PALLIATIVE CARE
Dying well in the community: an equation Brian Nyatanga
Brian Nyatanga is Senior Lecturer in Allied Professional Studies and Lead for The Centre for Palliative Care, University of Worcester Email: [email protected]
© 2014 MA Healthcare Ltd
W
hen I read the literature around death and dying, I often come across the idea of ‘dying well’ being propagated, not always including some of the important precursors to achieving this outcome. Dying well does not happen in a vacuum, and this comment revisits some of the key dynamics necessary in order for us to die well. While there is nothing negative about dying well, what seems to be omitted or ignored are the intricacies found between dying well and living well, living well and living longer. Dying well depends on certain aspects being in place and it is important that it should be considered with the other factors in the equation.The debate centres on whether there are two different processes (dying well and living well) or where these two are one and the same thing.The difference will be which one people choose to focus on. It is likely that people focus on living well when people are still healthy and dying well when there is a life-threatening illness. In the modern society, dying well may not be so easy to achieve any more. There are demands on—and expectations held by—patients. For example, because of medical advances, we tend to think that a cure is possible and that things will get better soon. On the other hand, our death is not always up to us, but there are social, professional, legal, nursing and economic factors that dictate how our dying will progress. To use one example, a social death involves relations around us, close family and our social friends’ input on how we die. For patients who choose to die at home, there is a different network of people present in the home, and some of them may dictate what should happen at our death and dying scene. Although the focus and argument is on improving the experience of dying (dying well), what is also happening is the actual experience of living (living well), which is probably central to what everyone is trying to help the patient to achieve. Health-care professionals like community nurses will argue that their input is aimed at improving quality of life for the patient. However, what is not clear is whether this input has a direct connection with the quality of death. Then the wellrehearsed debate starts again about whose perspective we are determining this quality from. Consider Peter, who has been in hospital four times in the last 12 months. On three of the admissions, he received cardiopulmonary resuscitation for myocardial infarction (MI). He was discharged and was sent home, where he suffered another MI, and was rushed to hospital again—but this time he died on the way, with ambulance crew doing everything they could to save his life. Peter may have had a reasonable quality of life before the hospital admissions, but he did not die well.The ambulance would not British Journal of Community Nursing June 2014 Vol 19, No 6
have been his chosen place of death, surrounded by ‘strangers’. In order to ensure that people die well wherever they are, certain things need to be in place: w Ascertaining where people would like to be cared for w Making sure that people are living well w Ascertaining where people would like to die In addition: w Asking family members whether they support the patient’s wish to die at home w Ascertaining what is important to them and helping them achieve it w Identify any pain, distress and offer interventions to make them comfortable. w Helping patients and families understand that living longer does not always equate to better quality of life w There is interprofessional communication and education/training for other services about palliative care and respecting the wishes of patients w Facilitate discussion about future planning where possible and recording this in a care plan accessible to all services that visit the patient at home. Of the elements mentioned above, continued education/ training in all aspects of palliative care is crucial to how people die. Understanding the importance of symptom management to the point of achieving spiritual calmness are all-important ingredients to ensuring people die well. Many writers, including Twycross (2003), argue that dying well includes involving families and those important to the patient. The family unit will often have needs ranging from emotional to practical, which health professionals should help and support them with.
