As a hospice or palliative care nurse, you know that you have a challenging and rewarding job. Helping people with quality care in the final stages of life is among the most important jobs of all. Not only can you support the person in need of care, but you can also provide comfort and happiness to friends and family members. Experience, kindness and empathy are qualities that go a long way in your profession. Certainly, each case is different. This requires an awareness of what is going on and an understanding of the uniqueness of each situation. There are a number of ways to provide the best possible nursing care to those nearing the final days of their lives.
Pay Close Attention to Details
A good nurse will closely observe the patient throughout the visit. This can have many positive benefits. While it is important to provide medical care, such as administering medicine and monitoring vital signs, keeping the patient comfortable can also give benefits. Here are some things to look for.
- Dry lips: If patients are licking their lips, they might be in need of water.
- Uncomfortable position: Patients are often unable to get into a comfortable position. Helping them adjust from time to time can be a big help.
- Coldness or warmth: Patients may not be able to turn the heat up or down, turn on a fan, open a window, or even communicate their wishes. Staying attuned to the temperature of the room, air flow and other issues can provide an added level of comfort.
- Establish a supportive relationship with patient and family.
- Be direct, yet caring.
- Be truthful, but sustain spirit.
Make a List
When engaged in palliative or hospice care, it can be easy to become overwhelmed with tasks or to get distracted. Making a list of your most important objectives for each shift can be a comforting resource to look at should things get hectic. A list could include some of the following items:
- Dispense daily meds
- Make sure the patient is hydrated
- Allow the patient to get rest
- Make sure the patient is comfortable
- Make notes on the medical chart
If you find yourself too busy, prioritize and concentrate on the most important tasks. Your list should contain your essential responsibilities.
Set Boundaries for Yourself
As a nurse, be cognizant that you are there to do a professional job. On some level, you probably want to connect with your patient and to express empathy, but it is crucial not to let the personal overwhelm your professional role. Over time, you may see many people die. If each person becomes a close personal friend of yours, the emotional toll for you could be enormous. Burnout in the end-of-life nursing profession is high, so remaining stoic and professional in your mindset is a necessity. While empathy and kindness are important, your primary focus should be to provide the highest quality care for each patient.
As a palliative or hospice care nurse, you are involved in one of the most intimate moments of a patient’s life and in the lives of family members. The ability to talk openly with the patient is a skill that must be learned over time. Genuine empathy for the patient is a good place to start. Here are a few things that people might enjoy talking about in their final days:
- Memories: Patients often love talking about the things they have done and the places they visited.
- Pets: Almost everyone loves talking about favorite pets they have had. It is a topic that usually has pleasant memories and can help take the mind off the present.
- Final Wishes: The patient may be interested in talking about his or her final wishes, little items that require closure or people that need to be contacted. You can provide a level of reassurance that final wishes will be honored.
Your skill in talking to patients can improve and become more natural over time. The U.S. National Library of Medicine National Institutes of Health publishes a pamphlet suggesting how to talk to patients about death and dying. It includes initiating conversations, going over treatment plans, helping the patient understand his or her diagnosis and talking about end-of-life wishes. Also, utilize the specialized skills of other team members, such as social workers and chaplains.
Take Care of Yourself
It is important that you don’t neglect your own physical and mental health. Make sure you are getting enough rest, eating the proper foods and staying hydrated. The stronger you are, the more effectively you can do your job. It is good to do something you enjoy each day, whether it is listening to music, spending time with kids or friends or taking a walk. Hospice nursing can take a toll on your emotional well-being, so remind yourself not to get too attached. Learn to recognize when you are stressed and practice techniques to cope with it (see mindfulness). And consider speaking with a chaplain for spiritual support.
Pat Yourself on the Back
It’s okay to give yourself credit from time to time. Remind yourself of all the good you are doing:
- Helping people ease into the final stage of life
- Allowing a patient to be comfortable and as free of pain as possible
- Providing a welcoming environment for friends and family members of the patient
- Making a difference in a person’s life just by being there and showing empathy
- Comforting those in need and sustaining the spirits of patient and family
Without you, a person’s final moments would likely be less comforting. Never forget the important role you play as an end-of-life caregiver.