Caring for the patient with a tendon transfer, sprain, or hip fracture is something an orthopaedic nurse is generally comfortable doing every day. We care for those with minor orthopaedic problems, and we care for those who have severe traumatic injuries. We are good at what we do. Most often other nurses marvel at our abilities to deal with this type of patient and thank God for those orthopaedic nurses who like that "stuff." But how many of us are comfortable dealing with end-of-life care planning? As competent as we are caring for orthopaedic patients, taking the next step to identify those patients who would benefit from having a "conversation" about the type of care they would really want as disease progresses is something many of us rarely consider.
The National Association of Orthopaedic Nurses Palliative Care Task Force has taken the initiative to look at our practice, our patients, and our role in this very important part of nursing care. In so doing, they have brought to each of us a decision that we must make. Do we want to take on the additional challenge that impacts so many of our patients and their families, or do we let those same patients and families come to grips on their own with the sometimes difficult significant life altering challenges?
I was especially struck by the thought that 75% of people would prefer to live out their final days in their own home, yet only 25% of patients actually achieve that wish (Watters et al., page 4). It is time that knowledgeable healthcare providers learn to have the discussion and help patients achieve their wishes.
Healthcare providers need to take a lead role in the development of policies and resources that allow patients to have the right to choose how they want to spend their final days without fear of incurring debt to achieve their wishes. Public resources to allow patients to stay in their home with assistance by various levels of care providers must be developed and promoted.
As someone who is currently trying to have a conversation with my 88-year-old mother-in-law and her 94-year-old sister who still live in their two-story home, I know the dilemma all too well. This conversation never seems to go well. Heart disease, fluid retention, spinal stenosis, and a loose hip prosthesis plague the older sister. Severe pain and near total inability to walk have forced the 88-year-old sister to become the caregiver. Refusing to let any of us help in any way has left many of us very frustrated. The mere thought of bringing in additional help to their home unleashes a torrent of anxiety.
What this has done for me, though, is to have the conversation early in my life. I believe that this too is something that each of us can do so that our children, nieces, and nephews have an "easier go of it" when this dilemma occurs. Make it easier on everyone, write down what you want today, commit to it, discuss it with family, and, if possible, allocate resources for that purpose. Your wishes in combination with healthcare providers who understand palliative care and a society that deems it important enough to support it will make the future much better for all of us.