At the commencement of my nursing career I was in a ward that dealt with a vast number of patients, some of whom were patients with a life limiting illness. Whilst confronting, this area interested me greatly. I found that as a nurse I had the ability to advocate for these people and dramatically impact on their quality of life. I learnt most of my palliative care skills by simply being in a situation where it was essential that I pick them up – wither by working things out for myself or watching and consulting with more experienced clinicians. I decided that to give my patients the best possible care it would be beneficial to undertake a PEPA placement.
The week I spend working in palliative care was challenging, surprising and highly educational. I was able to work with the community nurses whilst hey made home visits to their palliative patients and was able to spend time with the palliative care clinical nurse specialist as she made home visits and did hospital consults. The vast difference between working in the hospital compared to visiting people in their own home surprised me. I suppose the big difference is that in the hospital patients must abide by our rules and schedules. In someone’s home the experience seems much more personalized. We are in their space and must abide by their rules. As a nurse it is refreshing to be able to sit down in a patient’s home and really get to know them. The people we visited always welcomed us into their homes and seemed genuinely happy to see us. This is a reflection of the excellent work that the team does and the relationships they maintain with their clients.
The story of one particular family provided me with much to reflect on. Along with the clinical nurse consultant I was visiting a woman in her mid-forties who’d been diagnosed with end stage liver failure. We visited every day and I was able to meet her children, also her carers, and form a relationship with them. Members of the extended family were also closely involved but unfortunately did not have a relationship with the patients’ children. This posed an issue for the palliative care team. Both sides of the family had different views about the type of care that should be provided. They also commonly refused to be in the presence of one another. The palliative care team had to act as a mediator and facilitate family discussions whilst also advocating for the patient. Naturally, emotions were high and I was able to witness the CNS counselling each member of the family and ensuring the environment remained safe and the needs of all family members were met or negotiated. Her communication skills were unbelievable and she managed to keep all parties content.
On my last day of placement, just after midday, we received a call from our patient’s son stating that she had stopped breathing. The events of that afternoon delivered two significant lessons. Firstly, I put into practice the communication skills I had been learning all week as the CNS and I moved around different family members and provided comfort to them both by listening and counselling. This was challenging but I found that mostly the family members just wanted someone to listen to their stories and I was more than happy to lend an ear. Secondly, I was confronted by the extreme difference in emotion I felt being in the home of someone who had just passed away with their family as opposed to the same scenario in a hospital setting. It all felt so raw and I really felt the grief of the family. I spoke to my facilitator about my feelings in this situation. As I have mentioned above, being in someone’s home makes the experience feel all the more personal. I really learnt a lot from this experience in particular, specifically about how to look after the family of a patient and how to look after myself.
There were several other lessons that I learnt from my week in palliative care. My knowledge of the symptoms associated with end of life illness and their treatment increased markedly. My communication skills, particularly my ability to discuss death improved. I learnt about the pathophysiological aspects of many diseases, especially cancer. Also, and very importantly, I made contact with various other health professionals and found resources that I didn’t know were available to me. I now have a clear picture of where the palliative care team fit and when it’s appropriate to refer patients to them.
My week in palliative care was extremely rewarding and I am very grateful for the experience. The lessons that I have learned will help me in caring and advocating for my patients with a life limiting illness. I would recommend a PEPA placement to any health care professional that has contact with palliative care.