Most nurses will tell you that they didn't go into nursing thinking about death. Many nurses go into nursing to help others. Others start their career in nursing because they enjoy medicine and others join because it's a rewarding job. Eventually though, nurses find that death permeates their profession. It's woven into the tapestry of their daily work, no matter what field of nursing they choose.
Jump ahead to these sections:
- What Are a Nurse's Main Duties in End-of-Life Care?
- Patient Advocacy
- Patient Advocacy and End-of-Life Care
- The Hospice Nurse
- Do Nurses Play a Role in End-of-Life Care Decision Making?
Efficient and task-oriented nurses can disappear into the background of a patient's medical care. At times, they simply become part of the beeping noises, the meals, and the medications that work to keep a patient healthy.
At the end of life, however, nurses start playing a more prominent role. They come a little more into focus. What exactly is the nurse's role in end-of-life care? Let's find out.
What Are a Nurse's Main Duties in End-of-Life Care?
Nurses work throughout the medical field, in both administrative and patient care sections of a hospital or clinic. They may choose to work where their callings lie, like labor and delivery, emergency care, or oncology. Not all nurses are alike in regards to their training or department, but each nurse does essential work. However, their role is the same in one aspect. In one way or another, all nurses are patient advocates.
As patient advocates, nurses are taught to preserve a patient's dignity, encourage quality of life, and promote freedom from suffering. Nurses are encouraged to develop a rapport with their patients so they can advocate for them in the best way possible. Getting to know their patients, especially at the end of life, is part of creating a strong nurse-patient bond. It's that bond that allows nurses to do their job and honor their duty to their patient’s health and wellbeing.
Being a patient advocate means meeting their patient’s needs, taking the time to listen to their concerns, and being unbiased about a patient's choices.
Meeting a patient’s needs
As part of their job, nurses try their best to anticipate patient's needs and fulfill them. Nurses must assess a patient's physical wellbeing, mental health, and even their spiritual needs. For example, a nurse may see a need for a dietary change or notice signs of depression.
Upon assessing the patient, the nurse may notify the rest of the health team to help address the patient's needs. Part of being a patient advocate means actually listening to what patients say and need, as well as what they are not saying.
Listening to concerns
Sometimes, having a conversation with a patient is the most vital act a nurse can do. Lending a compassionate ear, offering some non-judgmental discussion, and noting concerns are meaningful and essential nursing actions. A patient may disclose their thoughts to a nurse because the nurse is a neutral third party and not part of the patient's family.
In regards to their care, patients may often feel comfortable speaking to nurses about their concerns when their loved ones are absent. Nurses as a result not only help to provide important care and relay concerns, they provide an opportunity for patients to feel heard.
Nurses are also human, and naturally, they have their own thoughts and opinions. However, when it comes to patient care, nurses are taught to be aware of their own implicit biases — and to avoid having their views impact their patient care.
No matter whether or not they agree with a patient’s personal choices, they must provide the same level of care and respect to every patient.
Patient Advocacy and End-of-Life Care
The nurse's role as a patient advocate doesn't stop when end-of-life care begins. During this time, a nurse's role as a patient advocate becomes more crucial than ever. They are often present during the most vulnerable and sensitive events — such as the end of life — that will happen to patients and their families. The nurse becomes witness to the emotions and fears of everyone involved. At this time, their role is to provide support for the patient and the patient's family.
However, as mentioned above, their central role is as a patient advocate. And sometimes, this role may be counter to what the family or other medical professionals want. A nurse must advocate for a patient's end-of-life wishes, regardless of the nurse's own opinions or the patient's family. The end-of-life period is intensely personal and vulnerable. In these instances, a nurse's role is to ensure the patient's needs and wishes are honored.
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The Hospice Nurse
For patients receiving end-of-life care, they likely receive the most amount of attention and care from hospice nurses. A hospice nurse provides pain management, disease, pathology interventions, as well as spiritual and mental health care at the end of life.
No other nurse works so intimately with death — and all the patient care that comes with it — than a hospice nurse. This comprehensive knowledge about end-of-life care sets hospice nurses apart and makes finding hospice care so important.
