I once wrote about feelings of inadequacy when nursing patients in palliative care. I felt their needs to be so complex, that – coupled with the competing demands of a standard ward workload – it was difficult to give the emotional care that I wanted to give, as well as attending to their purely physical needs.
If a patient receives end-of-life care in an acute hospital setting, their discrete needs may conflict with the needs of other patients, primarily because we’d like to sit with them, listening to them, talking to them. We’d like to find out if there’s any music they’d particularly like to be playing, who they want in the room, what they want and what they do not want when they die.
This sort of care doesn’t end with the patient so we’d like to be there to support relatives as well – to make them tea, listen to their worries, reassure them if we can and refer them to a counsellor where possible. But when you have a bay of six or eight acute patients to care for as well, there’s a good chance that this isn’t going to happen.
I have vivid memories of my father dying of cancer. As a family we were lucky – he was cared for by Macmillan nurses at home until he moved to a wonderful hospice. But, since then, I have seen palliative patients cared for in acute settings where the workload of the individual staff nurses is, quite simply, incommensurate with the needs of those patients who are dying. Although their physical needs for analgesia, and essential care may be met, the more time-consuming need for listening and talking may not be.
In the campaign ‘One Woman, One Midwife’, midwives lobby for continuity of care. Perhaps we should do the same in palliative settings? Because the care received by patients who are dying should be of the highest quality.
Arabella Sinclair-Penwarden is
a staff nurse in Devon