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Post-Conference Session Summaries“Changing Focus: From Aggressive Acute Care to Aggressive Palliative Care” Instructional Session 3, presented on Tuesday, April 24, and repeated on Friday, April 27 According to session coordinator and speaker Cyndi Cramer, BA, RB, OCN®, PCRN, society today is focused on a death-denying, or healing hero, culture, where death is seen as a failure. Healthcare providers feel morally obligated to do everything they can for a patient, and the point comes where providers are no longer sure if they are sustaining life or extending death. Cramer said that most people are not afraid of death but instead fear the dying process. Statistics suggest that fewer than 10% of people die suddenly, which means that 90% are dying after an illness. Therefore, Cramer said, healthcare providers need to develop aggressive palliative care to manage such patients. Providers should ask themselves, “Would I be surprised if this patient died in the next six months?” If the answer is no, then palliative care is indicated. In administering palliative care, providers should work toward patients' goals—not families' or the healthcare team's goals. Patients and families also need clear communication about what providers are able to do for patients. They may not understand euphemisms or softened phrases, so it is best to tell them exactly what healthcare can and cannot do for them. However, a gentler way of looking at “do not resuscitate” is still very clear: Ask patients and families if they want to “allow natural death.” Decision making regarding end-of-life care needs to balance burdens and benefits. Although care can result in longer life, comfort, time for relationships, a sense of community, communication, and meeting patients' wishes, it also may come with pain, suffering, financial burdens, dependency on technology, isolation, and immobility. Providers need to determine at what point the burdens outweigh the benefits. Speaker Betty Ferrell, RN, PhD, FAAN, discussed nurses' roles in palliative care and the preparation of nurses for end-of-life care. Nurses need to experience five processes to become successful advocates for transforming palliative care. First is catharsis of past experiences, where nurses carry the burden of life and death. Personal commitment follows, where nurses experience reawakening. Education is essential for empowerment, so nurses need to learn about topics such as symptom management, communication, culture, grief, and ethical issues. Nurses should familiarize themselves with data on the topic to help support their ideas. Finally, nurses need to establish partnerships for action and support—finding a champion in administration can help. Despite healthcare providers' best efforts, nurses may witness medically futile care, where patients are being treated for their disease but are unlikely to achieve meaningful survival. Such situations can cause moral distress for nurses. When faced with those situations, nurses should use family conferences and ethics consultations and foster peer support. According to Cramer, nurses can make a difference in palliative care. Many resources are available, such as the End-of-Life Nursing Education Consortium, ONStat, and the ONS Legislative Action Center . In their own institutions, nurses can start a palliative care committee and become a team with like-minded individuals. They can develop a team approach where the patient is at the center. They can change hospital culture, especially in teaching hospitals, which often are focused on aggressive cure—change the focus to aggressive comfort and palliation. Turn off the monitor and focus on the patient at the end of life. Avoid hiding behind your professionalism; instead, be personally present during patients' and family members' grief experience. “At the end of life, there's no second chance to get it right,” said Cramer.
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