Death may be a part of life, but nurses in many settings may not feel comfortable caring for terminal patients and their families. An experienced hospice nurse provides some guidance in the new book, To Comfort Always: A Nurses Guide to End-of-Life Care, 2nd Ed, which was published this year. The first edition was published in 2008.
Theres good material, textbooks, but nothing that was a basic primer, and thats what I wanted to create, said the books author Linda Norlander, MS, RN, director of clinical services for the Franciscan Hospice Program in Tacoma, Wash. I wanted to keep it relatively simple and with a theme of know what you dont know and know where you can find out the information.
For example, a nurse who cares for a patient with advanced dementia who becomes combative when the nurse tries to move her can refer to the book.
The book triggers the nurse to consider that the patient might be in pain (know what you dont know) and then refers the nurse to a couple of pain assessment tools such as the Abbey Pain Scale or the Pain Assessment in Advanced Dementia Scale and cites where to find them, Norlander said.
A fascination with medicine and caring for sick people drove Norlanders interest in nursing. She has practiced in hospice care since 1989 and earlier worked in public and home health.
One of the things that struck me was we didnt know how to care for patients who were dying and do it well, Norlander said. Hospice was a calling and an area I wanted to work in.
Becoming more comfortable with the terminally illJohn Mastrojohn, RN
Life and professional experiences with death help nurses become more comfortable caring for terminally ill patients. But that takes time. The book aims to reduce the learning curve and help nurses overcome some of the fears of saying or doing the wrong thing, to understand symptom management and to accept they cannot fix everything.
Death is something that everyone of us will experience, and understanding how to talk with family members about the death of a loved one is something that needs to be handled with sensitivity and compassion, said John Mastrojohn, MSN, MBA, RN, executive vice president, National Hospice and Palliative Care Organization in Alexandria, Va. Those working in the hospice field have insight and advice that other medical professionals can benefit from both in terms of helping patients and families understand issues that may be of importance and also in dealing with the death and loss of a loved one.
Hospice programs often use the book in orienting new nurses, and some educational programs ask students to read it. Traditional textbooks do not contain much end-of-life care content.
To Comfort Always provides the background and practical tips for caring for people with life-threatening conditions, said Joan Jody Chrastek, DNP, RN, with Fairview Home Care & Hospice in Minneapolis and an adjunct professor at Globe University in Richfield, Minn. She asks her students to read the book and discuss it. It also provides a way for nurses to care for themselves while doing this challenging work, Chrastek said.
For nurses considering a hospice practice, Norlander recommends having a strong medical-surgical foundation, reading the book and talking with colleagues in the palliative care field to obtain a better sense of the work. Nurses need to accept patients anger and fears, she said.
One of the greatest skills hospice nurses have is not in what they say but how they listen, Norlander said. We meet patients where they are at.
Nurse author says RNs can write
Norlander has written since she was 10 years old and has authored numerous journal articles and three books. She presents writing workshops to prepare fellow nurses to write, and dozens have taken her courses.
Nurses have so much to tell, so much wisdom, and writing is one way of sharing that, Norlander said.
She shared three tips for aspiring nurse authors.
If you have an idea, outline it.
Write, write, write.
Combine stories with evidence.
She also suggested writing for five minutes, letting the mind go and the words flow, without worrying about margins or punctuation. Just record your thoughts and feelings. After five minutes, read it and discuss it with someone, she suggested.