With an aging population and shifts in the way people die, all nurses should prepare to care for a dying person at some point in their careers or personal lives. Integrating a palliative approach early in the disease phase for people with life-limiting illnesses across all care settings will improve quality of life, death, and grief. Palliative care nurses provide support to patients diagnosed with terminal illnesses and their families. It helps patients of all ages and at any stage of a serious illness, providing emotional and social support. Patients get better quality of life, sometimes even longer.
Working at a nursing home in Queens, New York, I’ve taken part in the care of aging terminally ill patients. As a nurse, I practice “whole-person treatment,” in which I connect all aspects of my patient’s lives (Thomas et al., 2018). I make symptom treatment advice to their physicians if they are in pain, nauseated, or short of breath. It’s a rewarding task because you get to be a part of their final days and provide them with the best quality of life possible (Thomas et al., 2018).
We have a patient population of about 30. The nursing home is an in-patient setting located in the suburbs. Some of the illnesses I’ve encountered are Alzheimer’s disease, Hodgkin’s disease, Covid- 19, and Cancer. Adam is one of my patients, diagnosed with Alzheimer’s disease, and has a life expectancy of about two years, hopefully getting longer due to our care. My work is to make a patient feel better when going through the worst time of their life; quite fulfilling.
I work with a multitalented team of doctors, social workers, general practitioners, chaplains, and a clinical neurologist. Doctors provide symptom management and focus on the medical well-being of the patient. As a nurse, I respond to complex palliative care needs by integrating information and evidence using my advanced knowledge in the field and critical thinking (Sekse et al., 2017). In such a dynamic team, effective communication is key for maximizing the outcomes for the person receiving the care.
The chaplains prove religious support as per the patient’s wishes. Social workers conduct psychosocial evaluations, psychotherapy, and educating patients and families about their care. The neurologist works on the differential diagnosis of patients with atypical dementia and the treatment of late-stage neurologic symptoms of Alzheimer’s disease, such as seizures (Fee et al., 2020). The essence of our team is to provide comprehensive services that focus on the patients’ holistic care.
When patients experience any form of anxiety, dyspnea, or pain, we must relieve their distress. Patient’s quality of life suffers from their suffering, and they cannot do the most important things in their remaining time (Sekse et al., 2017). Physical examinations and a review of their medical records assist us in determining the severity of their pain, helping us determine the underlying cause. Alzheimer’s disease causes a steady deterioration in a wide variety of cognitive and physical capacities, ultimately leading to death. It, therefore, causes a lot of emotional distress on patients due to memory loss (Sekse et al., 2017). As a result, we give acetylcholinesterase and therapy to help curb the psychotic behavior, aggression, and depression on the patient.
When you take care of a patient, it is like being part of a team; with their doctors, patients, and families. Taking care of a terminally ill person full-time can prove to be cumbersome for families. Palliative care provides additional support. Having such a strong team helps family members digest information from specialists and doctors (Fee et al., 2020). Decision-making is also easier as the skilled team provides input, reducing the mental burden on family members. Whenever Adam had a crisis, we would intervene, which was always a relief to his family (Fee et al., 2020). We walk with both the patient and family step by step as we heed to the patient’s needs; we extend the same to the family.
How parents raised someone and their environment greatly influences their beliefs and philosophies. Some societies have family discussions about pain and end-of-life decisions, while others can leave the decision up to the patient and probably a partner. Therefore, health care providers need to consider the various factors that affect patient and family decisions (Fee et al., 2020). As a palliative care nurse, I heed their emotional needs as well. The patient always has autonomy. We have to recognize the patient’s right and ability to decide for themselves according to their beliefs, values, or life plan.
Patients with Alzheimer’s are eligible for hospice if their life expectancy is six months or less, as the disease runs its course. They also experience secondary conditions such as delirium, irritability, and recurring infections. The involvement of hospice in treating these patients can lengthen their lives (Tajari & Pandpazir, 2019). It may be time to consider hospice treatment when the patients’ condition begins to decline. Hospice patients have more pain management, are less likely to die in a hospital, and their families are happier with their end-of-life treatment (Tajari & Pandpazir, 2019). One of the legal and ethical issues considerations that apply in palliative care is truth-telling. The patient has a right to know accurate information account their health, planned care, options, and future expectations. We are obligated to abide by their wishes while also considering those affected by their care, such as family.
Staff who provide palliative care are likely to be stressed. The stresses associated with providing palliative care can interfere with the caregiver’s ability to provide care responsively and professionally. In areas where long-term relationships with patients and families are established, regular monitoring and access to professional knowledge by staff are critical. To curb these stresses, we hold regular team meetings, where open discussions are encouraged (Fee et al., 2020). We talk about our day and the challenges we faced with our patients. We are also provided with therapy services to help us cope, especially with loss. I would suggest outdoor activities to help take your mind off work as this has proved effective for me (Fee et al., 2020). I get a lot of emotional support from my close-knit family as they provide an outlet to the job’s stresses.
It is very important to take care of yourself as you take care of others. My favorite form of self-care is taking a rest day. Resting helps me gather my thoughts and renew my zeal for work while also resting my body as the job can get a bit tiring at times. As I’m constantly exposed to existential questions, difficult psychological conditions, and increased emotional distress, it is necessary (Fee et al., 2020). I also monitor my stress levels to know when to take action. When I’m free, I practice meditation as this helps calm my mind and get rid of my compassion fatigue. Eating healthy and staying hydrated is also my mantra. Indeed, in distress, one does not rise to the occasion but rather falls to the level of his training.
Working in palliative care has proved to be both a blessing and a challenge. I have found fulfillment and some stresses in the field. I have also put my knowledge to practice and learned more than I imagined. However, it is essential to acknowledge that the role has its downsides. Nonetheless, quality and patient-centered care remain a priority, and that is a philosophy that I believe supersedes any other and should be prioritized when healthcare is in question.
References
Fee, A., Muldrew, D., Slater, P., Payne, S., McIlfatrick, S., McConnell, T., Finlay, D., & Hasson, F. (2020). The roles, responsibilities, and practices of healthcare assistants in out-of-hours community palliative care: A systematic scoping review. Palliative Medicine, 34(8), 976-988. Web.
Sekse, R., Hunskår, I., & Ellingsen, S. (2017). The nurse’s role in palliative care: A qualitative meta-synthesis. Journal of Clinical Nursing, 27(1-2), 21-38. Web.
Tajari, M., & Pandpazir, M. (2019). The application of palliative care in dementia. Journal of Family Medicine and Primary Care, 8(2), 347-351. Web.
Thomas, H., Mitchell, G., Rich, J., & Best, M. (2018). Definition of whole-person care in general practice in the English language literature: A systematic review. BMJ Open, 8(12), 23-75. Web.