Palliative care...advice for a novice please.

Specialties Holistic

Published

Specializes in NICU & OB/GYN.

Hello,

I am a nursing student but I thought this was more of a general question that any new nurse may have. I was going to post it under "Hospice" but my rotation will be focused in a facility that deals with more acute situations. Here we have the "palliative care program", which consists of specialized palliative units attached to large teaching hospitals. They are a very family centred focused, have a holistic approach to care and they deal with all terminally ill patients of all ages. We do have a couple of hospices in the city as well but I was not assigned to this.

I was curious as to what palliative care was like in other places and if someone could give me advice going into this area as a novice nurse who has never experienced death or the dying process yet.

Thanks:)

I'm a nursing student, too. :) Last quarter, I read Kubler-Ross' "On Death and Dying" and found it to be a fascinating, informative read - enough so that it piqued my personal interest in palliative and hospice nursing for a possible long-term career choice, once my education is completed. The book provided wonderful insight not just into the care of the dying patient and their families, but foundations for empathetic, compassionate, respectful patient care in general that I personally have taken to heart. It even gave me the insight and inspiration to have a heartfelt, cogent conversation with my critically ill grandfather about his thoughts, feelings and fears about death -- something that I wouldn't have done in a million years had I not read this book. If you have never read it, I cannot recommend it highly enough.

I hope you have a rewarding rotation and learn a lot!

Specializes in NICU & OB/GYN.
I'm a nursing student, too. :) Last quarter, I read Kubler-Ross' "On Death and Dying" and found it to be a fascinating, informative read - enough so that it piqued my personal interest in palliative and hospice nursing for a possible long-term career choice, once my education is completed. The book provided wonderful insight not just into the care of the dying patient and their families, but foundations for empathetic, compassionate, respectful patient care in general that I personally have taken to heart. It even gave me the insight and inspiration to have a heartfelt, cogent conversation with my critically ill grandfather about his thoughts, feelings and fears about death -- something that I wouldn't have done in a million years had I not read this book. If you have never read it, I cannot recommend it highly enough.

I hope you have a rewarding rotation and learn a lot!

Thanks for replying...funny, last theory class our instructor talked all about Kubler-Ross as we were discussing grief. I was wondering..do you take a palliative course in your program or was it just your own self-discovery that got you onto this area? We have to take a course..very differeny than any we have. Lots of discussion, personal experience sharing and story telling. At first I was like.."I don't know about this.." I guess because I have been so used to the scientific factual based classes in the past. But I am really enjoying it now. I start clinical in 2 weeks and I am very nervous because believe it or not..I have never experienced death before!? I guess I have been just lucky.

Good luck to you, almost there! yay!:yeah:

I actually read the book on my own, LOL. I was in a development psychology/nursing theory class, and our textbook said that "On Death and Dying" should be a "must read" for any nurse. I have always had a difficult time dealing with my thoughts and feelings with regard to death, and wanted to gain some new perspective. Boy, did I, LOL. Prior to reading that book, if you had asked if I would ever be interested in hospice work, I would have said, heck no. But I feel like I gained new insight not only into hospice care, but my own feelings and fears about death and the dying process. It sounds strange, but it seems to me that once you understand your own thoughts about it, it helps to put caring for those who are dying (and dealing with their families) into perspective, which is one of the points of the book.

I really appreciated Dr. Kubler-Ross's perspective on patient care; like I said before, her philosophies are really adaptable and applicable to any healthcare setting, not just hospice or palliative.

Good luck to you, too! I've got a ways to go in my studies (I'm an evening SPN, only in my second of 7 quarters, then on from there to ASN, I hope), but I'm really looking forward to delving deeper into the profession! :)

Sara

Specializes in Pediatrics, Geriatrics, LTC.

I work in LTC and palliative care is a daily occurrence. What it means is that you are just keeping the patient comfortable till they die. Give them their pain meds, food and water, but not much more. You aren't doing CPR, or any heroic measures, (provided that's what they want) if they code let them go. Basically just giving them what they want to be comfy. No extra blood work, no PT, OT or podiatry, no unnecessary tests etc. They are actively dying and should be respected for that. That's my understanding

Specializes in NICU & OB/GYN.

I really appreciated Dr. Kubler-Ross's perspective on patient care; like I said before, her philosophies are really adaptable and applicable to any healthcare setting, not just hospice or palliative.

Good luck to you, too! I've got a ways to go in my studies (I'm an evening SPN, only in my second of 7 quarters, then on from there to ASN, I hope), but I'm really looking forward to delving deeper into the profession! :)

Sara

Thanks, you know you have inspired me to get reading. I think in our syllabus it mentioned to give her a read but then again they tell you to read so many darn books you lose track of the really important ones. I checked online and have held two books by her at my local library and will pick em up tomorrow. I think that is what I may need because like you, it sounds like I have the same reservations you may have had initially. I haven't been doing as well as I normally do in theory classes and at first I chalked it up to being burnt out or too busy. But I think you hit it on the nose..though those may be true I think some of it also has to deal with the fact that I am unconfortable with the topic and may have been avoiding the reflection aspect that is needed.

