Clinical placements

Palliative care is a team challenge for professionals and families

As part of a clinical placement in the community, I helped care for a patient receiving palliative care following a cancer diagnosis, who I will call David.

As part of a clinical placement in the community, I helped care for a patient receiving palliative care following a cancer diagnosis, who I will call David.

David was being cared for in the living room of the family home while he waited for a hospice bed. His wife was very involved in his care, liaising with the various health professionals looking after him, and doing all she could to support him and make sure he was well cared for.

It was evident during some visits, however, that David did not want to engage in his care, or in the decision making process. This seemed difficult for his wife, who was dealing with the emotional effects of David’s illness as well as her own health problems. She often slept downstairs with her husband, and was becoming very tired.

Many health professionals were involved in David’s care: district nurses administered medication for pain relief and provided wound and pressure area care, occupational therapists regularly assessed David’s need for specialist equipment, a specialist palliative care nurse helped with symptom control and provided a link with the local hospice, and care staff assisted with personal comfort and hygiene.

To a nursing student, the complexity of David’s care seemed daunting; co-ordinating the interventions and making sure nothing was missed, and that everyone was informed, seemed a huge task. I felt a lot of empathy for David’s wife, who had to negotiate this on a regular basis.

My experiences with David and his family reinforced the need to deliver holistic, relationship-centred care. You are entering someone’s home, and the care delivered must take into account the needs and wishes of the patient and their family. It would be easy for carers and family members to become overwhelmed by this, so an effective, trusting relationship with the health care team is vital. With so many health professionals and services involved in David’s care, the importance of accurate communication soon became clear to me.

Meeting David and his wife also highlighted the effect illness can have on a patient’s family. In hospitals, it is easy to briefly acknowledge visiting relatives without taking into account the wider context of their situation. But as nurses, we also have a duty of care to family members like David’s wife. Carers may not raise issues about their own wellbeing because they are prioritising the person they are caring for.

The need for effective planning and appropriate task allocation also became evident, as did the importance of listening to other professionals and asking questions. I now recognise that being unsure of something does not reflect badly on my ability to practise, and that asking questions will improve my knowledge and skills.

I hope to continue engaging with other health professionals in my nursing career, to help me learn new skills and promote an effective working culture.

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