Supporting nurses to care for our dying
An article written by Melissa Bruno
I was really fortunate from a young age to be exposed to the positive experiences caring for a family member who was dying at home can bring. Although sad, I was raised being taught that dying is a normal part of life. My early experiences showed me that caring with compassion for someone at the end of life can be a privilege and honour.
Despite over half of all deaths in Australia occurring in hospitals, nurses aren’t equipped with the knowledge, skills, and confidence to care for someone who is dying. [1] They often feel they don’t know what to say to patients and families and feel they don’t have the confidence to have conversations about dying. And yet nurses are often the first to recognise a patient is deteriorating. They spend most time with patients along their long illness journey, often in the most intimate of ways.
The palliative care link nurse program was developed to explore nurses’ attitudes towards death and dying and through support and mentorship give them the skills and knowledge to feel more comfortable to care for dying patients. [2] Link nurses complete Death Audits identifying areas of practice that can be improved on whilst also recognising what was done well. They also provide education to their colleagues on care of a dying patient to share what they have learnt.
The link nurse program has led to small, but often significant changes to practice at ward level making a difference to patients and families. Recently, I entered the room of a patient on a busy medical ward. On the bed was a beautiful handmade quilt and on the bedside cabinet a small tray. On the tray was an essential oil infuser giving off a beautiful, calming scent in the room, a small pot plant gave some colour to what is usually such a sterile environment and a candle lit the room. The family walked in to see their loved one dying but in an environment that they described as beautiful and often only seen in a palliative care unit or hospice. The family explained to me that the nurse had spoken to them about what to expect in the coming hours to days and supported them to provide some of the care required.
The ward palliative care link nurse was instrumental in providing this compassionate and healing space. A space that this family would probably never forget as they mentioned in a bereavement call I made to them shortly after. This is what sits at the heart of the program, making changes one step at a time to improve the care of dying patients in hospital, many of whom do not have the involvement of a specialised palliative care team.
References
-
Australian Commission on Safety and Quality in Health Care (ACSQHC). Safety and Quality of End-of-life Care in Acute Hospitals: A Background Paper. Sydney: ACSQHC, 2013.
-
Bruno M. The introduction of a palliative care link nurse programme to improve nurses' attitudes, knowledge and confidence in providing end-of-life care in an acute care setting. Int J Palliat Nurs. 2022 Nov 2;28(11):540-545. doi: 10.12968/ijpn.2022.28.11.540.
Useful links
End-of-Life Essentials – Online education modules and resources
Melissa Bruno
Nurse Consultant and Palliative Care Link Nurse Coordinator with the Northern Adelaide Palliative Service
Northern Adelaide Local Health Network