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Practice comment

"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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Readers' comments (4)

  • I work in acute medicine and yes we get many elderly frail patients who are dying. I don't think a busy, noisy ward is the right environment. It's fine if you have a sideroom where visitors can come and sit, spend the night etc and the patient is in a calm environment but that's not the reality of a busy acute unit. I'm sure most nurses also feel very sad when a patient dies alone. We must not forget that it's not just the elderly who die, many people die in hospital from all sorts of things.

    Why don't hospitals open nurse-led units for the terminally ill and dying, for anyone approaching the end of their life who needs symptom control, spiritual help or just a bit of peace and quiet.

    The only alternatives seems to be a hospice or a nursing home which are very difficult to get into and not always what the patient or family want.

    Unsuitable or offensive?

  • Peter Saul: Let’s talk about dying

    on Website Life in the Fast Lane with other interesting links

    http://lifeinthefastlane.com/2012/04/lets-talk-about-dying/

    Same video on the original site
    TEDx

    http://live11.ted.com/talks/peter_saul_let_s_talk_about_dying.html

    For those not familiar with TED, TEDx and TED-Ed these international sites on all manner of innovative, inspirational and entertaining ideas is well worth exploring

    http://live11.ted.com/

    Unsuitable or offensive?

  • Joan Halifax: Compassion and the true meaning of empathy

    http://live11.ted.com/talks/joan_halifax.html

    http://live11.ted.com/speakers/joan_halifax.html


    TEDTalks and TEDWomen

    Unsuitable or offensive?

  • Good to read Robyn's story. Nurses do need training in palliative and do need experience in sitting with the dying, talking to relatives and being involved in holistic care. Many are inexperienced and would rather leave the dying and their relatives to "sit it out" alone! Should not be so. End of life care is very important. The way a relative/friend dies, leaves lasting memories and they should be good ones! It's a nurse's priviledge to be there for the dying and for their relatives, during and after a life comes to an end

    Unsuitable or offensive?

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