The stigma around palliative care is that it is only associated with end of life, and in some minds, giving up. But that isn't the case, as palliative care is a vital part of any critical care.
In 2002, I returned to work at my prior hospital of employment and found many examples of forward-thinking in place. One seemed like an oxymoron. A palliative care nurse practitioner was now employed within the Medical Intensive Care Unit (ICU). I wasn’t sure what to make of this addition at the time, but years later, I’ve realized the very appropriate allocation of this advanced practice nurse within this setting.
The overall death rate in the ICU is high: 20%-35% of patients admitted to intensive care die.1 In addition, admissions to the ICU in the last month of life have increased to nearly 30%.2 Within cancer care, contemporary data confirms the importance of addressing the needs of patients with cancer within the critical care setting. Consider the following:
Associated with the increased prevalence of oncology patients within critical care settings are other corollaries.
Within the context of patients being unable to speak on their own behalf, surrogate or proxy decision-making has a plethora of problems and controversies.4 The prevalence of considerable symptom distress is another issue. In addition to cancer treatment-related sequelae, palliative care-related symptoms (i.e., thirst, anxiety, sleep disturbance, dyspnea) also require management.5 Lastly, poor communication amongst numerous physician specialists and with family members is pervasive.3,6-9
There are several interventions to be considered to address these issues. They require implementation within the critical care and oncology unit settings. Consider the following:
I had the opportunity to work with a research initiative within the 5 University of California hospitals to train critical care nurses in communication skills.10,11 The program’s goal was to provide needed instruction in the clinical setting about how to speak with the families of ill patients and the training consisted mostly of role-playing communication strategies with families, physicians, and family meetings.
Oncology nurses are one of many nurse specialties that care for patients with cancer. Emergency Department, PACU, surgical, rehabilitation, home care, dialysis, medical, and critical care nurses care for our patients at various phases of their cancer experience. The inevitability of oncology patients being cared for, and possibly dying, in the critical care setting is a real one in today’s acute care environment. Because of the prominence of cancer today, all nurses need to ensure they have the expertise and confidence to care for oncology patients at varied points along the cancer continuum.
References:
Tracking Symptoms, Physical Activity With Wearable Technology in Oncology Nursing
March 4th 2024Even though wearable technology can track symptoms and physical activity, among other information, in patients with cancer, more research is needed to determine how it all can benefit the management of these patients by oncology nurses.