Hospice nurse duties
Because a hospice nurse's work revolves around end-of-life care, they are an excellent resource for the patient and family. After all, their primary focus is on helping a patient die in peace, dignity, and comfort. Especially when it comes to home care, a hospice nurse can help the family with everything from the minutiae of what supplies to keep on hand to significant decisions like obtaining an Advance Directive.
Hospice nurses understand the needs that are specific to dying patients. They perform their assessments and interventions with a patient's situation, comfort, and emotions in mind. Much of their medical work is geared towards palliative care—alleviating pain symptoms to ensure relief and providing peace throughout the death process. Palliative care can be a part of a hospice nurse's role, but it isn't the only part.
For some patients who prefer to die at home with their loved ones, hospice nurses help to train the patient's caregivers and supervise care. This training may include teaching caregivers how to move a patient from the bed to a wheelchair, how to toilet or bathe their family member, and how to administer pain medications.
A hospice nurse also tends to a patient's spiritual and psychological needs. They often act as a liaison between the patient, the patient's family, and the patient's healthcare team. When it comes to spiritual care, a hospice nurse understands that death is very much a spiritual process for many people. As a result, hospice nurses often connect patients to spiritual and religious services as needed.
Do Nurses Play a Role in End-of-Life Care Decision Making?
Although nurses assist in educating patients, provide resources, and advocate for patients' wishes, nurses do not make end-of-life care decisions for patients. Patients and their designated health care proxies make those decisions.
Nurses can, however, start the dialogue about end-of-life care decisions. For some patients and families, talking about the end of life can be challenging, but the sooner the conversation takes place, the easier it is to manage. Nurses encourage patients to talk about their worries and concerns about death. They often attempt to start that uncomfortable dialogue, not to stir unease or unrest, but to ensure that they are able to relax and focus on their death.
Speaking about death and making end-of-life decisions is never easy. But to postpone the inevitable conversation only serves to confuse others later. At the time of a crisis or at the time of death, emotions run high. Making end-of-life care decisions earlier prevents tensions. It allows the patient and family to face the upcoming challenges with peace of mind. They can concentrate on the spiritual and emotional impact at the end of life, rather than disagreements about care.
Nurses are an ideal impartial resource when a patient has questions about end-of-life care decisions. Their focus is to provide security and comfort and honor the wishes of the patient. The patient can rest assured that their nurse will listen without judgment and point them to the right resources. When death is soon, it's comforting to know there is one person who roots for your wishes.
Nurses Provide Comfort in Death
Nurses often go into nursing because of their love for life. They can help people to live life well. Seeing a patient recover after an illness might be what nurses consider to be the ultimate goal at first.
It's with death, however, that nurses find the most meaning in their profession. By witnessing the process of death, they are able to learn the most about others and themselves. And in helping patients face death, nurses may find their highest professional and personal growth. In these situations, a patient's strength shines through the most, and a nurse can witness — in short scenes and vignettes — all that makes life worthwhile.
In death, nurses can find themselves providing the most comfort. The most significant role of a nurse is providing a peaceful and dignified death, as much as possible, for a patient. During the transition from life to death, a nurse serves as a source of relief, warmth, and familiarity. There is no other role in the nursing profession worth more than that.
- American Nurses Association, “What is Nursing?” Nursingworld, American Nurses' Association. www.nursingworld.org/practice-policy/workforce/what-is-nursing/
- ANA Center for Ethics and Human Rights, "Nurses Roles and Responsibilities Providing Care and Support at the End of Life," Nursingworld, American Nurses' Association, 2016. www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-positionstatement.pdf
- Nurses Service Organization, “End of Life Care, Responsibilities and Risks,” NSO, 2017. www.nso.com/Learning/Artifacts/Articles/end-of-life-care
- Hebert, K., Moore, H., Rooney, J. “The Nurse Advocate in End-of-Life Care,” The Ochsner Journal, 2011 Winter; 11(4): 325--329. www.ncbi.nlm.nih.gov/pmc/articles/PMC3241064/