The nurse’s role in end-of-life care
Caring for patients across the lifespan, nurses are effective advocates for health and wellness at every stage of life. Yet, in providing end-of-life care, where they often have a constant and highly visible role, they may be caught between the differing wishes and requirements of patients, families, physicians, administrators and laws or regulations. So it is important for nurses to feel supported and prepared when speaking to patients and families about end-of-life care — both from the legal and the ethical point of view.1
CNA’s Code of Ethics, which helps articulate the ethical values nurses must consider in their practice, also outlines the nurse’s role in relation to end-of-life care. For example:
- “Nurses ensure that nursing care is provided with the person’s informed consent. Nurses recognize and support a capable person’s right to refuse or withdraw consent for care or treatment at any time” (p. 11).
- “In all practice settings where nurses are present, they work to relieve pain and suffering, including appropriate and effective symptom management, to allow persons receiving care to live and die with dignity” (p. 13).
- “When a person receiving care is terminally ill or dying, nurses foster comfort, alleviate suffering, advocate for adequate relief of discomfort and pain, and assist people in meeting their goals of culturally and spiritually appropriate care. This includes providing a palliative approach to care for the people they interact with across the lifespan and the continuum of care, support for the family during and following the death, and care of the person’s body after death” (p. 13).
Respecting Choices in End-of-Life Care: Challenges and Opportunities for RNs, a research paper in CNA’s Ethics in Practice series, offers five scenarios to guide nurses in navigating some of the legal and ethical implications involved in end-of-life care.
Palliative care nursing
Palliative care, which is available in all primary care settings and at all stages of illness — not just near the end of life — seeks to improve quality of life and relieve suffering for patients diagnosed with chronic, life-limiting conditions. The palliative approach to care, which nurses have a fundamental role in, is highly individualized. It puts patients and their families at the centre of all decisions and considerations of care. It is also holistic, taking a patient’s spiritual, mental, physical, social, psychological and practical aspects into account. As well, it continues after a patient has died through ongoing support to the bereaved family and friends.2
The Palliative Approach to Care and the Role of the Nurse [PDF, 570 KB], a joint position statement by CNA, the Canadian Hospice Palliative Care Association (CHPCA), and the Canadian Hospice Palliative Care Nurses Group (CHPC-NG), outlines a range of issues in palliative care nursing, including advocacy and ethical and legal obligations.
Further information on hospice and palliative care is available from CHPCA, the national voice for hospice palliative care in Canada, and CHPC-NG, a member of CNA’s Canadian Network of Nursing Specialties.
CNA also offers specialty certification in hospice palliative care nursing.
1 Canadian Nurses Association. (2015). Respecting choices in end-of-life care: Challenges and opportunities for RNs [Research paper]. Retrieved from https://canadian-nurse.com/~/media/canadian-nurse/files/pdf%20en/respecting-choices-in-end-of-life-care.pdf
2 Canadian Nurses Association, Canadian Hospice Palliative Care Association, Canadian Hospice Palliative Care Nurses Group. (2015). The palliative approach to care and the role of the nurse [Joint position statement]. Retrieved from http://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/the-palliative-approach-to-care-and-the-role-of-the-nurse_e.pdf [PDF, 570 KB]