I guess I read it wrong and thought you meant you're a student in your last quarter. shucks, well..don't worry it will fly by (as I am sure you can already tell). I cannot believe I been in school for 4 years now!!

Thanks again for your feedback!

What it means is that you are just keeping the patient comfortable till they die. Give them their pain meds, food and water, but not much more. You aren't doing CPR, or any heroic measures, (provided that's what they want) if they code let them go. Basically just giving them what they want to be comfy. No extra blood work, no PT, OT or podiatry, no unnecessary tests etc. They are actively dying and should be respected for that. That's my understanding

respectfully, this is totally wrong.

it sounds like you are confusing hospice with palliative care.

with palliative care, pts are still actively involved in treatments for their disease.

while the focus is on still on comfort, palliative care focusus on goals while maximizing quality of life.

granted, most of these folks, end up on hospice services...

but it is the psychological transition of still 'plugging along' versus 'accepting' their terminality, that keeps one on palliative services.

i would not advise initiating conversation about dying/death to this pt population, unless they bring it up first.

i realize i should have provided a link, citing the differences...

if i have time, i'll do just that.:)

leslie

eta: let's try this link:

http://www.americanhospice.org/index.php?option=com_content&task=view&id=396Itemid=7

leslie

Specializes in NICU & OB/GYN.
respectfully, this is totally wrong.

it sounds like you are confusing hospice with palliative care.

with palliative care, pts are still actively involved in treatments for their disease.

while the focus is on comfort, medicare and most other insurances, recognize that palliative care allows the pursuit of 'futile' treatment.

granted, most of these folks, end up on hospice services...

but it is the psychological transition of still 'plugging along' versus 'accepting' their terminality, that keeps one on palliative services.

i would not advise initiating conversation about dying/death to this pt population, unless they bring it up first.

i realize i should have provided a link, citing the differences...

if i have time, i'll do just that.:)

leslie

Thanks Leslie. That helps paint a better picture for me. I guess there is no best way to be fully prepared for what my experience will be like. I will try my best to embrace the rotation and be open to any situation. I am taking time beforehand to read up on it as much as I can as I know every little bit helps with the learning process. I just love this site though, nothing compares to real-life nurses sharing their insights!

Thanks Leslie. That helps paint a better picture for me. I guess there is no best way to be fully prepared for what my experience will be like. I will try my best to embrace the rotation and be open to any situation. I am taking time beforehand to read up on it as much as I can as I know every little bit helps with the learning process. I just love this site though, nothing compares to real-life nurses sharing their insights!

shanlee, i edited/updated this post...

i typed that medicare and most other insurances, cover palliative care which isn't true.

(i was thinking of hospice...duh:o).

and i added a link from an old thread.

by all means, engage w/these folks, if they feel up to talking.

find out what they're capable of doing for themselves and try to respect their autonomy.

personally, i find palliative services a bit more precarious than hospice, because as states, these folks know they are critically ill but haven't fully accepted their terminality.

just treat them with dignity and sensitivity...you'll be fine.

leslie

my best advice to you is to listen & be informed. how you view death & afterlife has everything in the world to do with your upcoming experience. if you approach it with sensitivity and view it as something sacred that you have been allowed to participate in, it can change your life forever! the most amazing death that i have ever experienced was my first hospice death(not my first patient death). several years later i read the book "final gifts" by maggie callanan & patricia kelley(the book was so intriguing i read it in one day). i was amazed at how this precious patient had communicated with me during his final hours on this earth, using symbolic language and how common this phenomena is. such an incredible experience, i have never looked at death the same since. good luck with your rotation!:)

follow this link & i believe you will have a lot of your questions answered. http://www.cpmc.org/services/palliative.html

Specializes in RN, BSN, CHDN.

I have moved thread to Holisitic nursing forum so you can recieve the specialised answers you require. I was tempted to move it to Hospice then decided I would move it here. I hope you get the support and answers you need.

Specializes in NICU & OB/GYN.
The most amazing death that I have ever experienced was my first hospice death(not my first patient death). Several years later I read the book "Final Gifts" by Maggie Callanan & Patricia Kelley(The book was so intriguing I read it in one day). I was amazed at how this precious patient had communicated with me during his final hours on this Earth, using symbolic language and how common this phenomena is. Such an incredible experience, I have never looked at death the same since.

Thanks for the link! Funny, I just took out Maggie Callanan's other book "Final Journeys" and have just begun to read it. I have been fortunate to have a couple weeks off before I enter this rotation so I have had time to find some great readings out there!

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