Being Alive Is Not The Same As Living

I, like many before me, went into nursing to help comfort and heal.  My only goal was to bring one smile or laugh to a patient each and every day.  Now, after 34 years in critical care I have seen much effort in making people live longer, but it is a life of fear, confusion, pain and suffering. Physically, mentally and emotionally - for the patient, their family, and the staff.  Work is now, every day, a moral and ethical dilemma for staff.  People come to ER, are admitted, and wind up in the ICU.  They endure many invasive procedures, and are frequently restrained to keep these invasive lines and tubes in place.  All too often now I care for elderly patients with multiple health issues, and chronic debilitating illnesses, which can not be cured.  Rather than focusing on best medical practices, patient comfort, alleviation of symptoms, and finding out what is most important to the patient, and compassionately educating them on what we can (and unfortunately) and cannot do - we instead try to treat organ failures, treat sepsis, one more surgery, fracture ribs doing CPR, to buy them more time.  It is a shame that the additional time is spent in hospital becoming increasingly frail, rather than at home in familiar surroundings, with their loved ones.  To further complicate matters, it would appear that patient/family centred care has come to mean patient/family dictated care - where "everything" is to be done, even when it makes no sense and will cause needless pain and suffering.  It is currently a sad state we are in - patients are suffering, families are expecting too much, staff are unsupported and burned out.  Just because we can do all these medical procedures and treatments, doesn't mean we should.  We need to look at the true goal of care - the big picture - is it to live longer (that doesn't seem to be working so well)?  Or could we strive to help patients live as well as possible, assisted, educated, supported, pain free, where they want to be, and doing what they want to do to the best of their abilities for as long as possible?   Palliative care services should be introduced as a standard of care the moment there is a progressive, debilitating, illness diagnosed - so that people (regardless of their age) can be aware of what is available to them, when (and if) it is required.  There should be education in schools for the medical, nursing  and allied health fields so they are prepared to have these conversations.  Free online education.  Care Directive packages and Palliative Care pamphlets in clinics, doctors offices, and waiting rooms.  Perhaps we can get patients off the treatment conveyor belt, so they can have a dignified, end of life and not the protracted, death experience we currently struggle with all too often. Guidelines/flowsheet to assist in when palliative care and/or end-of-life conversations and referrals should be made.  Palliative care doctors order sets are helpful.  Treatments should only be offered if there are health benefits - tools to help guide care (age, medical history, present illness, frailty scores = palliative care) - doing CPR on a patient over 80, with multiple organ failures is not beneficial for anyone.  Death is an inevitable part of life that awaits us all - we can't change that - but we can change what it looks like. We need to learn to accept that fact, and go back to helping, not hurting, those in our care.