End-of-Life Care: Things Your Textbook Won’t Teach You

Nurses care for patients across the lifespan, during times of joy such as the birth of a new baby, and times of challenge, as can be the case when a patient is facing the end of his/her life. These patients can be any age, neonates through elderly, and can be cared for in a variety of settings, including acute care hospitals and community-based settings.
Novice and experienced nurses may feel they are not able to deliver end-of-life (EOL) care due to a number of reasons. Gaps in education, lack of comfort to deliver care and communicate with patients during EOL, and lack of experience in witnessing death are some of the reasons for these concerns (Corcoran, 2016). The lack of experience and gaps in education raised a concern to me in particular as an educator. I was curious as to what experienced nurses felt about these concerns, and so I asked a faculty colleague, Dr. Stephanie Jeffers, who is expert in this field to answer an important question: What are the things your textbook won’t teach you about EOL? Dr. Jeffers considered this question, and explained:

“Textbooks mainly focus on how to deliver physical care to the dying patient. This may include symptom management, pain management and post-mortem care. Additionally, textbooks have very little information on how to care for a dying patient in a holistic manner. What is not explained in a book would be the art of nursing/caring for a dying patient. This means how the nurse interacts with the patient and family, being present. It is talking to the patient even though they may be unconscious. Talking to the family, listening to stories about the patient. Communication is essential for being the patient’s advocate – what are the patient’s wishes for care? How they want to die? Communicate that to the family, interdisciplinary team. Finally there is a deep spiritual component. Patients may want you to pray with them which the nurse may do or the nurse can choose to just be present while others pray. Conduct a spiritual assessment. What are patients most afraid of in this time of transition? Hold a patient’s hand, offer the family coffee or a break, spend time being with them. How the nurse treats the patient and family in the final hours is what they will remember – make it a positive experience.”

Dr. Jeffers provides a holistic view of EOL care, something our textbooks do not always emphasize. There is an element of caring and respect emphasized in her response, and advocacy for the patient to have a say in how he/she will die. Providing care for these patients includes support, communication, and advocacy. Consider too that undergraduate education is a beginning, and you will need to continue your education in a formal program in higher education, or through continuing education opportunities. For example, the End-of-Life Nursing Education Consortium (ELNEC) project is a national education initiative aimed at improving palliative care (AACN, 2016). Nurses may feel that if they cannot cure their patient they have failed him/her; the ELNEC project however provides nurses with the skill and knowledge they need to care for these patients, and positively impact EOL care. No matter the path you take to become educated in EOL care, always remember to support the patient and family caregivers, keeping in mind the patient’s wishes and fears. All patients have stories to tell, do not view them as a diagnosis, take the time to get to know them and support them at the end of life.

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About the Author
Dr. Nancy Laplante is an Associate Professor of Nursing. She is the Coordinator of the RN/BSN & RN/MSN program options and the Director of Online Programs for the School of Nursing. She earned her MSN degree in 2004 with a focus in community health nursing, and a PhD in Nursing in 2007. Dr. Laplante is a board certified advanced holistic nurse, and serves as an Associate Editor for the Journal of Holistic Nursing.

She believes that compassion and caring are essential components of nursing education, and she strives to engage students in respectful, meaningful dialogue. She is a regular contributor to fundamental nursing textbooks and has published in the areas of holistic nursing education, educational perspectives, healthcare applications for the Internet of Things (IoT), and Service-Learning. Additional research interests include the image of nursing, creating presence in online learning communities, and self-care practices for nursing students. In her spare time Dr. Laplante enjoys spending time with her family and being a volunteer for a local animal rescue to support pet adoption and education in the community.

American Association of Colleges of Nursing (AACN, 2016). ELNEC Fact Sheet. Retrieved from http://www.aacn.nche.edu/elnec/about/fact-sheet

Corcoran, K. (2016). Evaluation of an Educational Workshop to Increase Comfort Levels of Professional Caregivers with End-of-Life Care, MEDSURG Nursing, 25(2), 103-109.