Where have all the (palliative care) nurses gone, long, long ago?

Categories: Care, Education, Featured, Leadership, and Must Read.

A variation on the well-known song “where have all the flowers gone” may seem a strange place to start an article about models of nursing and one for end of life in particular. However, its sentiments aptly describe the mood and content of a conversation which took place between a number of senior nurses some 18 months ago at St Christopher’s Hospice in London, when the idea for the Lantern Model was first conceived.

Reflecting on the opportunities afforded by the Year of the Nurse and Midwife in 2020, participating nurses were forced to acknowledge the growing silence of the nurse’s voice or views in relation to palliative and end of life care. There exists a lack of clarity about the unique contribution of nursing in the support of people who are dying or bereaved, and a consequential lack of attention to the development needs and opportunities of nurses engaged in this aspect of care by their employing organisations, the wider systems of health and care, and national leaders.

The tragedy of these insights lies in the fact that these nurses are, in reality, doing something that should position them much more centre stage. Their views about how to get care right are invaluable, and their calls for change in their working environments that help them achieve their potential need to be heard. Most importantly they are practising a model of care which has applicability across the health system and beyond end of life, but there is currently little conversation about this as a basis for replication or adaptation.

These nurses are performing a vital, skilled role that can transform a tragic experience of death and loss into something that people can tolerate and survive, with lasting positive legacy for those left behind. They help people who are dying, and those around them to continue to live well, to feel safe, comfortable and dignified and to play an active role in their own care. And they do this professionally and confidently. This is no mean feat and even more extraordinary in the light of COVID-19 with its devastating impact on the lives and health of so many people, in the UK and around the world. Nurses have been at the forefront of the response and have much to teach their colleagues, the wider system and society, but for this they need a shared vocabulary, renewed confidence to share their expertise and a stage from which to do this.  

In response, and with the support of the Florence Nightingale Foundation and the Burdett Trust for Nursing, a number of us in the UK decided to work together to describe the contemporary role of nurses delivering end of life care, their characteristics, skills, relationships and impact.

  • We observed nurses at work in a variety of settings.
  • We listened to feedback from patients, families and carers about what they valued most about the care they received.
  • We reviewed the academic literature, looked at existing models of care and nursing frameworks.
  • We then started to articulate our thoughts about a model of nursing that reflected contemporary practice and its context.
  • And we tested our emerging ideas with senior nurses around the world as well as with nurses working in a wide variety of settings and with different patient groups.
  • Finally, we gathered together our thinking, research and findings in to a new model for nursing – The Lantern Model.

We believe that The Lantern Model will provide nurses with a new language to describe their work. We hope it will give them fresh confidence to articulate their contribution within the broader multi-disciplinary team. We also hope it will help all nurses delivering end of life care recognise all that they do – with pride.

The Lantern Model has relevance for nurses in any setting in which they support someone coming to the end of their life. It is appropriate for nurses wherever they practice, and it attends to the care needs for anyone who is dying, regardless of the location of their care, their age or diagnosis.

We chose to name the model after, and use the image of a Lantern Flower, because it is a plant that survives the tough conditions of the desert and brings pleasing visual relief to an otherwise arid landscape. The resonance between the plant – which is resilient, constantly evolving and beautiful, and the nursing contribution to end of life is notable.

The model itself comprises a number of different components that reflect the multi-faceted nature of nursing.

  • It describes nursing processes and care provided by the wider multi- disciplinary team, linking these to the outcomes that these actions can deliver.
  • It confirms the personal characteristics of the nurse suited to this work and the organisational support that they require to give of their best.
  • It clarifies the vital tenets that underpin this offer and the contemporary context of nursing – which shape how people experience care and the role they want to adopt in their dying or bereavement.
  • The composite picture of nursing at the end of life generated by the model describes the unique offer of nurses to people who are dying or who face loss. The emerging image is rich, vibrant and memorable, consistent with its enactment.

How these different elements relate to each other draws on previous work undertaken by nursing academics Brendon McCormack and Tanya McCance on a person-centred nursing framework.

What next? We are keen that it is tested and adopted by nurses wishing to develop their practice and profession, and by those interested in supporting them in this endeavour.

The Lantern Model will be launched via a series of FREE webinars starting 20 January 2021. The aim is to generate new conversations about related competencies, research, leadership, metrics and other new opportunities.  See St Christopher’s | Lantern Model webinar series – St Christopher’s. or email Marie Cooper at m.cooper@stchristophers.org.uk.

Heather Richardson & Maria Cooper

*** It will be possible to download The Lantern Model from its landing page  www.stchristophers.org.uk/lantern from 2nd Feb. 

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