Sharing Our Experience as Palliative Care Nurses
Authors: Frederick D. Nyaho & Joyce N. Gagbo
Palliative Care Nurse Specialists, Ghana.
After qualifying as Palliative Care Nurse Specialists, our colleague healthcare professionals, including Heads of Sub-BMCs within the hospital, have come to embrace palliative care. On average, the Palliative Care Team receives three referral consultations each week. All the patients and their families that the Palliative Care (PC) Team has seen have been receptive to us, except for one patient’s son, who works with an Allied Health Institution and has been quite challenging to care for.
This young man’s mother was admitted to the Surgical Ward with advanced fungating left breast cancer and was referred to the PC Team by the Surgical Team for pain management and breaking bad news. The PC Team met with the patient and her two sons, who were her caregivers. The patient was not communicating clearly at the time, so one of her sons consented to serve as a proxy and help the team with the Edmonton Symptom Assessment System (ESAS). The patient’s problems were identified, and treatment started promptly. After 48 hours, her eldest son, who works with the Allied Health Institution, met with the team and bitterly complained that his mother was fine, only to discover that her condition had changed. A family conference was organized immediately using the SPIKES protocol to address his concerns. During the conference, it was revealed that the family wanted surgery to remove the diseased breast, believing it would help her recover.
During treatment, a Junior Doctor with the Surgical Team informed the family that a “toilet mastectomy” procedure would be performed. They misconstrued this as a “total mastectomy” procedure, believing it would lead to a full recovery. Recognizing their misunderstanding, the PC Team organized another family conference to clarify the procedure. Despite this, the family was not satisfied and requested the cessation of all palliative care interventions, including medication. The team honored the family’s wishes, considering the moral and legal concerns surrounding the provision of palliative care services. Nonetheless, the PC team maintains communication with the patient and her family. We continue to assist ward nurses with tasks such as securing new IV lines for blood transfusions or taking blood samples for laboratory investigations due to our expertise in these areas.
Reflecting on the event, if the primary physician and his team had been clear and assertive in communicating to the patient’s family that the surgery wouldn’t benefit her, it would have reinforced what the PC Team had communicated earlier.