"You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die."
— Dame Cicely Saunders, nurse, physician and writer, and founder of the modern-day hospice movement
A small percentage of persons with advanced disease die at home. However, one major limitation to carrying out this final wish is the lack of access to palliative care at home and the lack of nursing expertise to help patients during the final days. Studies indicate that nurses play a substantial role in hospice and palliative care, but the perception of the public is that they are not capable. Another issue is the reduced comfort level and negative attitude toward providing care for patients and their families at the end of life. Studies identify a lack of end-of-life care knowledge and skills among both newly graduated and student nurses. This is why providing nursing education is of paramount importance.
The Ruth Foundation meets this need for upgrading the confidence of nurses in providing Hospice and Palliative Care by providing ELNEC* (End-of-Life Nursing Education Consortium) locally. Included in the program is an Introduction to Palliative Nursing, Pain Management, Symptom Management, Communication, Ethical & Legal Issues, Cultural Considerations, Loss/Grief/Bereavement, and Final Hours. In addition, participants learn from role plays and case study reviews where they had opportunities to explore ways to improve self-care.
One of the most crucial aspects of palliative care for nurses is the ability to manage pain and other related symptoms in patients. Palliative nurses should be knowledgeable in identifying and assessing symptoms, as well as administering medications and other non-pharmacological interventions to alleviate discomfort.
Palliative nurses must be able to communicate effectively with patients and their families, as well as liaise with other healthcare professionals to ensure a coordinated approach to patient care. They should be skilled in providing support and counseling to patients and their families during end-of-life care.
A Palliative Care nurse should have a deep understanding and respect for cultural and spiritual beliefs, practices, and traditions. This is important as end-of-life choices can be influenced by cultural factors, and any misunderstandings can lead to distress for patients and their families.
Another essential aspect of end-of-life care involves care planning and coordination. Palliative care nurses should collaborate with other healthcare professionals and the patient’s family to develop personalized care plans to ensure the provision of high-quality care.
There are many ethical dilemmas in the course of palliative care nursing practice, especially surrounding issues of life-prolonging treatments and end-of-life decisions. Palliative nurses should have a strong grounding in ethical principles and should be able to apply them to clinical scenarios.
Lastly, Palliative Care nurses often encounter emotional and psychological challenges in their duties, which can leave them vulnerable to burnout and other negative outcomes. Self-care is critical to ensure that nurses remain emotionally resilient and competent in their roles.
The ELNEC curriculum has all the resources needed to empower palliative care nursing practitioners to take back to train others. There are also wonderful opportunities to network with others who are committed to improving care for all patients with life-limiting illnesses.
The most recent ELNEC Core held at The Medical City—South Luzon last April 28,2023.
* The End-of-Life Nursing Education Consortium (ELNEC) Project is a national and international end-of-life/palliative care educational program administered by City of Hope (COH) designed to enhance palliative care in nursing. Materials are copyrighted by City of Hope and the American Association of Colleges of Nursing (AACN) and are used with permission.
REFERENCES:
Fischer S, Min SJ, Cervantes L, Kutner J. Where do you want to spend your last days of life? Low concordance between preferred and actual site of death among hospitalized adults. J Hosp Med 2013;8(4):178–183.
American Association of Colleges of Nursing. End-of-Life Nursing Education Consortium (ELNEC) fact sheet 2016. American Association of Colleges of Nursing Website.
Von Ah D, Cassara N. Perceptions of cultural competency of undergraduate nursing students. Open J Nurs 2013;3(2):182–185.