Letter to the Editor

Dear Editor CONJ,

I am a Bachelor of Science candidate majoring in nursing with a strong interest in palliative care, (PC) and was delighted to come across a submission by Collins and Small entitled, “The nurse practitioner role is ideally suited for palliative care practice: A qualitative descriptive study”, published January 1, 2019, in the Canadian Oncology Nursing Journal. Although I agree enthusiastically with the authors’ points, I do feel as though one key concept merits some expansion.

The authors mention the fact that palliative care clinical training is lacking in the nursing curriculum, which may contribute to nurse emotional discomfort with end-of-life (EOL) care. They propose a solution in which healthcare institutions allot funding to their NPs to pursue clinical continuing education hours in PC. This solution is promising, but another education area that is important to address is practitioners’ attitudes toward death and dying, and how it impacts their EOL patient care. Education on death itself may be an essential component to examining and improving attitudes on dying, and caring for dying patients (Peters et al., 2013). There is a tendency in healthcare to view death as a failure, when this is not always the case. A paradigm shift toward viewing death as a natural part of life, and acknowledging that there are perhaps worse outcomes than death, may be necessary to help nurses feel comfortable with providing PC (Peters et al., 2013). When healthcare providers harbour negative attitudes toward death, they are reticent to speak honestly with patients and families about dying. It is the patient who suffers, subjected to medical treatments that may add meagre quantity to the very end of their lives, at the expense of quality. Treatments that they may not have agreed to if an open and compassionate discussion of EOL care had taken place. This concept is further underscored in Dr. Atul Gawande’s seminal book on dying, Being Mortal (2014).

Clinical nursing experience in PC is essential, but it will fail to do the most good if deeply-held emotional and intellectual barriers to accepting death are not given their due diligence. Death is difficult to talk about. This fact, more so than just lack of experience with PC, makes it that much harder for the clinician to do right by patients’ wishes and values. Death education potentiates nurse comfort with talking about death, which provides patients with support during this deeply frightening process. A fully-informed practitioner can make all the difference for a peaceful, dignified death.

Sincerely,