| Course | NURS 6910 Introduction to Palliative Care: Principles of Hospice and Palliative Care |
|---|---|
| Week | Week 3 |
| Paper type | Models of care analysis |
| Length | About 1,070 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6910 Week 3
Three Doors Into Palliative Care: Inpatient Consultation, an Embedded Oncology Clinic and Home-Based Care Compared for a Regional Health System With a Rural Edge
Student Name
College of Nursing, Walden University
NURS 6910: Introduction to Palliative Care: Principles of Hospice and Palliative Care
Instructor Name
Month Day, Year
Three Doors Into Palliative Care: Inpatient Consultation, an Embedded Oncology Clinic and Home-Based Care Compared for a Regional Health System With a Rural Edge
The Test Case
The composite regional health system in this analysis includes one tertiary hospital, two community hospitals, a hospital-owned oncology practice and a primary care network. Its service area runs from a mid-sized city to a rural county on its eastern edge, where the nearest specialist palliative clinician is more than an hour's drive away. The system currently has one inpatient palliative consultation team at the tertiary hospital and is deciding where to invest next. The analysis compares three models of specialist palliative care delivery: inpatient consultation, an outpatient clinic embedded beside oncology and home-based palliative care.
Models of palliative care differ by setting, by who delivers the care and by when in the illness patients are reached, and the literature increasingly describes them as parts of one system rather than competitors (Hui & Bruera, 2020). The question here is which part this system should build next.
Criteria
The criteria are fixed before the models are described, so that the comparison is not steered toward the most appealing option. Each model is judged on five criteria: reach, meaning which patients it can see; continuity, meaning whether the relationship survives transitions between settings; team composition, meaning who is needed to run it; fit beyond cancer, meaning whether it serves people with heart failure, lung disease and dementia; and sustainability, meaning whether it can be paid for over time.
Inpatient Consultation
An inpatient consultation team, typically a physician or advanced practice registered nurse with a nurse, a social worker and a chaplain, sees hospitalized patients at the request of the attending team. Referrals arrive during crises: an uncontrolled symptom, a family meeting about an admission to intensive care, or a decision about discharge to hospice. The model reaches patients at a moment of high need, and hospital consultation programs have been associated with lower costs of hospital care for patients who received consultation (Morrison et al., 2008). Its weakness is continuity. When the patient goes home, the relationship usually ends, and the plans made in the hospital depend on clinicians who were not in the room. For the rural county, the team sees residents only when they are admitted to the tertiary hospital, often after a long transfer.
Embedded Outpatient Clinic
An embedded clinic places palliative clinicians inside or next to the oncology practice, so patients can be seen on the same day as their oncology visits. The model's strongest evidence comes from early integration in advanced cancer: in the trial by Temel et al. (2010), patients with metastatic lung cancer who saw palliative clinicians regularly from diagnosis reported better quality of life and mood than those receiving oncology care alone. The clinic offers continuity, since patients return monthly, and it reaches people early rather than in crisis. Its reach, however, is mostly limited to people already in cancer care who can travel to the clinic, and its fit beyond cancer is weak unless the clinic also accepts referrals from cardiology and pulmonology.
Home-Based Palliative Care
Home-based programs send a nurse, often with a physician or advanced practice registered nurse and a social worker, to patients who are homebound or near homebound. A randomized trial of in-home palliative care for patients with a limited prognosis found higher satisfaction with care, a greater likelihood of dying at home and lower use of hospital and emergency care, with lower costs, than usual care (Brumley et al., 2007). The model reaches people no clinic will see, including many with heart failure, lung disease and dementia. Its costs are travel time and staffing: a nurse covering the rural county might complete a few visits a day, and recruiting clinicians willing to drive those distances is hard.
Home-based palliative care should not be confused with home hospice, although the two can look alike from the doorway. Hospice requires a limited prognosis and an election to forgo treatment aimed at cure of the terminal illness; home-based palliative care has no prognosis requirement, and patients may continue dialysis, chemotherapy or heart failure treatment while the team visits. Many patients in a home program will eventually move to hospice, and a program that knows its local hospices can make that transition without a gap in visits.
