Disseminating good palliative care practice using a public health approach
Working in Mexico, where palliative care remains a relatively new concept, Maricela is a driving force behind nurse education in this sphere, in addition to the daily work she does as a nurse in the Instituto Nacional de Cancerología de México (National Cancer Hospital). She is fighting a constant battle to prove that not only are nurses essential to the provision of quality end of life care, but that, with their unique combination of art and science, they can truly lead and enhance the care of this patient group.
I am passionate about working with this group of patients, and being able to share my experiences and knowledge with my colleagues and patients.
Like many of her fellow nursing pioneers, Maricela takes equal pride and pleasure in the care and support she provides patients at the end of life, as she does passing on the skills she has learned to fellow nurses to ensure palliative care reaches more people in her native Mexico.
When she started working at the Instituto Nacional de Cancerología de México (National Cancer Centre), Maricela and her colleagues found they were constantly having to prove themselves, and that they as nurses really could be the cornerstone of palliative care.
“Every day we had to demonstrate that we could perform all of the tasks essential to caring for people at the end of life – identifying and assessing patient need, creating a plan and delivering care as well as ensuring they have everything they need when they are sent home.”
She sums up her twin role in her own words: “The impact I can see from what I do is that my care helps reduce the suffering of patients and families, and offers education and training for the family members to perform the care needed by the patient at home.”
It’s the training and educational role that Maricela’s assumed amongst her nursing colleagues that is helping create an even deeper impact. She’s developed a diploma in palliative care nursing with Universidad Nacional Autónoma de México (the National Autonomous University of Mexico). In the three years it’s been running, nurses from across Mexico have taken the course.
“I get so much satisfaction when I see that I’ve managed to fill the students with the enthusiasm and love of palliative care that I feel, that passion to help improve the quality of life of people with advanced disease. That pleases me so much.”
Maricela has also worked with another of our nursing pioneers, Kath Murray, translating the palliative care nursing text she’d created as part of the Life and Death Matters project.
Kath believes Maricela’s success as a teacher stems from her commitment to bring the technical to life, integrating theory into practice. Her efforts to achieve this know few bounds. She has been known to create her own mannequins in order to show how to conduct procedures.
Maricela, through a combination of clinical skill, compassion, passion and an unstinting drive to embed the same qualities in others, is raising standards of palliative care as well as the status of nurses in its delivery.
What drives you to make a difference?
It’s the twin privilege of being in a position to support patients at the end of life with quality care and being able to pass on these skills that drive Maricela every single say.
She says: “My experience has mostly been with adult cancer patients. When the patient is experiencing high levels of suffering, I am able to support them, help them and accompany them to improve their quality of life. Being able to do this motivates me to continue training and to train my colleagues to offer the best care to this vulnerable group of patients.”
There’s a strong sense of joint enterprise and collaboration amongst Maricela and her nursing colleagues that also helps inspire her.
“It fills me with satisfaction to belong to the group of fellow nurses of Latin America who are also dedicated to the care of the palliative patient, and share experiences that can further enrich my work with the patients I support.”
How do we see the art and science of nursing expressed?
COVID-19 has, Maricela believes, helped both to clarify and elevate the role of nurses in the eyes of the public, and palliative care nurses exemplify this.
“While it has been a very difficult year for nurses, some good things have come out of it. The pandemic has allowed the whole world to realise our value as well as our strength and commitment.”
This new found public understanding of the vital role of nurses simply builds on Maricela’s firm belief that palliative care nurses embody the mix of art and science.
“Palliative care allows us to demonstrate the really human side of our profession, because on many occasions the care we provide becomes purely biological, physical, and we can forget the needs of the people we care for. Palliative care gives us the opportunity to see each patient as a unique being who has unique needs that we must care for holistically.”
How can nurses strengthen their leadership and impact?
In terms of setting an example, there is little more Maricela can do to show nurses’ potential for positive impact. That won’t stop her continuing to provide quality care for her patients every day and looking for ways to ensure ever more nursing colleagues both achieve their potential and receive the recognition they deserve.
“Many of my colleagues still consider themselves to working in the shadow of their doctor colleagues, when in fact we are on a par with them, and as a profession we can and should demonstrate that. We still have a lot of work to do to achieve that recognition.”
“We have the ability to change the lives of many people who are looking for comfort and support at the toughest time of their life. As nurses, there is much to enjoy in our work, in every patient we care for, especially when we have contributed to a dignified death.”
As a teacher, Maricela not only provides excellent content in her presentations, but she also creates teaching aids to help people see how to integrate the theory in practice. In a country where lecture is the most common form of delivery, her creativity and willingness to be different is outstanding.