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Palliative Care

Clinical reasoning and decision making within the role of a palliative care advanced clinical practitioner

20 February 2025
Focus
02 February 2025
Volume 34 · Issue 4

Abstract

Advanced clinical practice invites curiosity, rationalising the reasoning behind clinical symptoms. Developing one's own style of critical thinking is a journey that is influenced by a variety of factors including stress, risk, time and knowledge. There has been significant scrutiny in practice around making a clinical judgement when a person is entering the terminal phases of life, yet little clarity exists for clinicians regarding what information is required to make this decision. Within the role of advanced clinical practitioner (ACP) in palliative care there is an expectation to offer guidance and support to persons and families as well as junior nursing and medical staff of the changing phases of a person's illness. There is ‘one chance to get it right’, yet predicting death and dying remains predictably unpredictable.

There has been significant scrutiny over the years regarding making a clinical judgement as to when someone is entering the terminal phases of life, yet little clarity exists for clinicians regarding what is required to make this decision (White et al, 2018). Within the role of the advanced clinical practitioner (ACP) in palliative care there is an expectation to offer guidance and support to individuals and families, as well as junior medical and nursing staff, regarding the changing phases of illness. This responsibility is grounded in advanced clinical practice within the four pillars of advanced practice (Health Education England (HEE) et al, 2020). The author's own experience in practice indicates that the subjective and emotive journey for palliative care patients with conditions at an advanced stage has key indicators including loss of mobility and reduced consciousness; nurses providing patient-facing care are often aware of key prognostic indicators of a patient's deterioration before medical colleagues. When combined with a medical assessment the practitioner is able to provide a clearer indication of when a patient is entering their terminal phase of life and the adjustments needed to support their care.

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Advanced practice
End-of-life care
Diagnosis
Prognosis
Decision making