CONTINUING OUR SERIES TO CELEBRATE THE INTERNATIONAL YEAR OF THE NURSE AND MIDWIFE 2020 AND THE BENEFITS THAT NURSING AND MIDWIFERY BRING TO THE HEALTH OF THE GLOBAL POPULATION.
To mark this world first, the European Association for Palliative Care (EAPC) is publishing a special series of 12 monthly posts to honour the work of nurses who work in palliative care and draw attention to several issues that are linked to this crucial workforce.
Today, we are delighted to welcome as our guest writer, Professor Philip Larkin, Professor of Palliative Care Nursing at University of Lausanne, Switzerland.
I was recently asked to contribute to a new guideline on end-of-life care on the grounds that nursing remains an essential component of good care of dying people. On reflection, what good care actually means is a point of conjecture. However, in my preparation, the word ‘comfort’ seemed to appear in different guises and pervade the language used to describe what we ultimately hope to achieve out of the complex work of palliative care. Indeed, the phrase ‘to comfort always’ appeared frequently in my search, attributed to a wide range of scholars from Hippocrates onwards, and reflected in a number of books and publications related to palliative care, including for example, David Clark’s revised biography of Cicely Saunders in 2016.
Other scholars and clinicians too, have ascribed to the notion of comfort as an integral part of care and the alleviation of suffering (see for example, the autobiography of Edward Livingston Trudeau who spent his life living with and researching into tuberculosis in the 19thcentury). However, from a nursing perspective, the evidence about the function and benefit of comfort is relatively sparse. It can certainly be found as a prerequisite for care in many foundation documents, such as Florence Nightingale’s Notes on Nursing, and later in many of the nursing models which became the backbone of nursing science in the early 1960s and 1970s. My own search revealed some interesting conceptual analyses of comfort (stalwart of academic nursing students in the 1980s) and, as noted, some contemporary reflections, including those of Dame Cicely Saunders. On the whole, comfort seems to be an implicit expectation rather than a measurable outcome and as ill-defined as the term ‘palliative care’.
In these last frenetic months of some of the greatest challenges that nurses (and others) have faced in giving care, the desire to provide comfort in a myriad of ways has made a difference. Finding ways for people to say goodbye to their relative, the respectful act of preparing the removal of a person who has recently died to the mortuary or funeral home, managing sudden or unexpected death are quite different from the planned transition towards death associated with palliative care. Choosing to be separated from friends and family for their protection and being present to the sickness of others when the risk to self was equally great. All of these actions speak to a new expression of comfort that, in this International Year of the Nurse and Midwife, we can never forget. Comfort applies to all of us, in equal measure.
What will this mean to us as palliative care nurses? Probably, not a lot in terms of daily practice – (sorry about that!). Nurses will continue to provide the comfort and care which is integral to their practice, in a variety of ways and settings, because it is needed. We might take time to reflect on what these last months have meant and what the future holds, but we will continue to do what we do best as creative and compassionate caregivers. Our nursing contribution will always be that difference.
The message of comfort is an important one for the next generation of palliative care nurses. As science develops, our practice will change, our investment will grow and our professional identity reframe. That is the way it should be, as nurses become forefront in the determination of clinical excellence. If we can remember that in all the technological advancement we might achieve, the inspiration of comfort, as a healing principle in our practice, has the potential to sustain and shape us to seek new opportunities and even greater achievements for optimal patient and family care into the 21stcentury.
Celebrate the International Year of the Nurse and Midwife 2020 on the EAPC blog #nurses2020 #midwives2020.View the series here and join us again in August when Dr Nicoleta Mitrea PhD, Director of Education and Development – Nursing, Hospice Casa Sperantei, Brasov, Romania, will be our guest writer.
Links and resources
- Read more about Prof Philip Larkin here.
- Contact Phil here.
- ‘State of the World’s 2020 Nursing Report’ Published by the World Health Organization, this report provides the most up-to-date evidence on and policy options for the global nursing workforce. It also presents a compelling case for considerable – yet feasible – investment in nursing education, jobs, and leadership. An online section available on the NHWA online portal contains individual country profiles presenting key statistics on nursing workforce.