The pivotal role of nurses in the provision of children’s palliative care

Categories: Care and Featured.

In honour of International Nurses Day on Sunday 12 May, Busi Nkosi RN, and advocacy lead for the International Children’s Palliative Care Network (ICPCN), has written this paper on the the pivotal role of nurses in children’s palliative care.

Nurses are the lynchpin of health teams

Nurses and midwives are a vital resource in health care provision across the world. Nurses are the lynchpin of health teams, playing a crucial role in health promotion, disease prevention, treatment and care. They represent 50% of the workforce, of the 43.5 million health workers in the world, it is estimated that 20.7 million are nurses and midwives. [i]

However, this is far from adequate especially in middle and low income countries. These numbers are continuing to decrease and it is estimated that by 2030 the shortage of nurses and midwives will fall from 9 million to 7.6 million, and the greatest fall will be experienced by the African and Eastern Mediterranean regions. The WHO states that over 60% of WHO member states report having 40 less nursing and midwifery personnel per 10 000 population.[ii]

The role of nurses in palliative care

As has already been stated, nurses form the backbone of health care delivery. The provision of palliative care also relies heavily on nurses and midwives – usually more so than on other members of the multidisciplinary team. Nurses are versatile. They regularly perform the duties of numerous specialists such as physiotherapists, dieticians and counsellors when these are not available. Therefore to reach out to all the millions of people experiencing serious health related suffering, it is imperative that nurses are trained in palliative care. In countries like Uganda and Kenya, nurses have been trained to prescribe opioids thus making pain relief widely available in areas where doctors are scarce.

The role of nurses in children’s palliative care

There are estimated to be more than 21 million children in need of palliative care, with more that 8 million of these needing specialised palliative care.[iii] Despite this great need for CPC, very few of those who need it can access it.[iv] Countries around the world are in different stages of developing CPC services with low and middle-income countries (LMICs lagging far behind. Sadly it is in these countries that palliative care for children is needed the most. The Lancet Commissions state that more than 5.3 million children under 15 years of age, experience serious health-related suffering(SHS) each year and that every year at least 2.5 million children die with SHS and 98% of them are from LMICS[v]

What is children’s palliative care?

The World Health Organization describes children’s palliative care as care that enhances the quality of a child’s life through the effective control of pain and relief from distressing symptoms while giving active and holistic care to the child and members of the child’s family.  It can begin at the time of diagnosis, continue throughout the duration of the illness and is applicable even during treatment aimed at cure. Palliative care is provided to the family at the time of death and into the bereavement period for as long as it is needed.  Effective palliative care makes use of available community resources and is provided by a multi-disciplinary team of trained practitioners. It can be provided anywhere, including the child’s own home.[vi]

Who are the children who need palliative care?

Amongst others, children’s palliative care is applicable for children with:

  • Cancer
  • HIV/AIDS
  • Cardiovascular diseases
  • Cirrhosis of the liver
  • Congenital anomalies
  • Endocrine, blood, and immune disorders
  • Kidney diseases
  • Meningitis
  • Protein energy malnutrition
  • Neurological conditions
  • Neonatal conditions
  • Drug resistant TB

Palliative care is an essential component of universal health coverage (UHC) and should be available at all levels of health care settings. It should therefore be integrated into the main health systems of countries. It is important that nurses and midwives are trained in CPC. This can be done by including it in nurse training curricula. It should also be available as post graduate courses, short courses and in-service training.

The WHO estimates that the world will need 9 million nurses and midwives by 2030 to reach Sustainable Development Goal 3 of health and wellbeing for all ages. This presents an opportunity to ensure all these nurses receive training on palliative care and children’s palliative care as part of their general nurse training.

On this very important day for nurses, we at ICPCN wish nurses around the world well in pursuing their chosen career and delivering the best service possible for their patients.

References

[i] https://www.who.int/hrh/nursing_miwifery/en/

[ii] https://www.who.int/gho/health_workforce/nursing_midwifery_density/en/

[iii] Journal of Pain and Symptom Management. Vol.53 No. 2 February 2017. Estimating the Global Need for Palliative Care for Children: A Cross-sectional analysis.

[iv] J Downing, D Birtar, L Chambers, R Drake, B Gelb, R Kiman. Children’s palliative care: a global concern. 2012

[v] The Lancet Commissions. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage:  Published online October 12 2017.http://dx.doi.org/10.1016/SO140-6736(17)32513-8

[vi] World Health Organisation. 2002.