Tips for compassionate end-of-life care in acute care
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A blog post written by Jeanette Lacey, End of Life Care Nurse Practitioner, Hunter New England LHD
I am often asked when working in a public hospital acute care unit, “How can we get better at end-of-life care? (We are really bad at it.)”
It is not always an easy question to answer. Acute care by its nature is acute, dynamic, challenging, busy, and hard work. Our public hospital systems are challenged daily, our patients are getting older, they have more co-morbidities, and yet the evidence tells us that not many patients are talking about their end-of-life care or wishes.
I most commonly hear this question in our Emergency and Critical care areas. These are busy spaces; patients arrive to our emergency department often very unwell. Emergency departments are well versed in the ‘Golden Hours’ for trauma; ‘sepsis kills’, ‘time is muscle’, ‘time is brain’. Mantras to remind us to diagnose fast and get people to the right place of care.
What of those patients who come in clearly dying, or even undergoing cardiopulmonary resuscitation (CPR)? How can we better care for them? We can provide them with what every person needs - dignity, respect, and privacy. Emergency and Critical care areas are especially good at relieving pain and providing dyspnoea management; they can also address the needs of families and friends.
While these areas are not designed for perfect textbook end-of-life care, staff can give the best, most compassionate care to the dying in that environment, at that moment in time. The following points may assist with dignity, respect, and privacy.
- The beds have curtains for a sense of privacy (the curtains of silence), and all staff have the capacity to talk a little quieter when they know what is happening in that sacred space behind the curtain.
- Staff can work within their health care teams to allow a bit more time with patients and families.
- You can call in other staff who can help which may include social work, pastoral care, or palliative and end-of-life care teams.
- By spending a little bit of time with patients and families finding out what they need as a family and explaining what is happening as they witness what they fear most - the loss of someone they love.
I believe a further answer to the “we are really bad at it” comment is, if you don’t feel that you have the knowledge or confidence to deliver this sort of care, go and learn more, take advantage of one of the many programs available throughout Australia, many of them free to you to improve your skills;
We should all have the capacity to deliver quality end-of-life care wherever it is that we need to do it, when we need to do it.
Jeanette Lacey, End of Life Care Nurse Practitioner, Hunter New England LHD