Nurse navigators are well equipped to provide palliative care, according to a presentation given by Bonnie Freeman, DNP, RN, ANP, CT, ACHPN, at the 2017 Oncology Nurse Advisor Navigation Summit earlier this summer.
Palliative care focuses on patients’ comfort and reducing suffering when dealing with what are often terminal illnesses. Though there is no requirement to forego further curative treatment when undergoing palliative care, it is usually the final step on patients’ care journeys. While there is a subset of nurses specifically trained to provide palliative care, nurse navigators’ skillset clinically matches palliative care nurse practitioners’, with education and certain requirements being the only significant differences.
Freeman notes that when providing palliative care, navigators’ emphasis should be on facilitating communication between the patient, family members and the care team to ensure that goals and preferences are respected. When it comes to end of life care, Freeman presents the CARES tool, an acronym denoting certain steps to ensure patients are treated with dignity and addressing the most common issues at the end of life:
Comfort Pain management is essential; there is no maximum dose of opioids for pain control. Patients are more likely to die of their disease than from opioids. Evaluate the need for vital signs, labs, vital signs [sic], IV fluids, and tube feeding. Explain to the family the difference between the normal dying process and suffering.
Airway Use of a fan can reduce shortness of breath. Explain to the family agonal breathing vs suffering; supplemental oxygen is more for the family than the patient. Control the death rattle.
Restlessness and delirium Allow the patient and family to address possible unfinished business, say good-bye and give permission to stop fighting. Educate the family that the patient is not aware of behavior, and to be peacefully confused is possible.
Emotional and spiritualsupport Your humanity is needed the most. The family becomes the focus: be sure they are getting rest and taking breaks; provide coffee, water, etc; and continue to be available to answer questions.
Self-care Be realistic. You are not all-knowing or all-powerful; accept that a power greater than yourself will ultimately decide the fate of the patient, but you should find comfort in knowing that you did your very best.