End of Life Nursing Care: Embracing Change Presents a New Challenge

If you provide end of life nursing care, you probably get tired of people telling you how brave you are. After all, the work you do is incredibly rewarding. But nobody can deny that it’s also emotionally difficult.

Helping people say goodbye requires empathy. Deep empathy. The kind of empathy that allows you to look at a person and get a sense of what they need.

Of course, palliative care is a specialized discipline, grounded in best practices. But it’s also about intuitive human connection; it’s about understanding and caring for those who are at their most vulnerable.

Because they focus so much on the human element, many practitioners don’t think a lot about efficiency. If you fall into this category, you may be reluctant to try doing things differently.

Whether it’s streamlining your workflow or implementing a new technology, the result of change probably looks the same. A steep learning curve. A more inflexible way of working. And – worst of all – less one-on-one time with your patients.

But it doesn’t have to be this way. Sometimes, change can be both beneficial and painless.

In this post, we’ll look briefly at the evolution of end of life nursing care. We’ll consider why professionals in the field are so often opposed to change, and how this attitude can get in the way.

The Ongoing Evolution of End of Life Nursing Care

In health care, as in most sectors, the last few decades have been a time of rapid change. Scientific discovery and technological advancement have improved the way we treat illness in ways that were once unimaginable.

Of course, end of life care has not been untouched by these shifts. As just one example, there have been massive breakthroughs in pain management since the 1970s.

The complex pain that many experience near the end of life continues to pose challenges. But the impact of recent developments – such as those related to drug-delivery methods – can’t be denied.

Our understanding of the emotional and spiritual needs of patients and their families has also grown. The broader medical community is beginning to understand what palliative care specialists already know. Treating people in the last phase of life requires a holistic approach.

Recent changes have allowed patients to receive care outside of hospitals. Whether you treat people in their homes or in an inpatient facility, you’ve seen the difference a comfortable environment can make.

Palliative care has evolved so much, it’s hard to believe it’s a relatively new field. And this evolution must continue.

Given the aims of this type of care, many practitioners resist initiatives designed to improve it’s efficiency. After all, at it’s heart, delivering end of life nursing care isn’t about efficiency. It’s about enriching the months, weeks, or days that patients have left.

That said, recent development has created a growing number of gaps in care that must be addressed.

Transitions between environments are becoming more complex – they require greater consideration. Multidisciplinary teams need better ways of sharing information. Patients and their families should have more control over interactions with practitioners.

Improving efficiency often means improving quality of care. And yet, many nurses and caregivers remain skeptical of innovation. Why?

Compassion and Resistance

Those who provide end of life nursing care have a rare set of qualities. Compassion, empathy, and the ability to instil trust are crucial. So is emotional stamina.

Can you handle difficult conversations with honesty? Are you able to communicate with people who are in distress? If you work on the frontline of palliative care, the answer to these questions is almost certainly “yes”.

It’s precisely these qualities that have caused many palliative care professionals to oppose changes that have occurred in other areas of medicine.

A recent Guardian article touches on this idea. According to interviewee and nurse academic Elaine Stevens, good palliative nursing is often about forgoing “high tech care”. End of life care is “directed at the quality of life as opposed to the quantity of life”, notes Stevens.

There’s truth to both of these statements. It’s also true that many physicians dealing with very ill patients still focus on the prolongation of life. And aggressive treatments aren’t always in the best interest of patients.

In fact, according to a study by Singer and colleagues, many people receiving palliative care worry that technology will be used to prolong their lives in ways they don’t want.

Given these facts, it’s understandable that many nurses in the field resist innovative technologies. The same is true of trying new management techniques and workflows. Isn’t it enough to simply continue focusing on patient-centred care?

Here’s the thing: innovation isn’t incompatible with patient-centred palliative care. And either is change.

Learning to use some caregiving technologies can waste precious time. And those who have worked in health care for many years have probably seen a few inefficient process “improvements”.

That said, when it comes providing end of life nursing care, embracing the right change can do a lot of good.

Finding the Best Way Forward

Those who work in palliative care are rightly protective of the the role human connectedness plays in their work. But it’s a mistake to believe that improving care team efficiency will come at a cost to patients.

Within your facility or the care team you belong to, you wouldn’t refuse to use a drug pump that provided patients with relief. And yet, many are hesitant when it comes to innovation that could improve communication, coordination, and continuity of care.

These are three areas where many palliative care teams can make further progress.

In outpatient settings, connecting circles of care can be a challenge. Though most patients would prefer to be at home, this option doesn’t provide the same access to care team members as inpatient treatment. Also, given the disconnect between palliative care specialists and other medical professionals, care team coordination can be especially tricky.

In inpatient settings, those who provide end of life nursing care are always present. They ensure that the most important steps – listening and empathizing – are taken care of.

But within palliative care units and hospice centres, improving organization is still important. Care team coordination can be a challenge – no matter where a patient lives. And when family members are offsite, they may feel less connected and involved.

Dealing with these issues – through the use of technology or process improvements – doesn’t have to take nurses away from patients. In fact, the opposite is true.

Even in the best of circumstances, you can’t be with your patients all the time. Digital technologies allow those you care for to connect with you, face-to-face, even when you can’t be there in person.

And consider what organization and scheduling can do for family members. By keeping patients and those who care systematically informed, you can help them maintain a feeling of control.

On the whole, when care teams work efficiently, nurses spend very little time on updates and administrative tasks. The result is more time, not less, with patients. Efficient communication also means a more connected circle of care and better support for patients and families.

A Balanced Approach is Still Best

Today, providing the best palliative care possible means finding the right balance.

Technology, innovative assessment tools, and new ways of working with care team members can drastically existing processes. They can make end of life nursing care more efficient. And it’s important to understand that efficiency has many end benefits for patients.

It’s true that some medical professionals don’t always honour patient needs and preferences. In extreme cases, they may use technology to provide curative treatments that are longer wanted or needed. But those who provide palliative care are likely to stay true to the values of their discipline, resulting in a more balanced approach.

One final reminder. Whether you’re implementing change or adhering to ongoing best practices, remember the value of communication, coordination and continuity of care.

Feature image courtesy of young shanahan

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