I have been thinking about the concept of palliative care and the role of the nurse in palliative care lately. During this past month Barbara Bush, the United States former first lady passed away. In her final days she decided not to seek further medical treatment and to receive “comfort care.”
“Comfort care” is a term that can be misunderstood. Comfort care does not mean stopping all medical treatment. While it does mean stopping aggressive medical treatments, it does not mean stopping treatments such as pain medication or treatments aimed at alleviating symptoms and side effects. Comfort care is a viable and reasonable option a one nears the end of life.
According to The World Federation of Right to Die Societies “the term “comfort care” is often used synonymously with the term “palliative care.” Comprehensive palliative care, which includes pain and symptom management, support for patient and family, and the opportunity to achieve meaningful closure to life, is the standard of care for the dying, especially by many hospice programs.”
The World Health Organization (WHO) “describes palliative care as services designed to prevent and relieve suffering for patients and families facing life-threatening illness, through early management of pain and other physical, psychosocial, and spiritual problems.”
Ellen Goodman, co-founder of the Conversation Project is raising awareness about the importance of having conversations about end of life care and wishes. On The Conversation Project website you can get a conversation starter kit for free.
The benefits of having these conversations are many. “Patients who have end-of-life discussions are much more likely to be satisfied with their care, die at their place of choosing, and have markedly less distressed relatives,” said Smith. Thomas Smith, MD, is the director of palliative medicine and professor of oncology at Johns Hopkins. “In fact, looking at people who use hospice, the survival of their spouse is higher. It is really fascinating.”
Nurses working in palliative care have a steadfast focus on end-of-life care. 24-hour nursing availability is a hallmark of palliative care. This availability is geared toward managing pain, side effects, and symptoms as well as supporting the family. Palliative care nurses will typically have very good listening skills since they not only focus on pain and other symptoms but also on compassionate listening, education, guidance and counseling. By doing this they promote the highest quality of life for the patient and their family.
Another important skill for the palliative care nurse is being able to make accurate assessments. These assessment result in the nurse being able to develop plans to deal with symptoms and side effects. Common issues include constipation from narcotic pain medications, nausea and vomiting, lethargy, insomnia, anxiety, and dyspnea. The palliative care nurse is responsible to implementing techniques to minimize these troublesome issues. These serve to make the patient and the family more comfortable and relaxed.