Comparison
Table 1 rates each model against the five criteria for this system.
Table 1
Three Models Rated Against Five Criteria for the Composite System
| Criterion | Inpatient consultation | Embedded clinic | Home-based care |
|---|---|---|---|
| Reach | Hospitalized patients, in crisis | Oncology patients who can travel | Homebound patients, including rural |
| Continuity | Weak; ends at discharge | Strong for clinic patients | Strong in the home |
| Team composition | Full team at one site | Clinician plus nurse; shares oncology staff | Nurse-heavy; travel adds time |
| Fit beyond cancer | Good | Weak unless referrals widen | Good |
| Sustainability | Supported by hospital cost savings | Visit billing; space in oncology | Hardest; visit billing rarely covers travel |
No model scores well on every criterion. The existing consultation team already covers crises; the choice is between continuity for oncology patients and reach for the homebound.
An Adaptation for the Rural County
A fourth option combines elements of the others. The ENABLE model, tested in a series of trials with people with advanced cancer, used advanced practice nurses to deliver structured palliative care sessions largely by telephone, and the second trial found better quality of life and mood among those receiving it (Bakitas et al., 2009). A nurse-led telephone program based in the embedded clinic could reach rural patients between clinic visits, with home visits reserved for those whose needs cannot be met by phone. Hui and Bruera (2020) describe this kind of layered design as a way for small systems to extend specialist care beyond the building.
Recommendation
The system should build the embedded oncology clinic next, with two conditions. First, the clinic should accept referrals for patients with advanced heart failure and lung disease from the start, so that its fit beyond cancer is designed in rather than added later. Second, one clinic nurse's time should be dedicated to a telephone program for rural patients, modeled on the ENABLE approach, with the option of home visits when the program shows demand. Home-based care is the right third step, but it is the most expensive to sustain, and the telephone program will show how many rural patients need it before the system commits a full team to the road.
References
Bakitas, M., Lyons, K. D., Hegel, M. T., Balan, S., Brokaw, F. C., Seville, J., Hull, J. G., Li, Z., Tosteson, T. D., Byock, I. R., & Ahles, T. A. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. JAMA, 302(7), 741-749. https://doi.org/10.1001/jama.2009.1198
Brumley, R., Enguidanos, S., Jamison, P., Seitz, R., Morgenstern, N., Saito, S., McIlwane, J., Hillary, K., & Gonzalez, J. (2007). Increased satisfaction with care and lower costs: Results of a randomized trial of in-home palliative care. Journal of the American Geriatrics Society, 55(7), 993-1000. https://doi.org/10.1111/j.1532-5415.2007.01234.x
Hui, D., & Bruera, E. (2020). Models of palliative care delivery for patients with cancer. Journal of Clinical Oncology, 38(9), 852-865. https://doi.org/10.1200/JCO.18.02123
Morrison, R. S., Penrod, J. D., Cassel, J. B., Caust-Ellenbogen, M., Litke, A., Spragens, L., & Meier, D. E. (2008). Cost savings associated with US hospital palliative care consultation programs. Archives of Internal Medicine, 168(16), 1783-1790. https://doi.org/10.1001/archinte.168.16.1783
Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363(8), 733-742. https://doi.org/10.1056/NEJMoa1000678
NURS 6910 Week 3 instructions, in plain terms
Most Week 3 prompts ask you to describe and compare models of palliative care delivery and to recommend one for a setting, sometimes your own organization. Papers of three to five pages with a comparison table are common. Define the setting first, including who it serves and where the gaps are. Choose the criteria before you describe the models so the comparison stays fair. For each model, explain how referrals arrive, who delivers care and where patients meet the team, then test it against your setting. Use evidence about each model's outcomes, but be precise about the populations studied. Close with a recommendation that includes conditions and an order of steps, not just a preferred model.
