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A terminal diagnosis: Strategies for helping patients and their loved ones

Date: January 27, 2017

Throughout their careers, nurses will work with many patients living with a terminal illness. Nurses are at the front line of patient care and can make an enormous difference to terminally ill patients’ lives, both in terms of the physical care and the emotional support they receive. Nurse managers and nurse educators should ensure that nurses are educated in some important care strategies for helping terminally ill patients and their loved ones.

What is terminal illness?
Before an examination of some of the most effective ways for nurses to help patients nearing the end of their lives, it is important to first take a look at what constitutes a terminal illness. According to Marie Curie, a charity based in the United Kingdom, terminal illness is understood as a condition wherein curative treatment no longer works and death is more than likely. However, under that umbrella term are significant variations. For example, a terminally ill patient may have advanced cancer and a life expectancy of mere weeks, while other patients may be living with a terminal illness for years before they reach the end of their lives. In any case, receiving a terminal diagnosis and coping in the aftermath is often emotionally challenging for many patients. The source elaborated that terminally ill patients will receive varying degrees of care, contingent on the nature and stage of their illnesses. In most cases, treatment is designed to relieve pain and manage symptoms as opposed to looking for a cure.

Helping patients
Nurses play a crucial role in the frontlines of patient care and often will be involved closely in helping patients come to terms with a fatal illness. There are a number of strategies that nurses can employ to help patients through this challenging time.

A model for care
A study published in the European Journal of Oncology Nursing, “The power of nursing: Guiding patients through a journey of uncertainty,” studied a group of oncology nurses working with patients in Japan. The study identified three effective approaches to helping patients cope emotionally while receiving end-of-life care. Hiroko Komatsu and colleagues understand the strategies researched as a conceptual, patient-centered care model that can be implemented in a hospital setting. The model can be employed by nurse managers and nurse educators to teach registered nursing staff about best practices for counseling the terminally ill. The model is understood as progressive and is divided into three stages.

Stage 1: Working to connect with patients on a level that extends beyond simple small talk. In essence, this approach involves building a friendly relationship with the patient and coming to understand the patient’s unique needs. Empathy, patience, attentive listening and understanding all must be demonstrated to help patients through this challenging time. The research found, however, that it is important for nurses to build working relationships while also remaining professional — essentially refraining from getting too close and emotionally invested in the unwell patient.

Stage 2: Known as the shared action phase, nurses help coordinate care that is acceptable for the patient in question — for example, finding the right balance of pain medication, choosing between the right kinds of palliative care, helping patients understand what to expect in terms of the progression of their illness and so on. This stage is also essentially about helping patients adjust to their new life and finding ways to move forward.

Stage 3: The developing potential stage, this final strategy involves helping patients focus on the positive aspects of their lives and offering praise when necessary. While finding hope in the face of terminal illness is often a challenge, nurses are able to achieve this goal by helping patients devise ways to make the most out of their final days, whether that’s spending as much time as possible with family and friends, focusing on personal interests and hobbies or anything else.

General approaches to patient care
The above model takes a more in-depth and conceptual look at effective ways that nurses can provide emotional support to the terminally ill. Nurse managers and nurse educators also should be sure to highlight some more general approaches to care during training sessions, including the following:

  1. Providing information
    With less information, some patients can become frustrated. Although it is not typically the role of a nurse to break bad news regarding a terminal diagnosis, nurses can help supplement or recap information with the patient. As the Houston Chronicle pointed out, it is important to understand, however, that patients will receive information at varying paces and in varying degrees of detail, contingent on emotional state, mental health and other factors. The goal of the nurse is to become attuned to the patient’s needs, providing the information he or she wants to know and answering all questions as truthfully, yet delicately, as possible.
  2. Listening to the patient
    According to “Compassionate care of the terminally ill,” research published by the U.S. National Library of Medicine, one of the most effective ways that nurses (and physicians) can help provide emotional support is to actively listen to patients. The listening should involve encouraging patients to open up about their life story and recount significant moments that have shaped who they are and contributed to their happiness. Such discussions can help patients look back on their life and more effectively come to terms with the fact that they are about to die. It also can help to discuss the patient’s spiritual or religious beliefs, if they have any. The Houston Chronicle stressed, however, that it is important for nurses to avoid explaining their own spiritual beliefs to the patient.
  3. Identifying depression
    All terminally ill patients will become depressed at some point throughout their journey. Consequently, nurses should be educated to discern between grief over a terminal diagnosis and symptoms of clinical depression, which is common in the chronically ill. In the “Compassionate care of the terminally ill” study, researchers noted that up to a fourth of cancer patients experience the clinical form of depression known as major depressive disorder.

Helping loved ones
Nurses also can help the loved ones of the chronically ill come to terms with the diagnosis and help them navigate the uncertain and emotionally draining journey. Effective tips for working with these loved ones, according to the Houston Chronicle, include the following:

  • Coping in a professional way when loved ones become frustrated or angry at the health care team.
  • Providing additional care for loved ones — arranging sleeping at the hospital, etc.
  • Answering questions in detail.
  • Offering emotional support and listening.
  • Connecting loved ones with additional information, resources and support.

Helping nurses
Ultimately, nurses should be taught to balance emotional support with professionalism, the Houston Chronicle detailed. Signs that a professional line has been crossed include exchanging details with patients such as email addresses and telephone numbers, and visiting the patient while off duty.

Consider Bradley University
Helping nurses learn how to more effectively aid terminal patients is fulfilling work that can make a difference in patients’ lives. Nurse managers and nurse educators stand at the frontlines of these education initiatives. If you’re interested in this type of work, consider pursuing a career in nurse management and applying to Bradley University’s online Master of Science in Nursing program. It could be your first step toward a new career. To learn more, click here.

Sources

https://www.mariecurie.org.uk/who/terminal-illness-definition

http://www.ejoncologynursing.com/article/S1462-3889(14)00038-6/pdf

http://work.chron.com/must-nurse-effective-caring-terminally-ill-patient-9752.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC406380/

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