Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 11.0 Helping Staff to Provide Good Care

Never be afraid to try something new. Remember, amateurs built the Ark. Professionals built the Titanic.
- Anonymous

Caring for Caregivers

Service industries thrive on customer satisfaction. In health care, staff can bring compassion and warmth to each patient encounter - or, through inattention or lack of concern, can compound a patient's stress. In end-of-life care, staffing issues are even more critical than in most other business and health interactions. Whether staff meet a customer's needs ultimately influences how customers - dying patients and their loved ones - experience one of life's most profound transitions.

Good end-of-life care depends on the ability of staff to routinely provide what is, in fact, an intense degree of care.

The needs of dying patients can range from the dramatic to the mundane. Patients may need expert interventions to treat complex symptoms, or families may ask a volunteer to help with grocery shopping. In each instance, and at every point in between, clinicians and administrative and support staff must be able to anticipate patient needs, when possible, and to respond confidently, quickly, and effectively.

Because gravely ill patients have an array of emotions, symptoms, and needs, caregivers must be deeply committed to patient care. Regardless of their professionalism, those who work in end of life encounter emotional challenges - the unpredictability of death, the repeated losses, the interaction with grieving and overwhelmed family members and loved ones. Although their potential for burnout is high, those who work in this field generally first speak of their satisfaction in caring for patients and families.

In This Chapter

Resources on personnel abound, so this chapter focuses on a narrow slice of human resources: the special issues faced by organizations whose workers care for the dying. This chapter describes:

People who work for end-of-life programs, from receptionists to oncologists, are often drawn to the field because of their own experiences with dying friends and family, and are often committed to improving end-of-life care. Most people who work with the dying do so out of a deep love for humanity and a passion for what they do. Their hearts often lead them to the field, and their personalities keep them at it. It is this heartfelt conviction and dedication to improving the status quo that often distinguish people who work with the dying from those who work in other realms of health care.

Innovators Need to Know

Observing and experiencing an interdisciplinary team as it cares for a dying patient and supports a grieving family is like watching an orchestra prepare for and then perform a symphony. The conductor knows how each bar of music should be played and how it should sound, but the individual musicians only focus on their own section, with the conductor's direction. They rehearse intensely and persist toward perfection. In the end, the audience enjoys a beautifully played symphony. The audience is not aware of, and probably doesn't care about, the chaos, exhaustion, and frustration experienced by musicians working under deadlines and striving for perfection.

Like musicians, members of the interdisciplinary team must focus on their role in caring for individual patients. At the same time, however, they must have a conductor's sense of how the final piece should sound. Unlike in an orchestra, however, in palliative care, members may be asked to ``change instruments'' at any time - even in the midst of a performance.

  • Interdisciplinary teams provide the framework for excellent end-of-life care.
  • Good teams do not just happen - they happen through time, training, and commitment.
  • Team meetings provide a forum for staff to discuss patient issues and to address concerns about the organization or team itself.
  • Team-building strategies are a way to reinforce the team's mission and goals.
  • Paraprofessional staff benefit from ongoing training and opportunities to participate in in-service training programs.
  • All staff members face issues of grief, bereavement, and loss and need time to reflect or grieve when patients die.

<<< Previous Next >>> [ Go Up ]

order from

This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ ].

Sourcebook logo