Palliative and end of life care aim to provide the best available care for people entering the dying phase of their life. This care and support also extends to families and close friends or those deemed important by the person who is dying. Two years ago, the Covid-19 pandemic drastically changed the way palliative care is provided by making it hard to remain truly close to dying people because of social distancing and the need to wear personal protective equipment (PPE). While these measures were necessary to save lives, they were a disruption to the proximity that usually existed between the staff and patients, and the patients and their close family units. On a practical level, it is clear that one of the negative legacies of the Covid-19 pandemic, is a trail of shortage of staff and a depleted workforce as a result of staff deaths, or the effect of long-Covid. It is therefore important that an appraisal be done regarding the role and input of community nurses who provide palliative care, highlighting some of the positive aspects of the support to dying people.
What the asset brings
Community nurses (CN) in charge of providing palliative and end of life care are central to the quality of care provided, and by extension, the dignity in death afforded to these people. When viewed in this way, one can argue that CNs are the asset in palliative care provision to dying people and their families and friends, while in the community setting. Each day, they bring their genuine self to care, their selfless persona to walk by the patient's side, their compassionate self to support, their empathetic self to listen, and their emotional self to connect with patients. They also bring knowledge and skill to offer treatment, as well as supportive options to give patients a choice. Beuken and Evans (2021) assert that such an approach brings with it a sense of understanding, compassion and hope. While these may be underestimated, it is important to acknowledge that by doing these good acts of service, they also expose their vulnerable selves as they ‘connect’ to patients at an emotional level.
If anything, this pandemic has taught us that we must care for each other as equals, as we needed each other equally at the peak of this pandemic. The point to press home is the need for compassionate care for community nurses (the asset) which should not just be realised by the public, but also by their managers and organisations. This is simple logic – we look after the carers like community nurses, with compassion, by valuing them, and they will most certainly provide compassionate care to their patients (Beuken and Evans, 2021). To make sure healthcare professionals remain an asset to palliative care provision, managers and organisations should always remember these professionals can also experience grief when the patient dies. The patient's death can also trigger their own losses and grief.
It is worth reflecting on the powerful message by Dr Remen when she made the point: “the expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet”. The only way we can ensure not getting wet is by wearing waterproof clothing. This then raises the question about what kind of ‘waterproof equipment’ healthcare professionals, and community nurses in particular, have at their disposal to avoid being consumed with emotions and grief of their patients' loss.
‘the expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet’
Death is the only certainty
While death is inevitable among the people we care for, it is critical that we support healthcare professionals to be resilient. Being resilient often starts with us knowing ourselves; our strengths, and our vulnerabilities. Caring for ourselves is key - knowing aspects that trigger our own emotions, so that we take extra care to minimise the impact. For community nurses who tend to work alone, always remember to touch base with your team of professionals for support and guidance. As nurses, we are trained to reflect on our practice, and this is even more important when providing palliative care. While there are reflective models to use out there, reflection can also be done in different formats (structured and unstructured), and even while driving in between patient visits or while driving back to the office.
Ultimately, by ensuring community nurses continue to be the asset in palliative care, we also lay the foundations of dignity in death for people dying at home.