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Nurses may realise early in the piece that patients are ready to move from life-prolonging treatment to palliative care but are unable to make that decision for them, a recent study has highlighted.
University of Queensland School of Social Science associate professor Alexander Broom’s study looked into doctors’ and nurses’ approaches to decisions made in pre-palliative environments.
“The nurses were facing quite a dilemma,” Broom said. “They were well aware of the increasing need for patients to stop life-prolonging treatment but at the same time didn’t necessarily hold the power of decision-making.”
Broom said there should be a more formalised way of providing nursing input and systematically feeding into the decision process. “At present, it is informal and they are feeding back information to doctors and they are mediating between family, patients and doctors.”
He said the ability to do this comes down to resources and acknowledging that the ability to provide this information is a core skill for nurses.
A barrier to implementation surrounds the demands on nurses’ time, Broom added. “One of the outcomes of the studies showed the increasing demand on nurses [and that there was] quite a significant risk of some nurses in some contexts not necessarily being able to spend the time with the patients to understand where they are at and communicate that to doctors.”
In terms of implementation, Broom said it wouldn’t be difficult to establish regular team meetings between doctors, nursing staff and allied staff around tolerance for life-prolonging options and the potential for an early transition into palliative care. “That’s a pretty simple process and it’s all about communication,” he said. “If you get a clinical or organisation environment that is willing to support nurses to continue these at-the-bedside, intimate relationships with patients, to understand where they are at, combined with specialised nursing’s palliative care expertise and strategies for doctors to communicate, then it is certainly possible.”
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