/Latino and their family caregivers. Existing dementia care approaches may have limited responsiveness to their cultural needs. We partnered with a Hispanic/Latino dementia caregiver advisory board for input on outpatient dementia care approaches, including how to address palliative care needs. Eleven caregiver advisors from two U.S. states participated in six virtual meetings. Meetings were transcribed and researchers used a composite narrative approach to summarize the advisors' perspectives on outpatient dementia care as lived experience stories. Composite narratives represented their (a) experiences as an informal care coordinator, reflections on their support system, and care planning; (b) unmet needs and barriers to culturally aligned care, and (c) need for reliable care coordination that incorporates cultural values in dementia palliative care approaches. Caregivers emphasized their caregiving struggles and said that even when they had ample support for their loved ones, they lacked emotional support for themselves. Caregivers noted the vital role of culture, faith, family, and language in shaping their experiences. They described needing guidance from trusted clinicians to navigate challenges. They requested linguistically and culturally adapted education on dementia and caregiving. In conclusion, through this community engagement process, we illustrated the importance of outpatient dementia care approaches that are linguistically accessible, culturally relevant, and attentive to input from Hispanic/Latino caregivers to address palliative care needs in the context of dementia.
Registered nurses (RNs) are the most trusted health professional, comprising the largest segment of health professionals, and are consistent members of interprofessional palliative care teams. However, palliative care team members are often unfamiliar with or misunderstand the scope of nursing skills and expertise. While there is literature that discusses palliative care models and the use of RNs in advance care planning, there is a paucity of literature that specifically discusses their broad skills and contributions to palliative care teams and patient care. Research indicates that RNs determine and execute care that is appropriate for the situation and needs of patients by using their clinical judgement and knowledge of diseases, treatments, the healthcare system, culture, and social and behavioral sciences. They share similar expertise with other professions across the biomedical-psycho-sociocultural-spiritual care models; however, they focus on whole person care. With such a comprehensive scope of practice, RNs are well-positioned to identify patients’ multidimensional needs and coordinate care accordingly. The purpose of this article is to illustrate the palliative RN’s specific knowledge, competencies, and skills which contribute and optimize the delivery of high-quality patient-centered, palliative care. Palliative nurse competencies frame a case study to highlight RN’s expertise in providing and coordinating whole-person, patient-centered care, and how these skills foster positive patient outcomes. Finally, a strategy is offered for a team to maximize the use of the RN.
