A nurse’s challenges

Palliative care is concerned with quality of life rather than quantity of life. Many patients do not have an opportunity to access formal hospice services because they live in remote areas or they are in a care environment that cannot draw on expertise from local palliative care providers. This leaves a nurse with an option of looking for means to look for means to reach where the patient is.

Breaking bad news of long term illness to a patient and family members due to the anticipated causing of anxiety and depression to both the patient and the family scares many nurses. Sometimes these issues affect them emotionally and psychologically.

In the health facilities, there is conspiracy of silence and by the time the patient is referred for hospice care, they are not aware of their diagnosis and prognosis. The nurse in palliative care is expected to do the breaking of bad news, something expected of a doctor or nurse who had the first contact with patient after diagnosis.

Addressing the financial constraints due to the expensive medication involved with patient’s long term illness e.g. surgery, chemotherapy and radiotherapy. Nurses also face a challenge in helping the family cope with anticipated loss after loss/grieve especially to young children of the affected client.

There occurs a change in focus from cure to care and subsequent alteration in patient goals. Facing the reality of death is a traumatic experience for a patient and their family members. It can also be a traumatic time for nurses without the necessary knowledge to assess, plan, evaluate and advocate to their patients.

Cultural factors and beliefs about palliative care, terminal illness and handling of death and issues surrounding it pose as a challenge. Preparing people for death is a challenge since in the African culture, it’s viewed as a taboo to speak about death. This requires a lot of braveness and more knowledge on how to go about it.

Relatives have challenges in end of life care forcing us to train them and occasionally when visiting we find new members who may have no understanding on the patient prescription. This may lead to inconsistency of drug administration to patients. Some family members lack cooperation in provision of home based care.

Lack of palliative care knowledge by other health care professional where in some cases, patients are admitted for respite care but there is failure to give drugs as prescribed, e.g. Morphine.

Late diagnosis and referrals to hospice also proves as a challenge.

Curbing the challenges

Vigorous awareness of palliative care services so that it’s not a new concept in the health sector and in the community to ease addressing the issue and creating awareness on cancer and early screening.

Team approach through more trainings and interactions with palliative care workers to share experiences in seminars would help in achieving the ‘active total care of patients whose disease is not responsive to curative treatment.’

Provision of Continuous Medical Education sessions (CMEs) to practitioners on the use of opioids to control pain would equip nurses with knowledge and alleviate myths associated with morphine use that limits its use.

Timely referral could give a family satisfaction, improve their coping mechanism and impart adequate knowledge on palliative care giving a nurse motivation in his/her work.

Previously nurses were viewed as lacking qualification to prescribe morphine due to fear of abuse by over dosing and the phobia of prescription of such drugs restricted by the dangerous drug act (DDA). Lately things have changed and nurses are knowledgeable enough to comfortably prescribe morphine.

Trusting nurses with morphine prescriptions especially with the continued trainings on the use of opioids and management of pain. They have knowledge on the use of strong of opioids and at what level of pain morphine can be administered using the World Health Organisation analgesic ladder. Patient’s comfort especially with proper pain control gives a palliative care nurse satisfaction.

Debriefing among palliative care nurses could help lessen their burnout and be able to continue providing end of life care.

Motivating palliative care nurses through seminars and visiting other hospices to learn new approaches to end-of-life care. Feedback from patients and relatives also gives palliative care nurse motivation to continue offering palliative care services.
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