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Saturday, December 20, 2008

Interesting Link: End of Life Care

I have an interest in medical ethics and end of life care. Here's an interesting link I followed today, written by a hospitalist in his blog:
My Patients Are Dying...And I've Never Been Prouder.

This is a really well-written piece about the importance of planning for end-of-life care in the hospital, and the better-late-than-never shift of focus from "The Patient Must Never Die!" to a discussion of the viable options and possible shift of focus from "doing everything" to making the patient and family comfortable. We all die, sooner or later, and not many of us want to do it in the ICU, especially if there is no real hope for a positive outcome.

The one thing I would like to see more of is a focus on the nurses' role in palliative care. This doctor talks a lot about all the physicians he has worked with who have advanced the issue of end-of-life care, and mentions the multidiciplinary Palliative Care Team he works with. He mentions the social worker by name, but then refers to the "PCT-trained nurses" as a group, and never talks about the bedside nurses that not only carry out orders, but coordinate the efforts with the patient and family, and create the environment that families need and remember later. Nurses really make palliative care possible. Certainly the doctors who make the major treatment decisions are important, but there are a million intangibles that cannot occur without an educated, compassionate and willing nurse caring for the patient and family.

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