Reflection On End Of Life Care
Whilst working on a morning shift I was asked if I would assist with washing and making a patient comfortable. She was an elderly lady with advanced inoperable cancer, subsequently on an end of life pathway receiving palliative care. The World of Health Organisation (WHO) defines palliative care as: “The active total care of patients whose disease no longer responds to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families” Towards the end she could not communicate, only making short groans if she was in pain when we moved her. She was given a bed bath, change of sheets and a clean nightie. Throughout the nurses helped protect her dignity by keeping the door and curtains closed and keeping the patient covered as much as possible. The nursing staff continually spoke to her and reassured her, whilst I held her hand. The patient died a few days later with dignity and respect and peacefully with her friends by her side. I was involved in the last rites.
I felt quite self-conscious when standing by the bedside. I did not know how conscious the patient was of the situation around her. It was obviously important to talk to her but initially I found it difficult to know what to say and was conscious of others listening to me and wondered if I was saying or doing the right things. The nurse present was very concerned she may die whilst we were washing her as he recognised Cheyne-Stokes breathing. I had never seen anyone this way before. I felt more upset seeing her deteriorate than I did when she died purely because I felt she was now free of the discomfort.
The care plan for the last days of life had been met. The patient’s psychological, social and spiritual needs had been addressed, and the patient was comfortable and free from pain (Kemp 1999). The care that was carried out protected the patients’ dignity and respected her as a human being. I found it very rewarding to be part of the team that helped this patient, in her last days of life, die with the dignity and respect she deserved. Everything that could be done for the patient was done in a very professional, but also a very caring manner. The NMC guides us to: “Make the care of people your first concern, treating them as individuals and respect their dignity”. I feel that we had achieved this for the patient. If I find myself in this situation again I would be confident enough to implement palliative care in a professional caring manner, which hopefully will mature with personal experience and by observing other nurses. I would talk to the patient whether or not they were conscious and also aim to provide support for the family.