Palliative Care

MollyJ · Jul 23, 2002

I think Palliation is a mindset. When I went to nursing school LONG AGO it was the care versus cure mindset. Now I don't want what I write here to denigrate this fine nursing program described above; it sounds like something I could personally be very interested in. It sounds like a voice in the desert.

My old diploma program did not address palliation per se, but we talked alot about nursing care and nursing problems. However, I personally did the critical care route and I think that working those high tech environments pulls the nurse away from the care mentality and towards the "cure" mentality. Please--I am not saying that critical care nurses are uncaring. But when nurses get caught up in a culture of doing it because it can be done, calling anything but doing that high tech procedure "malpractice", etc, they've started to focus, along with their medical colleagues, on Cure VS Care.

So many critical care nurses post here and say, "Geez, i can't believe what we are doing in my ICU to old people who are demented, chronically ill or care home residents." These nurses are rebelling against the "cure" paradigm.

Palliation and "care" are beautiful, under-utilized concepts. Ultimately, as Americans confront the notion that we can provide more health care than we can afford to provide, embracing palliation and "care" will become the face of health care.

I formerly did case management on high tech peds cases. These children and their families needed care vs cure thinking injected into their cases. So much was done to these children because we had the technology and it could be done. But little was done in the way of asking, "SHOULD it be done?" Even when the questions were asked the families were so wrapped up in the fast-moving, high tech care "steam engine", that families felt paralyzed to jump off of the train. They'd already entered into the curative mindset culture. Pursuing the elusive "curative" technology in these children's cases OFTEN forced their families into a frankly dysfunctional maelstrom.

As a culture, families and the public expect miracles, cures, happy endings. They've seen that outcome out of high tech care so often, that they ill conceive of anything else. But the fact is that high tech care often serves people poorly.

viva la palliation!

mattsmom81 · Jul 23, 2002

I think being a Palliative Care Nurse Practitioner would be a very rewarding field...I've been glad to see the specialty develop too.

I agree totally, Molly, and have been known to get into it with docs who want to do every friggin line and procedure known to man on patients that don't want it....so many just want to be kept comfortable....and go home to die if possible...and they don't know they can refuse the doctors orders......this is when we have to stand tough and be patient advocates, even if we pizz off the doc. (and I frequently do...hehe!):roll

adrienurse, LPN · Jul 23, 2002

Man, I'm really glad that the idea is catching on in my city. I used to have to argue so much with docters in order to advocate for my patients, in my last job. I worked with so many dinosaurs I was always teaching teaching teaching. Never got in trouble, but was always afraid that I was going to when I was saying to doctors "That's okay...but what about prescribing this medication _________". People are so damn afraid of prescribing more than 5 mg of morphine. Also like that we now start SC lines so that the person doesn't need to be poked over and over again once they're no longer swallowing.