How this NURS 6910 Week 3 example is built
The paper opens by describing the composite system and citing Hui and Bruera's review of delivery models. A short section fixes the five criteria. The inpatient section cites Morrison and colleagues on consultation programs and hospital costs and notes the loss of continuity at discharge. The embedded clinic section cites Temel and colleagues' trial of early integration. The home-based section cites Brumley and colleagues' in-home trial and distinguishes home palliative care from home hospice. Table 1 rates the three models. An adaptation section describes Bakitas and colleagues' ENABLE model as a telephone option for rural patients. A recommendation section sets two conditions and a sequence for the system.
NURS 6910 Week 3 rubric: what earns full marks
Delivery model papers are usually weighed on the fairness of the comparison, the accuracy of the evidence and the quality of the recommendation. Fixing criteria in advance signals fairness, and graders often check whether every model is tested against every criterion. Evidence is scored on accuracy, including whether trial populations are described correctly and whether cost findings are stated without exaggeration. The setting analysis earns credit when it shapes the comparison rather than sitting in the introduction. Recommendations score well when they are specific, conditional and sequenced. Tables that summarize the comparison help graders. APA citations and clear headings complete the rubric, and some instructors add credit for noting where hospice fits among the models.
NURS 6910 Week 3 help from the desk
Model comparisons lose points when they describe three models in general terms and never apply them to a setting. Another loss comes from choosing criteria after describing the models, which makes the favored model win by design. Some papers treat home-based palliative care and home hospice as the same thing. Others recommend building everything at once with no sense of cost. Describe your setting, fix criteria first, test each model against it, compare in a table, be exact about evidence and recommend a sequence with conditions. The desk can draft an analysis for the organization your prompt names. Where your setting has no palliative program at all, say so and start from there.
Get a NURS 6910 Week 3 example written to your instructions
Describe the settings your Week 3 prompt names, whether hospital, clinic, home or a nursing facility, and include the rubric. A models analysis is written to those settings with its criteria stated up front, returned inside 24-48 hours with no fee on a first request. A region or system from your materials replaces the composite one.
More NURS 6910 papers and MSN samples
- NURS 6910 Week 1: Discussion post
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- NURS 6910 Week 6: Communication case
- NURS 6910 Week 7: Family assessment
- NURS 6910 Week 8: Discussion post
- NURS 6910 Week 9: Spiritual and cultural assessment
- NURS 6910 Week 10: Palliative Case Analysis
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- NURS 6730 Week 3: Budget analysis
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NURS 6910 Week 3 questions, answered
Why fix the criteria before describing the models?
Because comparison without agreed terms drifts toward whichever model sounds most appealing. Stating reach, continuity, team composition, fit beyond cancer and sustainability at the start commits the analysis to one yardstick. If your rubric lists its own criteria, such as cost or access, those replace the example's five, and the table is rebuilt around them without changing the method.
What is the ENABLE model mentioned in the paper?
A nurse-led approach to early palliative care studied in a series of trials with people living with advanced cancer, much of it delivered by telephone to reach patients far from specialist services. It appears in the example for that central idea only, as one way a rural county might receive concurrent palliative support. It is presented as an adaptation to weigh, not as a model your paper must endorse.
Does the analysis cover hospice as a fourth model?
It mentions hospice where the home-based section needs a boundary, since home palliative care and home hospice can look alike from the doorway. The difference in eligibility and in whether disease treatment continues is stated in a paragraph. When your section treats hospice as a model to compare in full, a fourth column and section are added in the same pattern.
Where can I find a free NURS 6910 Week 3 sample paper?
This page carries the complete analysis, five criteria, three models, the rating table and the recommendation, open to read at no charge. An analysis for your own organization can be requested.
Which model does the NURS 6910 Week 3 analysis recommend building next?
The embedded oncology clinic, accepting heart failure and lung disease referrals from the start, with one nurse running a telephone program for rural patients before any home team is built.