HeARTh Care by Sally O'Hara

There’s a lot of rhetoric out there about what is needed for good care at the end of a life: rhetoric from the euthanasia lobby, the advanced care directive aficionados and the advocates for good palliative care. Being a palliative care nurse, of course I align myself with the palliative care groups. However, before I am a palliative care nurse, I am a nurse. I wonder, after forty years of nursing, what that is.

Recent experience in the acute care sector has reinforced for me the importance of Basic Life Support, infection control, a response to anaphylaxis, hand hygiene, disaster management, hourly rounding, regular assessment for risk of pressure areas, falls risk assessment…...the list goes on and on. These topics, and more, are crucial in any area of nursing and are possibly best described as the science of the profession, the building blocks from which to expand skills and commitment and from which one could also launch the art of nursing.

If one could only describe what that meant.

I do know that it’s not about ticking those infernal boxes.

The boxes represent the science, and drive the tasks needed to be done by the end of the shift, in order to prove that you have the time management skills of a superwoman or man.  Or, that you have ensured the patient and escort went to the right appointment at the right time with the right paperwork. Or, that the medications have been given correctly. (Are there 7 or 8 ‘rights’ for safely giving medications? Or is it another number completely??)

The boxes are the tally for knowing you have completed your shift successfully.

Why is it that so many nurses, having successfully ticked their list for the day, leave work so dissatisfied? I suspect that it’s because they feel they could have done better: that they have not had the time for nurture, that their art has not been explored and that the space between themselves and the patient has been filled with busyness, and not care.

Amidst the rhetoric about what is needed for better end of life care is the acknowledgment that there is need for education. Part of that education should be about the art of nursing and the culture of compassion, based on good clinical knowledge, built on top of the science, and rigorous in debunking the myths about death that so often prevent the delivery of good care.  And this type of education should not be limited to help those few patients who have received a referral to palliative care, but to those who haven’t.

The art-full nurse will understand that the 84-year-old man with diabetes and gangrenous toes and an unwell ageing wife, is now facing an existential crisis and is suffering.  The art-full nurse may also understand that the patient with unrelieved chronic back pain is not continually being re-admitted because of drug-seeking behaviour (after all, she has many drugs in her kitchen cupboard that don’t have to be double signed out for her to take), but because her fear of becoming addicted is leading her to seriously under dose herself, and she is suffering all of the consequences of chronic, unrelieved pain.

Maybe it’s time we filled the space between ourselves and the patient with something other than busyness.

Maybe it’s time we started to address the quality of lives of those with chronic illnesses who are also facing the last stages of their lives.

Maybe it’s time we started to talk about the art of health care.