The patient, an older man with end stage heart disease, is brought to the hospital in distress, accompanied by his panicked wife, who is obviously frightened for her partner and unsure of what happens next.
You know that further treatment at this time is unlikely to change his prognosis and in fact, some treatments such as CPR might even be harmful. And yet, as a health professional, you feel obligated to do something.
What if that something was a conversation?
An April 2013 study revealed that although most elderly patients prefer only comfort measures at the end of life, life-sustaining technologies are increasingly being used in the final stages. Results from the study, published in the April 2013 issue of the Journal of the American Medical Association (JAMA) Internal Medicine, found that the correct patients preferences for end-of-life care showed up in their medical records only 30% of the time.
Nurses are uniquely positioned to work with patients and family members to find out if patients have engaged in advance care planning conversations, expressed their wishes and who their Substitute Decision Maker is. Although social workers and other health professionals might also have these discussions, it is the nurse who is most often at the bedside, spending time with the patient and family and liaising with other team members.
The conversation can take many forms. It could mean asking some tough (but important) questions. It might mean listening to a patient talk about their values and concerns. It could be guiding a Substitute Decision Maker through treatment options when the patient can no longer communicate.
On the front lines of care, nurses play a unique role in caring for both patients and family members. And while we are increasingly being asked to take on greater roles in less time, we also have the power and the duty – to ensure that our patients voices are heard.
Louise Hanvey is the Project Director for the National Advance Care Planning in Canada Project Speak Up: Start the conversation about end-of-life care, with the Canadian Hospice Palliative Care Association (CHPCA). She is a registered nurse with broad clinical experience.