Palliative care is an important – but often overlooked – part of the healthcare system. However, its importance is always brought to the forefront of patients and practitioners minds during public health crises such as the global COVID-19 pandemic that has been a significant feature in public health since early 2020. For many patients that suffer from severe symptoms from COVID-19 infection, palliative care is a reality that both their health practitioners and their families must handle. Nurses, who are often at the frontline when it comes to public health crises, are important stakeholders to involve in the palliative care process. In the study by Rosa, Karanja, Chow, and several other researchers, the authors highlight the specific means through which palliative care practitioners, especially nurses, can contribute the most effectively to handling issues particular to the COVID-19 pandemic. The article provides insight into a branch of care that is in need of more focus and research while remaining relevant to the current landscape in the healthcare field.
Summary
Nurses, especially those specializing in palliative care, play an important role in supporting the healthcare system in general. In the current landscape, palliative care nursing – or palliative nursing – has provided extra support to care groups in intensive care units, emergency departments, and environments for long-term upkeep. In the context of the ongoing public health crisis, palliative care contributes by delivering specialist services and essential support with regards to decision-making, symptom management, ethical practice, care during the time of death, and communication with both patients and their families. The continued evolution of the pandemic has made it clear that palliative care has been and will continue to be necessary. Through the application of palliative care in nursing, taboo issues such as death and serious illnesses become manageable. The researchers argue that consistently and strategically investing in palliative care during this pandemic will strengthen the response and resilience of the healthcare system. Likewise, allowing for an expansion in the scope of work for palliative nursing will allow the burdened healthcare system with the means to respond more effectively to the current crisis as well as future health crises. However, despite the capabilities of palliative care to streamline the system, there are gaps in knowledge when it comes to the best way to apply it to the current conditions. The ever-evolving nature of the COVID-19 pandemic has made it difficult for operational guidelines made at the beginning of the crisis to continue being applicable. The article by Rosa et al. seeks to address the gap by taking into account the available research and practice from handling the pandemic so far and highlighting the specific roles that nurses can take in palliative care to contribute significantly to the current landscape.
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Since the identification of the strain in 2020, COVID-19 has increased the pressure on the public. Patients that have fallen seriously ill and their families have had to face anxiety, bereavement, and grief. Furthermore, the backdrop of social and economic instability that has accompanied the spread of the disease has increased levels of strain. A key part of palliative nursing is addressing both the physical and the emotional strain that is present in times such as these. Palliative care training allows nurses to handle not only the emotional distress of their patients but also the complicated decision-making processes that accompany such cases. With these situations carrying high levels of uncertainty with regards to patient health, and limited options for recovery, palliative nursing is the best choice for care. Its focus on the return of dignity to patients and the reduction of suffering can optimize the quality of life for patients whose condition is severe. Specifically, the authors recommend a bigger focus on barriers to healthcare that create inequalities between the individuals that are infected with the virus. They also suggest that palliative care is integrated into the mainstream healthcare delivery system further upstream in the health management process. This means that elements of palliative care such as symptom management, pain management and emotional distress management are integrated into the nurses during admission. This ensures that the patient experience is optimal. It also ensures that important discussions about care in high-stress situations are guided appropriately. Another recommendation is that palliative nurses are engaged as autonomous members of interdisciplinary teams so that they can contribute as best as possible. This includes ensuring that hospital policy promotes their scope of work and ensuring that other members of interdisciplinary teams understand the contributions of palliative nursing and how they fit into the team. The involvement of palliative nurses in decision-making and policy formulation at the organizational level will also significantly improve the impact of palliative care during the pandemic.
Rationale
One of the reasons that this article was chosen was for its relevance to the current healthcare landscape. The article provides specific recommendations tailored to the global health crisis, especially with hospitals currently being overwhelmed with a large number of acute care patients. One of the issues that have been characteristic of the COVID-19 pandemic has been increased ICU and HDU department beds occupancy. Thus, there has been a rapid increase in the number of patients requiring palliative care for a variety of reasons – severe symptom management, complex decision-making, managing emotional distress, and care at the time of death. With an increase in patients that would benefit from palliative nursing, the material in the article seemed appropriate to focus on.
The focus of the article on a healthcare field that is often overlooked was another reason for its selection. While palliative care is highlighted in training, it is not a popular choice. Highlighting the application of palliative care to nursing practice in the global pandemic is a means of bringing more interest to it. From a personal perspective, reading the article and researching its contents has inspired a deeper interest in palliative care.
Lessons Learned and Application
The article has integrated important lessons in incorporating elements of palliative care in the admission process. Through reading it, it has become apparent that managing expectations, pain, emotional distress, and symptoms from a macro level rather than individually is a process that can be used at the early part of the healthcare process. Especially in the context of a public health crisis, it is important to have these elements as a feature of the healthcare process from the beginning rather than incorporate them towards the end.
There are two means of the application when it comes to the material presented in this article. The research can be applied from the individual or the organizational perspective. From the individual perspective, nurse practitioners can engage with patients with the entire scope of the healthcare process in mind rather than treating the current symptoms. This means incorporating counselling, symptom management, and expectation management from the start of care. From the organizational perspective, nurse leaders can ensure the involvement of palliative nurses in interdisciplinary teams. Leaders can also advocate for palliative nurses to be involved in policy formulation and management. This can ensure that palliative care is involved at all relevant stages of care for the average patient. Furthermore, it will ensure that the scope of work for palliative nurses is well-understood and optimally applied to the healthcare setting.
References
Immovilli, P., Morelli, N., Antonucci, E., Radaelli, G., Barbera, M., & Guidetti, D. (2020). COVID-19 mortality and ICU admission: the Italian experience. Critical Care , 24 , 1.
Radbruch, L., Knaul, F. M., de Lima, L., de Joncheere, C., & Bhadelia, A. (2020). The key role of palliative care in response to the COVID-19 tsunami of suffering. The Lancet , 395 (10235), 1467-1469.
Rosa, W. E., Gray, T. F., Chow, K., Davidson, P. M., Dionne-Odom, J. N., Karanja, V., ... & Meghani, S. H. (2020). Recommendations to leverage the palliative nursing role during COVID-19 and future public health crises. Journal of Hospice & Palliative Nursing , 22 (4), 260-269.
