Making ‘invisible’ nursing work visible: The work of oncology nurses in introducing early palliative care

AN OPPORTUNITY TO CATCH UP WITH OUR ‘PAST POSTS’ – Today we’re republishing a research article from Canada that was selected as  ‘Editor’s Choice’ in February 2020.

Each month, Professor Catherine Walshe, Editor-in-Chief of ‘Palliative Medicine’, chooses an article that readers may find particularly interesting or useful and invites the authors to draw out the key points on the EAPC blog. Focusing on research that is novel, a robust review, from a specific country or just slightly left of field, the ‘Editor’s Choice’ post aims to share experience and stimulate ideas. We hope you’ll read the longer article in ‘Palliative Medicine’, or EAPC members can access a free copy from the EAPC website.

Shan Mohammed RN, PhD is an Assistant Professor, Teaching Stream at Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, and a Fellow of the Centre for Critical Qualitative Health Research, Toronto, Canada. Here, Shan explains the background to his research study and longer article published in the February 2020 issue of  ‘Palliative Medicine’ which has been selected as ‘Editor’s Choice’ for February…

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Most of us have been cared for by a nurse at some point in our lives – nurses are skilled at treating disease and providing physical care and emotional comfort when people are most vulnerable. In my 15 years as an oncology nurse, I have cared for many people with haematological diseases such as leukaemia and lymphoma; this work has been the most meaningful of my career. Despite this, I have sometimes found it difficult to describe what nursing work was to people who were not nurses. Since it is part of the everyday rhythm of care and personalised comfort, nursing work is often thought of as ‘invisible’ and behind the scenes. When I teach undergraduate students about this idea, I use the example of the nurse who advocates for a patient with unrelieved pain to get a pain medication increased – yet often the patient only acknowledges the physician who prescribes the medication.

Nurses make a major contribution in introducing palliative care to patients (and families) who are receiving medical treatment for their disease but have not been referred to palliative care. However, nursing work in this area has not been formally examined because nurses often do not have the formal authority to refer patients to palliative care. Yet, as a nurse, I was there with the patient ‘24/7,’ speaking to patients and families about their goals of care and witnessing the physical impact of advanced disease and cancer treatments. Nurses may be well positioned to have these challenging discussions about palliative care with patients and families, yet I wondered if this work was also invisible.

To examine the role of nurses in introducing palliative care (and to render this work visible), we interviewed registered nurses, advanced practice nurses, and nurse practitioners about the role they played in introducing palliative care in several ambulatory oncology clinics (Mohammed et al., 2020). The results of our study showed that nurses played an important role in finding a space to have these challenging conversations, building trust with patients and families, and providing education about the many benefits of palliative care for patients with advanced disease (Mohammed et al., 2020).

Palliative care is inherently interdisciplinary. Our study suggests that the introduction of palliative care is a team effort that also must involve nursing. Nurses have the knowledge and skill to direct this process and can anticipate which vulnerable patients might benefit most from access to this care. Nurses, in turn, need to be supported by being offered opportunities to have these close relationships with patients, receiving respect from the healthcare team, and being provided with education in palliative care.

The results of our study are exciting because they demonstrate that relational work is the foundation of both oncology nursing practice and palliative care. As a university professor, I know that teaching undergraduate students about relational care is difficult but essential. A recent US Gallup poll showed that nurses are perceived by the public as the most trusted profession.Yet, despite the trust we hold with patients, nurses are susceptible to downsizing and cutbacks because of cost saving measures. The findings from our study suggest that promoting patient access to palliative care might be hampered if nurses are not directly engaged in relational work with patients.

Nurses on the front lines need to recognize, value, and voice the unique knowledge they have of patients and families as they advocate with other members of the healthcare team for improved access to palliative care. At a broader professional level, nurse leaders and educators need to advocate for more comprehensive and ongoing training on how relational care is linked to introducing palliative care.

 

VIEW THE FULL ARTICLE IN ‘PALLIATIVE MEDICINE’
This post relates to the longer article,“I’m going to push this door open. You can close it”: A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care by Mohammed, S., Savage, P., Kevork, N., Swami, N., Rodin, G., & Zimmermann, C. published in Palliative Medicine 2020, 34 (2); pages: 209–218. https://doi.org/10.1177/0269216319883980 Article first published online: 29 October 2019. Issue published: 1 February 2020.

• Read more about Shan Mohammed here.
• Contact Dr Shan Mohammed by email.
• Read earlier Palliative Medicine Editor’s Choice posts on the EAPC blog.
• Follow Palliative Medicine on Twitter @palliativemedj 

EAPC MEMBERS – DOWNLOAD THIS, AND ALL OTHER ‘EDITOR’S CHOICE’ ARTICLES, FREE OF CHARGE

If you are currently an Individual or Associate EAPC Member you have full access to the Members Only Area of the EAPC website, and the chance to download a free PDF of all ‘Editor’s choice’ articles and many other papers too.  Just click here, enter your email address and membership password and choose from the list of journal articles published in 2020. (Please search under the journal article title,“I’m going to push this door open. You can close it”: A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care”).

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