As an end-of-life care Nurse Practitioner in a busy acute care hospital, life can be busy. My role in the hospital is to improve the quality of care and support to those that may die while they are here. It’s an exciting, fast-paced, challenging, and dynamic environment, it requires flexibility, expert communication, and sometimes significant negotiation skills. Calls are from nurses or junior medical staff who feel that a patient is dying but are unable to change the current goals due to communication issues with patients, families or their colleagues. Staff seek help and ask; “Is this person dying?”, “Are we caring for them the way they want?”, “Is this kind?”, “Is this right?”, “Is it the safe and high-quality end-of-life care we all expect?”.
Most commonly staff call when a patient has been recognised to be approaching the terminal phase of their life; most people I get a referral to see will not be alive in 48 hours. They are most commonly patients who have been receiving active management of a condition, and despite optimal medical management their condition has continued to deteriorate. Most of the time, through a shared decision-making process between the patient (when able), their family, and a medical team, this continued deterioration is the catalyst for a discussion about end-of-life care.
Medical and nursing teams will call then and ask me to support them, the patient, and the family. The process of dying used to be a witnessed, shared experience for many of our very old patients. It occurred in the front rooms of our houses. Family and friends gathered around and knew how to care for the dying and each other. However, since the advent of modern medicine in the 1950s our community and family no longer understand what death looks like. I have to reintroduce the concept as a normal and expected part of life, that does not have to be traumatic or awful, but sad, yes, we cannot change that.
As a Nurse Practitioner, the benefit of being able to provide rapid symptom assessment and management, as well as the prescribing and evaluation of pharmacological management provides a rapid response to people who need it. The importance of understanding who a person is, their spirit, their culture, their religion, provides an environment that is person-centred and appropriate to the needs of that person. Many patients and their families require a compassionate presence, and time to talk. Feeling safe to cry, be angry, to have final wishes and regrets heard, for families to go home when it is all too much, or stay to provide a vigil; in our care we provide these opportunities. The way that we care for the dying will impact the living and their perception of death and dying in the future.
Jeanette Lacey, End of Life Care Nurse Practitioner, Hunter New England LHD
This blog is part of a series of blogs commissioned by End-of-Life Essentials to support health professionals in providing end-of-life care. You can find more information on the End-of-Life Essentials website.