Palliative care is not just about 'stopping the pain'.

Hello, this is Natsu.

For six years since I started my career, I have worked in a respiratory medicine and surgery ward.
It was a ward with many lung cancer patients, even among respiratory cases, and
I looked after them from their initial examinations to their final moments.

In that environment, I became interested in palliative care, and
I would like to share what I learned when I attended a conference recently.

When working as a nurse, it is easy to assume that 'palliative care equals controlling pain'.

In my ward, too, we adjusted cancer patients' pain with medical narcotics,
thinking about how to help them live their daily lives peacefully.
I thought that was the entirety of palliative care and the correct answer.

However, at the conference I attended the other day, I realized that this way of thinking was only 'a small part' of it.
Today, I would like to talk a little more deeply about how to face'invisible pain', which really struck a chord with me.

Protecting self-esteem while swaying between 'safety' and 'autonomy'

What really hit home during the conference lecture was the theme ofthe 'dilemma between safety and autonomy'in palliative care.

Even for patients with a short prognosis,
the desire to 'move on their own' does not disappear.
However, in a hospital setting, falls and slips are a serious issue, accounting for about half of all incidents.

To ensure safety, we use bed sensors and rush over when they go off.
But for the patient, this becomes'the stress of having their freedom monitored',
which sometimes hurts their self-esteem and leads to behavior like trying to climb over the sensor to move...

The important thing here was not just to restrict them.
Through ethics conferences, we must thoroughly discuss and share'what the patient wants and what they do not want done to them'.
Damaging their self-esteem leads to a deeper'spiritual pain' than physical pain.

Carefully protecting their self-esteem.
I strongly realized that this in itself is a form of excellent palliative care.

The loneliness of 'dyspnea' that doesn't show up in data

There were many lung cancer patients in the ward where I worked.
Apart from the progression of their illness, many complained of 'shortness of breath' caused by panic symptoms or intense anxiety.

For this suffering that does not appear in numbers or data,
we tend to easily suggest, 'There is medicine to ease your anxiety.'

But from the patient's perspective, this becomes a feeling of distrust that'my true suffering is not being believed',
and it can become a trigger for breaking the trust between medical staff and the patient.

There were many things we could do as nurses, other than just distributing medicine.


* Matching your breathing with the patient and gently staying by their side* Gently touching stiff muscles to help release tension
* Carefully listening to their feelings of 'suffering' without denying them
* Creating a comfortable environment with pleasant scents and temperatures

Of course, patients are not the only ones, and
we have other duties, so we cannot do everything.

The important thing is to regulate breathing together and support the patient so they can have a sense of control, thinking,
'If I do this, I can feel a little better.'
That accumulation leads to the patient's self-efficacy (confidence).

Listening to 'the other person's story' instead of my own

What made me think the most deeply this time was the phrase,'do not impose your own story'.

Thinking, 'It is better to remove the suffering even if it means taking medicine,'
based on my knowledge and sense of justice as a nurse, is merely 'my story'.

Patients have 'their own story' that they have cherished throughout their lives.

* 'I would rather talk clearly with my family even if it is a bit painful, than have my consciousness clouded by medicine'
* 'I want to be myself as naturally as possible until the very end'
Our correct answer is not necessarily the patient's correct answer.

While building a relationship of trust, I want to gently accompany the other person's story,
and think together about what they value in life and what they want to choose.

I am convinced that this is the kind of nursing I want to aim for as a mid-career nurse and as a human being.

Conclusion: Natsu's thoughts

Palliative care is by no means something that only takes place in a 'special place'.
Even amidst the busyness of daily tasks, we can protect a patient's self-esteem,
support them through their anxiety about breathing, and respect their personal story.

Before brandishing our 'correctness' as professionals,
I want to first listen closely to the story of the person right in front of me.

This conference reminded me of that 'origin of nursing' and the 'light of my career' that I should follow.

When busy, it's easy to just go through the motions of care as a 'task'.
But if I can take one step into a patient's story, that is enough for today.

Thank you for reading until the end.
If you like, please give me a like, follow, or comment.

Hello again, I'm Natsu.
Thank you for finding this note.

I am a nurse in my 12th year.
Having experienced respiratory medicine, respiratory surgery, COVID wards, and outpatient clinics,
I am currently on maternity leave and building a GPT for nurses.

▼ As an introduction, I have briefly summarized my career so far.

▼ A guide to this note is summarized here.

▼ I have summarized recommended articles for mid-career nurses.

In addition, other articles and GPTs for mid-career nurses are summarized here.

If you want to read about the nursing of various people, go here.

I would be happy if this reaches people who are struggling in the same way.
Please follow me if you like.

Thank you for reading this far.

If you have any questions, whether they are about this article
or something else, please feel free to ask.