Are You Comfortable with End-of-Life Care?

March 17, 2008

How comfortable are you with end-of-life care? Do you like working with patients who are dying and with their families? Is it a challenge for you that you welcome? Or is it difficult for you to cross over from saving a life to helping someone live comfortably in their final days?

How comfortable are you with end-of-life care? Do you like working with patients who are dying and with their families? Is it a challenge for you that you welcome? Or is it difficult for you to cross over from saving a life to helping someone live comfortably in their final days?

A nurse doesn’t have to work in palliative care or hospice to be faced patients who are dying and for whom treatment will not prolong life—we all know that. A patient may not be officially deemed as palliative, but we know what DNR means. Or do we?

When I worked in an ICU in the early 80s, I had a great head nurse who gave us a wonderful orientation to the unit. I remember a particular topic and conversation. We would get patients in the ICU who were “no codes” sometimes, and that puzzled a couple of us who were just starting in the unit. We felt that ICU meant that we were fighting to save a life. The head nurse said that if a patient was a no code, but had a treatable problem, the patient should never die of that treatable problem. So, if someone had pneumonia, he or she should be treated with antibiotics because that was not the reason of the impending death. To not treat would be to cause the patient extra suffering.

That statement had a profound effect on me. It made sense once it was explained to me, and I’m grateful to her for pointing it out to me. End of life doesn’t necessarily mean end of all treatment.

So, that brings me back to the question: “How do you feel about working with dying people?” I know some nurses who hate it. They like to save lives; they feel that a death is a failure to the team. That’s not necessarily a bad thing. We need people to think that way and work that way in certain milieus, but not in all.

To tell you the truth, working with someone who is dying is not all that different than working to save someone. You need to help them be comfortable; you’ll likely need to manage pain and symptoms. You have the physical aspect of care that can be just as involved, if not more so, than for someone who you are treating and expecting to recover. The challenges are numerous, and your problem-solving skills may take a beating from time to time. You need to not only work on how you help the patient and family, but often how you feel and think about certain issues yourself.

Most importantly to me, working with someone who is dying gives a nurse a chance to do the actual nursing we were trained to do. We can take the time to give those backrubs, to sit and talk, and to provide the basic hands-on care that we seem to never have time for in a traditional hospital environment.