Hospital Impact: 5 considerations for nurses who provide end-of-life care

nurses

Palliative care nurses spend their workdays in one of life’s most tender, difficult and vulnerable moments. In helping patients and their families at the end of life, these particularly resilient healthcare professionals can provide an invaluable service when they are mindful of their patients’ preferences and the responses of loved ones.

With practice and compassion, many nurses can achieve the level of grace that end-of-life care calls for--as long as they keep these five points in mind:

  1. Each patient has specific needs. Patients find themselves in many different circumstances at the end of life, and palliative care nurses must always remember that their approach with different patients must not become routine. A patient who is mobile may only require assistance with medication, and may otherwise benefit from unhurried conversation. Many patients listen and communicate best through touch rather than voice, and the nurse should be carefully attuned to whether that is the case. Real needs are best understood through careful listening so be sure you put in the time, to make that possible.
  2. Not all patients have advance directives. Only 15 to 30 percent of patients in end-of-life care have specified their advance healthcare directives. That number should be much higher, but until the percentage starts to rise, palliative care nurses need to do as much as they can to facilitate discussions about advance directives with the patient and family members. Whenever possible, nurses should encourage that official decisions be made before the palliative care stage.
  3. Nurses must learn what’s important to each patient. Especially at this stage in a patient’s life, a nurse’s job is not to come on the scene and lay down the law about what’s going to happen and how it’s going to happen. Instead, the nurse should enter with a question: How can he or she help the patient with the time that’s left? To answer that question, it’s important to learn about your patient. Does he or she want to spend this time at home, surrounded by friends and family? Or would he or she rather be in a home-like setting somewhere else? Maybe a patient wants to be as active as possible, and even continue working. Maybe a particular patient wants to go on an adventure. A nurse will never know if he or she doesn’t ask, in detail. 
  4. Nurses must also assess their own needs. It’s just as important that nurses understand their own needs and strong preferences. And they need to do so honestly. For example, nurses must ask themselves whether they are uncomfortable around certain conditions or patients. Are there tasks or situations the nurse strongly prefers not to take part in? Nurses need to know this about themselves, and speak up with their employers when necessary. 
  5. Patients come first. This last point may seem so obvious as to be a throwaway, but, surprisingly, it can be one of the most difficult for palliative care nurses to stick to. At the end of a person’s life, family members will want to provide insight into the patient's end-of-life planning. Of course, nurses must take those opinions into account and discuss them with the family. But those preferences absolutely never outweigh or override the patient’s desires. Palliative care nurses’ obligations are to their patients, and part of what it means to be graceful in this job is remaining firm on this point.

Peggy Flannigan is the associate chair & associate professor of nursing at Bradley University in Peoria, Illinois.