Student nurse Jessica discusses her placement experience providing palliative care to a patient in her home
jessica smith bradford uni
During my first clinical placement, I had to take care of a lady with palliative cancer. It was incredibly touching to care for a patient in her last days of life at home; being involved in such personalised end-of-life care was challenging and an honour.
I had been visiting this lady since the beginning of my placement. Her personal strength and courage were admirable, I wondered how she could be so positive with such uncertain times ahead. Towards the end of my placement, a call came through from her husband for a visit.
When we arrived, he greeted us with his familiar cheery welcome, but behind the cheer there was fear in his eyes. I wasn’t prepared for what I was to be faced with. I felt like I was seeing a different woman. Frail, exhausted, visibly thinner and completely vulnerable, she was barely able to keep her eyes open and her neck and chest were covered with cancerous lesions. The cancer was clearly winning. As I crouched next to her to say hello, I hoped my shock wasn’t visible.
That first day went by in a blur. It was decided that we were to ensure her comfort. I was present during the discussion about her resuscitation status. We couldn’t deny that our aim now was to support the patient and her family, striving to do our best in terms of care and commitment. That day, I left their home feeling incredibly guilty that we’d dropped the bombshell, devastated them and during their hour of need left them with their imminent grief.
We tried our best to make her comfortable and achieved it in varying degrees. A hospice bed was unavailable, so we convinced her to have equipment at home. We battled for five days to relieve her pain and distress, which she denied feeling whilst we were present. We reassured her that whilst it was admirable to be so brave, there was no need to suffer unbearable pain.
She peacefully passed away at home, surrounded by family and also with dignity and courage.
Caring for a patient in her home makes you feel like an intruder at times and in this case also the bearer of bad news, yet at the same time we were welcomed and respected for providing a high standard of care. We carried out the actions we had promised and treated her as if she was our own relative, upholding her dignity and strength and keeping her in charge of decisions where possible. Excellent, person-centred nursing care provided support and comfort in her last days of life.
However, I had so many mixed feelings about going to her bereavement visit. I was afraid of how it would feel to be in her home, with her no longer there. I’d already felt the weight of grief looming, I wasn’t sure how the emptiness would now feel. However, I made the bereavement visit. The gratitude expressed to each and every one of us by the family was all the proof that we needed to know we had done our best.
This experience has reminded me why I’m pursuing a career in nursing. It’s made me realise that no matter where and when you join your patients and their family on their journey and no matter how difficult that journey is, as long as you are fully present with them and remain honest, genuine and caring, then hopefully their vulnerability and fears will ease and they will be comforted.
Jessica Smith is currently in her first year studying adult nursing at University of Bradford