Top 20 Steps for Staff

  1. Listen more. Talk less.
  2. See the patient. They are the expert in their own end of life process; discover what is important to them. What are their goals of care?
  3. Be an advocate with genuine positive regard (hear the hopes, the desires, the needs, the fears from an open, non-judging perspective).
  4. Recognize the holistic approach to end of life care, understanding the patient has physical, spiritual, psychosocial needs that should be addressed.
  5. Refer! Don’t do the job alone! The hospice/palliative care team encompasses the entire team with the combined levels of expertise and abilities to assist a patient and family through debilitating illness and the dying process.
  6. Avoid becoming the sole supplier of support to a patient or family and avoid usurping others’ roles.
  7. Never say “there’s nothing else to be done”…When symptoms are burdensome there is ALWAYS something else to be done.
  8. Be aware of the individual symptoms most important to the patient, and their family (it may not be the same as what is on your agenda).
  9. Be a detective; searching for the clues that help to determine what the needs are (patients and families may not recognize them and may not report easily remedied situations). Know what issues are affecting quality of life for the patient and their family.
  10. “Normalize” the dying process without ever becoming immune to the overwhelming trauma patient and family undergo during this time (none of it feels “normal” to them).
  11. Look for the teaching moments for both the patient and the family, and don’t miss the opportunities.
  12. Support. Advocate. Care. Become an integral part of the patient’s support system.
  13. In the event an ethical or moral dilemma for you develops in providing care for the patient/family system, excuse yourself from the team and ensure there is a replacement that is better suited (this is not the chance for your “personal growth”, this is the one opportunity to get things right).
  14. Keep learning: there is always something more to be learned! End of life care and symptom management is an ongoing educational experience, both due to continued research in evidenced based practice, and the wide variety of patient conditions that will be presented to the hospice/palliative care team.
  15. ASK for help (that’s why there is a team!) when uncertainty in the treatment plan or lack of symptom management/alleviation of symptoms are affecting the patient’s quality of life. Don’t wait to collaborate with the team.
  16. Never forget, when struggling with patient symptom management and changing the treatment plan that TIME IS OF THE ESSENCE.
  17. If you develop compassion fatigue and find you are working for a paycheck, it’s time to make an inventory of what you need to refuel in order to deeply care for patients and families during their most vulnerable time.
  18. Remember to do self care and self reflection; find ways that both co-workers and friends outside of work can help you stay balanced.
  19. Even the experts find themselves at a loss; never become complacent in your search for doing better and providing excellent end of life care, but also giving yourself grace and remember these two things: a. You are not a super-human! and b. You bring presence, more than any and all levels of skill, to the patient and family.
  20. Listen. Listen. Listen.
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