Sometimes in our line of work, our patients do not get better. Sometimes, despite our best efforts, they get worse. And sometimes they die. This month has been a difficult one, as the majority of my hospital caseload has included patients at the end of life. I have also had a graduate student working with me. Needless to say, we have experienced many “teachable moments” together this month and my twitter feed has been surprisingly supportive (see posts/retweets @CCCSLPNET).
What I have learned/tried to teach is:
The importance of understanding the patient’s goals and perspective.
The importance of withholding my personal feelings/judgements while providing the most accurate information I can to explain the patient’s deficits.
The importance of alternatives, knowing that if ‘Plan A’ does not meet the patient’s goals, there needs to be a ‘Plan B’, and possibly a ‘Plan C’.
The importance of teamwork
I am fortunate to work with a wonderful team of physicians, nurses, dietitians, case managers and a great Palliative Nurse Practitioner. Through these collaborations I have learned that the Palliative Care conversation, that “first conversation” can happen early, before the end of life, to help clarify the patient’s goals for care in order to mitigate unnecessary care and avoid unwanted returns to the hospital. I have learned to avoid blaming the patient for their informed choices by endeavoring to eliminate the term “non-compliant” from my documentation. If after education, the patient decides not to follow my recommendations, that is their choice. They are not non-compliant. They are choosing a different course of care based on their goals/values. I need to respect that.
It is always an on-going process. Each patient is different and it is never easy, but we strive. I remind myself that it is an honor and a privilege to assist in the care of these patients at this stage of their life…. That helps.
About the Author