A nurse’s role in palliative care is different from other specialties. Although all nurses are skilled in caring for patients, palliative nursing means being available to the patients 24 hours a day to manage their pain and discomforts and to provide support to the families.
A nurse doesn’t just have a single role in palliative care. Instead, it’s a series of roles geared towards providing support to both patients and families during one of their most difficult times. These roles fall on top of the conventional duties that nurses are expected to perform, like assessing symptoms and carrying out treatment plans.
Here are some of the roles nurses fill when it comes to palliative care:
Nurses are health educators. They teach patients about their health conditions and help them establish skills which they can use to manage the situation. This is particularly important, especially to patients who choose to spend their remaining time in their homes. This is also essential to patients who will be having new caregivers.
Psychologist / Counselor
Patients who are at the last stages of their lives need all the support they can get. Nurses aren’t just skilled in providing care, but they are also considered the best when it comes to providing emotional support. They know therapeutic communication like the back of their hands and the best ways to use it to make their patients feel better. They can encourage patients to verbalize their feelings and concerns. They help make patients be more open about the things they worry about without making them feel judged.
Nurses are considered the primary caregivers of their patients. When a nurse is assigned to one patient, he is essentially responsible in making sure his patient is physically well. This role includes assessing pain levels, giving appropriate medications, providing non-pharmacological pain relief and feeding.
When a patient is no longer capable of caring for himself, nurses assist in performing activities of daily living. They help patients in grooming and hygiene to make them feel better about themselves.
This is probably one of the most challenging roles nurses have when it comes to palliative care. Most family members and health care providers choose aggressive treatment choices when it comes to acute conditions in an attempt to help patients. Unfortunately, however, this isn’t always what patients want. During these times, nurses are expected to advocate for their patients and speak up for them.
In certain cases, nurses advocate for families, too. Nurses help families clarify their goals and make them reconsider what their patients would have wanted. They give families a clearer picture of the reality and its implication to the patient.
In the event that death is imminent, nurses help families with the process of acceptance.
Some patients are uncomfortable about letting their families know how they are feeling. Others feel doubtful about sharing their secrets and relaying their final wishes. When a patient trusts his nurse enough to share these things, it becomes the duty of the nurse to carry out his patient’s wishes.
Nurses engaging in palliative care have one responsibility not everyone in the profession is willing to take: help patients in establishing advance care planning decisions.
There are different ways you can find out about how your patients prefer to be taken care of during the end-of-life stage:
Advance care planning involves asking questions that are most wrenching to both patients and families. That includes inquiring and deciding on the right treatment plan after considering all the factors that can affect a patient’s status. Most of the time, the answers to those questions will be based on the patient’s and family’s values so there’s really no way for you to predict them using your own clinical judgment.
You can also get an idea about your patient’s wishes by listening. Patients are often verbal about their values and principles, especially during the most critical stages of their lives. In the event that your patient speak out about his wishes and final decisions, remain nonjudgmental and be sure to fulfill his wishes or communicate them to the family, with your patient’s consent.
When a patient is no longer able to communicate and his wishes haven’t been determined yet, a substitute decision-maker would be needed. As a nurse, it is your responsibility to guide your patient’s decision-maker about the treatment options that are available, their implications, benefits and drawbacks.
The catch, however, is that not every patient has access to formal hospice services especially those who live in really remote areas. In such cases, nurses have to find a way to reach out to patients and deliver the bad news.
The task is scary for nurses, especially with the anticipation of causing hurt, anxiety and depression to the patient and his family. In extreme cases, it can affect the nurse emotionally and psychologically to the point that they fail to perform their roles.
Another challenge nurses face in palliative care is the cultural view of the patients. In some cultures, death and terminal illnesses are things you can’t talk about openly. As a nurse, apart from courage, you also have to know how to properly approach the situation.
Your patients and their families need to be aware of what’s really happening. Although it’s tempting to withhold information to protect them from grief and depression, you should stick to your responsibilities as a nurse and keep them as informed as possible. They need to receive factual and accurate information so that they can choose the best approach when it comes to treatment and care. The more aware they are, the better decisions they can make.
Working in such a demanding environment isn’t easy. To effectively fulfill nurses’ role in palliative care, you have to be physically, mentally and emotionally prepared for the job. Learning how to deal with your own thoughts and emotions can help you succeed in this line of work.