End of life care. What does it mean? Does it refer to care in the last days, the last weeks, or the last years? What type of care is provided by an end of life care program? Is it holistic? Patient and family centered? What are the program goals, criteria, expectations?
In the past decade “end of life care” has become a commonly used term. While Hospice Palliative Care leaders across the country fail to reach consensus on a definition, many programs use the term to describe a portfolio, a program…. Without a definition, without standards and guidelines, End of Life Care risks becoming End of the Road Care.
Fewer than 25% of dying Canadians receive the services of a specialist HPC team, and even fewer die on a hospice palliative care unit. It is unlikely that hospice palliative care programs will ever be funded to address the needs of the dying across all settings. The majority of Canadians will die with chronic disease(s), in long term, acute and home care settings. The majority will die with an ambiguous dying trajectory, without a clear period of “dying” until death is imminent and consequently miss the benefits of a hospice palliative care program.
An exciting new research project is underway in BC. “The Initiative for a Palliative Approach in Nursing Evidence and Leadership” (iPANEL) The goal of iPANEL “is to advance the further integration of the palliative approach into nursing practice in every care setting.” (https://www.ipanel.ca/ )
A palliative approach integrates palliative principles and practices in care for all individuals dying with any life-limiting disease, earlier in the disease process, in all settings. A palliative approach can be integrated in care by generalists. The challenge is to educate the health care team. Just as a “palliative approach” is integrated across all settings, and earlier on in disease process… a “palliative approach” should be integrated in educating the entire health care team, earlier in the process.
What does this mean for educators developing core curriculum for PN and HCW students?
LPNs and HCWs care for those living-dying with chronic illness. The length of stay in most settings is decreasing and the number of deaths in LTC is increasing. LPNs provide leadership and function very independently in many settings, and HCWs provide an estimated 80% of direct care.
As curriculum writers prepare content for the new BC Provincial Practical Nurse Curriculum Guide, you can begin by ensuring that your students:
- Recognize that palliative care is not a specialty, is not tied to location, is not limited to the last days and hours, and is not limited to people dying with cancer,
- Describe ways that a palliative approach can improve care and enrich the living-dying experience of people with life limiting illnesses, in all settings, earlier in the disease process, and
- Demonstrate competencies associated with a palliative approach.
Integrate a palliative approach in core curriculum and ensure that your students are prepared to provide best care at end of life. Integrate a palliative approach in core curriculum and help ensure that End of Life Care does not become End of the Road Care!
I embrace what you share here Kath as during my nursing training I found I was struggling with not having the ‘tool’ to care for those going through death and dying process and their care givers. I felt inadequate as a care provider as I valued being a ‘bedside’ nurse, holding a hand, stroking the forehead, making them comfortable, helping with their pain, physical and emotional. I did a paper at the end of my year to fulfill a ‘gap’ in my needs to help with fulfilling it. I interviewed, spent time to get to know the individuals and support givers, and did self analysis from taped interviews (with consents). This was helpful along with research of information from different sources as to how I could ‘do better’ which strengthened my next approaches with these individuals. I also did poems of these experiences and analyzed them: they reflected my responses in many ways and levels of the journey I was progressing towards.
In the end, I felt that within the curriculum I had, a course that you are suggesting to HC providers at all areas of care would definitely been of benefit.
Thanks for your comment. Wonderful to hear how you took the initiative and pursued study independently. Sounds like it was a rewarding experience, and that you gained much. Way to go! From here on, you will continue to direct your learning. I love education, love to engage with new knowledge, to create and utilize new research in practice.
I wish you the very best in nursing. This is a profession that I have always loved.
I would love to send you a reflective writing journal,… if you would like a copy of it, please email me and I will send it to you.