Arthur, 80, was fond of the simple things in life. He still felt uneasy in the hospital and around doctors, despite being treated for chronic heart and kidney failure. Now he was dying and he wanted no more of doctors and hospitals. Arthur's family, aware of his last wishes, was doing its best to honor them.
Arthur was admitted to the ICU, where he signed a do-not-resuscitate order. A morphine infusion was initiated to control his pain.
Soon after Arthur was admitted, his condition deteriorated and his family was called in to spend the few last moments with him. Arthur became apneic as his family entered the room. They saw a nurse holding Arthur's hand and softly telling him that his family would be cared for, that he had no need to worry. The nurse then ushered the family into the room and encouraged them to take the time they needed. After the nurse left, they noticed that she'd shaved Arthur. He'd prided himself on his grooming but was unable to do it himself during his latest illness.
Two weeks after Arthur died, the family came back to the ICU and told his nurse how much it meant to them that Arthur had been shaved before he died and comforted during his last moments. His daughter and son both said that their loss had been somewhat lessened because of the kind actions of one nurse who took the time to care for their dad.
Now let's consider how you can have a similar effect on a patient's family by providing palliative care for their loved one.
Unique opportunity
Nurses have the opportunity to interact and connect with patients and family as few other professionals can. Seeing people at their most vulnerable and being able to make a difference in a family's memories of a loved one's death are deeply significant activities.
According to the literature, families need proximity, involvement, and information about their loved ones during critical illnesses. Patients' and families' needs must be addressed so that healing can begin when a cure isn't possible. Nurses are the links between the family and those resources. Palliative care is needed in critical care whether or not that need is expressed verbally. The overall goal of palliative care is, at its core, meticulous symptom management.
Searching for values
The healthcare team must initiate a discussion about the dying patient's wishes and values and how his needs can best be met. Although Arthur's family knew what his wishes were, sometimes a patient's wishes aren't known. In these cases, the healthcare team can initiate a discussion with the family, focusing on what the patient values. Ideally, the discussion will occur prior to hospitalization and be revisited periodically to ensure the patient's issues haven't changed.
The nurse at the bedside, the patient, and his family are best suited to ascertain how to meet the patient's needs. The nurse at the bedside has an influential role in modeling effective communication with other healthcare providers and also the patient and family.
Being prepared
This particular patient and family benefited from the presence of the nurse at the bedside and her own comfort with dying. Not every nurse is comfortable with death. For those who aren't, resources are available to help. Materials can be obtained from the Hospice and Palliative Nurses Association, the American Association of Critical-Care Nurses, and the Society of Critical Care Medicine.
Accessing appropriate resources may be the initial step in creating a change process where healing isn't viewed as solely curative but as palliative as well.
RESOURCES