Where does fundamental care fit within palliative care?

A blog post written by Professor Alison Kitson, Vice-President and Executive Dean, College of Nursing and Health Sciences, Flinders University; Foundational Director and Knowledge Translation Lead, Caring Futures Institute, Flinders University

I used to work with two very well-known nursing researchers who were involved in a large European Union funded palliative care research project investigating non-pharmacological interventions in palliative care. This was in the late 2000s, early 2010s and we had just set up the International Learning Collaborative (ILC) to start our work on understanding the fundamentals of care. Brigit and Carole attended some of our annual meetings and we got to talking about why it was that providing fundamental care to dying patients had somehow started to be described as ‘non-pharmacological’ interventions. Or maybe fundamental care did not even qualify in that bracket either.

For example, take a fundamental care need such as comfort. What can a nurse do with and for a dying patient that will enhance their comfort? Clean skin, clean mouth, sitting or lying in the right position, right noise and light level, not hungry and not anxious; managing pain; checking for constipation or other issues; in other words, enabling the patient to relax. We can see that in order to achieve one fundamental care need (comfort) there are a lot of other fundamental care needs to consider (personal hygiene; nutrition and hydration; psychological wellbeing and context conducive to enabling the patient to be comfortable). Now the question is, if the patient is given a strong opioid in order to relieve any symptoms of pain, does that mean the other fundamental care needs are not required to be dealt with? Is there an implicit hierarchy working in the mind of the nurse (and patient) that if the pain is managed, then the other aspects of care are not required to achieve the goal of comfort?

The unintended consequence in my view of calling fundamental care a ‘non-pharmacological’ intervention is that it relegates it to a series of uninformed tasks rather than regarding it as central to caring for a dying patient. It also regards the pharmacological interventions as more important than the human interaction and engagement. Consider also a situation where the dying person is in an acute medical ward. What is the likelihood that more attention will be paid to managing the drug regimen that making sure fundamental care needs were delivered in a person-centred way?

These are the sorts of questions we try and seek answers to through the Fundamentals of Care Research Program in the Caring Futures Institute. We are generating a coherent way to think and talk about fundamental care which is leading to better ways to teach it and research it. We want to work very closely with colleagues, carers and patients in palliative care, or entering a stage in life closer to death and dying, to ensure we learn from you and help develop better ways of doing fundamental care.

For more information on the fundamentals of care watch this presentation by Alison Kitson: https://www.youtube.com/watch?v=YLj1D6fpz7o

Professor Alison Kitson, Vice-President and Executive Dean, College of Nursing and Health Sciences, Flinders University; Foundational Director and Knowledge Translation Lead, Caring Futures Institute, Flinders University