"Simple actions can help a lot at incredibly difficult times"
Good communication, openness, honesty and support are key to making palliative care manageable for relatives and carers
As the population ages, the number of deaths that occur in hospital is expected to rise (Al-Qurainy et al, 2009). I find the majority of patients who are admitted into adult acute care are old, frail and, at times, vulnerable. Given the high percentage of patients dying in acute care, nurses need palliative care education (Grant et al, 2009).
Palliative care featured in all my student placements, in both hospice and acute settings. After these experiences, I believed I was knowledgeable about palliative care. However, when I found myself on the other side of the nurses’ station, my perspective changed completely. And rightly so.
Palliative care education is largely patient centred. It focuses on pain control, emotional support and advice about managing the future. Do we pay enough attention to caring for relatives and carers? Many of them keep a bedside vigil 24 hours a day - an experience I have discovered is not only exhausting but also emotionally draining.
My grandmother passed away in acute care - a place many see as an inappropriate and hostile place to spend your last days. But the experience my family and I had was completely different. It showed the small things that can be done to support patients as well as relatives and carers at an incredibly difficult time.
The nurses caring for nanny gave us as much control as possible. It was the little things, such as allowing us to help her take her tablets and helping her move in the bed, that made the experience easier.
Being a nurse, I naturally wanted to know exactly what was happening. So I appreciated that nurses shared vital signs readings with me and family members. We had a full understanding of nanny’s condition, allowing us to be somewhat prepared for the inevitable in those final hours.
Having experienced poor care in the private sector, nanny was moved to an NHS acute hospital. Nurses and doctors listened to and acted upon our concerns. This gave us an overwhelming sense of relief, and we could relax knowing she was finally being cared for appropriately.
The simplest thing nurses can do is talk to patients and relatives. Many nurses and healthcare assistants excel at this. Everyone talked to nanny and us with the utmost care and compassion. This made us feel supported and not afraid to ask questions.
My experience highlighted how good communication, openness, honesty and support are key to making palliative care manageable for relatives and carers.
As nurses, we can deliver the right care by doing the simplest things that are sometimes overlooked. We can make a terrible experience easier to manage, and that is a very special thing that should never be overlooked or underestimated.
Robyn Byrne is a staff nurse, respiratory ward, the Royal United Hospital in Bath.
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Al-Qurainy R et al (2009) Dying in an acute hospital setting: challenges and solutions. International Journal of Clinical Practice; 63: 3.
Grant M et al (2009) Current status of palliative care - clinical implementation, education, and research. CA: A Cancer Journal for Clinicians; 59: 5.