A key part of being a health professional is to critically reflect on practice, whether as a paramedic, nurse, or indeed any other health profession. This skill is nurtured from the beginning of our training and helps us to critically think about and learn from our experience, in order to improve and enhance our practice, for the benefit of patient care. I have been reflecting back to when I started my undergraduate degree in 1999 and I realise there was little, if any, emphasis on end-of-life care, with no clearly defined learning objectives or opportunities in the curriculum. The mantra at the time, underpinning both ambulance and paramedic practice, was the three Ps: preserve life, prevent deterioration and promote recovery. All aspects of training and education were focused on the active treatment and recovery of patients with little consideration for end-of-life care.
Since the release of the Department of Health and Social Care's End of Life Care Strategy in 2008 and extensive subsequent research, much has changed and there has been a significant advancement towards the delivery of patient-centred end-of-life care, not just in the UK, but across the world. Despite this, as a society, we find it difficult to talk about death and dying, and this can also be said of health professionals. If we don't talk about it, how do we know what our patients' wishes are?
Education and training have come a long way since the turn of the century, but still have a lot further to go with regards to end-of-life care, and we need to talk about it much more openly. Much of the literature states that further education is required to support clinicians to feel more confident and prepared in their roles, to support patients to achieve a ‘good death’. With the advent of living wills and advanced care plans, an expectation on all health professionals to provide end-of-life care has emerged. Within the past 5 years, a colleague of mine overheard a paramedic say that they were trained to save lives, not deal with end of life as it was not in their job role. Indeed, this can be borne from the historical role of the paramedic which has led to confusion about scope of practice and the unnatural feeling of not doing anything, or through fear of repercussion. Again, the term ‘not doing anything’ has different connotations. Many still see the paramedic role as very hands-on and practical, with a heavy reliance on skills and intervention. Some paramedics may worry of skill decay if not ‘doing something’ on a regular basis. But I would say that our strongest attributes and skills are those that we use every single day, that we sometimes don't even realise because they are so innate to us; care, compassion, respect, communication—to name a few. For some patients, ‘not doing anything’, from a skills perspective, but instead using our other core attributes, is actually doing so much more for patient care than we realise.
Respecting a patient's wishes, values and beliefs, preserving dignity, providing supportive care and being the advocate at their time of need, is indeed all part of the role. The term ‘patient advocate’ is not commonly used in paramedic practice as it is in other professions such as nursing; however, it is certainly an integral part of the role.
We are in a privileged position to provide compassionate, individualised and supportive care for patients in the out-of-hospital setting. End-of-life care in paramedic practice has come a long way, but still has further to go. We are all part of this crucial journey and we need to talk about it much more. In recognition of Dying Matters Awareness Week (13–19 May), the current issue of JPP is dedicated to this conversation.