Conclusion Dying well can be achieved if people live well. There is an important relationship here, and living well must be a prerequisite to dying well. The final point to make is that we are all going to die. Knowing this is fundamentally important because we can savour life even more and not always focus on what will happen in death and dying. It is therefore our duty as professionals to communicate bad news sensitively, to enable patients and families to savour their lives too. Thus, when one generation flourishes and dies well, the next will be encouraged and death may be welcome. It would be a welcome legacy for palliative carers when people talk openly and look forward to dying well. BJCN Twycross RG (2003) Introducing Palliative Care, 4th edn. Radcliffe Medical Press, Oxford
307
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 1, 2015. For personal use only. No other uses without permission. . All rights res
Dying well in the community: an equation Brian Nyatanga
Brian Nyatanga is Senior Lecturer in Allied Professional Studies and Lead for The Centre for Palliative Care, University of Worcester Email: [email protected]
© 2014 MA Healthcare Ltd
W
hen I read the literature around death and dying, I often come across the idea of ‘dying well’ being propagated, not always including some of the important precursors to achieving this outcome. Dying well does not happen in a vacuum, and this comment revisits some of the key dynamics necessary in order for us to die well. While there is nothing negative about dying well, what seems to be omitted or ignored are the intricacies found between dying well and living well, living well and living longer. Dying well depends on certain aspects being in place and it is important that it should be considered with the other factors in the equation.The debate centres on whether there are two different processes (dying well and living well) or where these two are one and the same thing.The difference will be which one people choose to focus on. It is likely that people focus on living well when people are still healthy and dying well when there is a life-threatening illness. In the modern society, dying well may not be so easy to achieve any more. There are demands on—and expectations held by—patients. For example, because of medical advances, we tend to think that a cure is possible and that things will get better soon. On the other hand, our death is not always up to us, but there are social, professional, legal, nursing and economic factors that dictate how our dying will progress. To use one example, a social death involves relations around us, close family and our social friends’ input on how we die. For patients who choose to die at home, there is a different network of people present in the home, and some of them may dictate what should happen at our death and dying scene. Although the focus and argument is on improving the experience of dying (dying well), what is also happening is the actual experience of living (living well), which is probably central to what everyone is trying to help the patient to achieve. Health-care professionals like community nurses will argue that their input is aimed at improving quality of life for the patient. However, what is not clear is whether this input has a direct connection with the quality of death. Then the wellrehearsed debate starts again about whose perspective we are determining this quality from. Consider Peter, who has been in hospital four times in the last 12 months. On three of the admissions, he received cardiopulmonary resuscitation for myocardial infarction (MI). He was discharged and was sent home, where he suffered another MI, and was rushed to hospital again—but this time he died on the way, with ambulance crew doing everything they could to save his life. Peter may have had a reasonable quality of life before the hospital admissions, but he did not die well.The ambulance would not British Journal of Community Nursing June 2014 Vol 19, No 6
have been his chosen place of death, surrounded by ‘strangers’. In order to ensure that people die well wherever they are, certain things need to be in place: w Ascertaining where people would like to be cared for w Making sure that people are living well w Ascertaining where people would like to die In addition: w Asking family members whether they support the patient’s wish to die at home w Ascertaining what is important to them and helping them achieve it w Identify any pain, distress and offer interventions to make them comfortable. w Helping patients and families understand that living longer does not always equate to better quality of life w There is interprofessional communication and education/training for other services about palliative care and respecting the wishes of patients w Facilitate discussion about future planning where possible and recording this in a care plan accessible to all services that visit the patient at home. Of the elements mentioned above, continued education/ training in all aspects of palliative care is crucial to how people die. Understanding the importance of symptom management to the point of achieving spiritual calmness are all-important ingredients to ensuring people die well. Many writers, including Twycross (2003), argue that dying well includes involving families and those important to the patient. The family unit will often have needs ranging from emotional to practical, which health professionals should help and support them with.
Conclusion Dying well can be achieved if people live well. There is an important relationship here, and living well must be a prerequisite to dying well. The final point to make is that we are all going to die. Knowing this is fundamentally important because we can savour life even more and not always focus on what will happen in death and dying. It is therefore our duty as professionals to communicate bad news sensitively, to enable patients and families to savour their lives too. Thus, when one generation flourishes and dies well, the next will be encouraged and death may be welcome. It would be a welcome legacy for palliative carers when people talk openly and look forward to dying well. BJCN Twycross RG (2003) Introducing Palliative Care, 4th edn. Radcliffe Medical Press, Oxford
307
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 1, 2015. For personal use only. No other uses without permission. . All rights res
