How nurses can prepare for end-of-life care

Chaka Brittain, DNP, RN, CNE, had just sat down for lunch when she noticed something was wrong.

She and a group of her nursing students were taking a break from a clinical visit to a local hospital where they were learning firsthand how nurses care for patients, but one student was missing. Brittain knew that student had been up in the cardiovascular ICU and was about to go find her when she suddenly appeared.

“She was completely out of sorts,” recalls Brittain, who is a faculty member with Capella University. “She was crying. She was totally distraught. She didn’t know what to say. She was devastated.”

Brittain had been hearing code blues (the most critical alert) over the hospital’s address system and now she knew why. The patient her student nurse had been caring for, who was recovering from open heart surgery, had gone into cardiac arrest. Despite performing CPR for two hours, which the student nurse provided along with the care team, the patient still died. His family was asking, “What’s happening? What’s going on? He’s supposed to be recovering.” The student nurse was overwhelmed and not equipped to deal with the situation.

“In most nursing schools, they hammer on the technical skills nurses need day in and day out, such as how to put in an IV, clean a trach tube, etc.,” Brittain says. “But too often they only address end-of-life, palliative care once in an entire program. That is nowhere near good enough. I’ve had to console families and patients in numerous situations, professionally and personally. Nurses need to be better prepared. They deserve better.”

A holistic approach to end-of-life training

Brittain argues that it is important for nursing schools to provide a more holistic framework to integrate human communication throughout the undergraduate curriculum.

“There are so many aspects of end-of-life care – chaotic family meetings, knowing what to say and not to say, being a truly compassionate caregiver at the bedside – there is no way you can cover it all in one module,” Brittain says. “It’s so important that these skills are integrated throughout a curriculum in the same way we integrate technical skills.”

She adds that there is a strong desire for more comprehensive end-of-life education among nurses.

“When I explore this topic with my student nurses, they are so grateful and say things like, ‘I wish I had learned this four semesters ago,’” Brittain says. “The reality is this: at 2 a.m. when the patient is breaking down and the doctors have gone home, it’s the nurse who is there with the patient to help them grapple with their mortality. It’s a lot to process, particularly for new nurses. We owe it to them to prepare them for that.”

That need to be prepared goes beyond the patient. It is just as important when dealing with family members. Being knowledgeable and aware of the different roles family members play and how to work with them is a key competency for any nurse.

“Knowing how to meet each one of their needs in a hyper-stressful situation doesn’t just happen,” Brittain explains. “Nurses need to train for this, to role-play, and to remember always that nurses don’t just care for patients, we care for extended family members, too.”

Educate yourself

For practicing nurses who feel they have not been sufficiently trained in palliative care, they can still  prepare themselves for the end-of-life situations they will inevitably face. For example, the End-of-Life Nursing Education Consortium (ELNEC) provides resources to help nurses cultivate the skills they need. Other resources include the American Academy of Grief Counseling and the Hospice and Palliative Nurses Association, which offer self-paced, online resources for nurses.

“The bottom line is that nurses owe it to themselves, their patients, and patients’ families to be able to appropriately and compassionately provide end-of-life care,” Brittain concludes. “Every nurse will face this. It’s natural. It’s reality. To get through it with grace and understanding takes thoughtful preparation.”

Prepare yourself for a career in nursing with an online degree in nursing from Capella University.