Prompted by the prospect of the Year of the Nurse and Midwife in 2020, St Christopher’s Hospice nurses Heather Richardson and Marie Cooper, set out almost two years ago to devise the first new model for palliative and end of life care nursing in three decades.
The Lantern Model, made possible with the support of the Florence Nightingale Foundation and the Burdett Trust for Nursing, articulates the unique, vital and skilled role of nurses caring for people who are dying or bereaved and, by highlighting their contribution, makes the case for increased investment in their recruitment, development and retention.
The model is underpinned by a variety of evidence – patient and family views, subjective experience of nurses and a review of the academic literature. It has been generated through extended discussion and engagement with senior nurses with a broad range of nursing experience at the end of life.
The proposed model borrows its design from work on a person centred practice framework created by two nurses, McCormack and McCance. Their model comprises a number of domains, that are interrelated and contribute to person centred outcomes.
The Lantern Model comprises seven similar components, also interrelated. These are described below:
High-quality nursing seeks to make a difference to people’s health and lives. At the heart of our model are the outcomes nurses working to this model can expect to achieve on behalf of those for whom they provide care.
‘From the acute onset of illness or the moment of diagnosis, individuals look to nurses for reassurance and understanding, as a human connection in the overwhelming reality of healthcare.’
Ferrell BR and Coyle N (2008). The nature of suffering and the goals of nursing. Oncology Nursing Forum. 35(2): 241-247
The Lantern Model is set within a contemporary context of end of life. This will, of course, vary according to whereabouts in the world the application of this model is being considered and we encourage those interested to use the Lantern Model to refine this section and the detail of the desired outcomes to reflect local preferences and priorities.
‘In increasingly secular and atomised societies, people are unfamiliar with the processes, realities and rituals associated with dying and grieving, there has been a progressive loss of language and opportunity to discuss death. The loss of norms, rituals and the social role of the dying person has cut death loose from historic cultural practices. This means even when health care services operate at the margins, families and communities may feel unable to manage a dying process, feeling it should be managed by professionals, and relegating control to them’
Lancet Commission on the Value of Death. Unpublished to date. 2020
The outcomes of care described previously are only possible when nurses engage in particular processes of nursing described below. The nuance of the enactment of each of these processes will vary depending on the context of care and the degree of experience and expertise of the nurse.
‘Authentic engagement refers to a relationship between human beings that is deeper than what can be captured by traditional notions of professionalism. When a nurse is authentically engaged with a patient and/or the patient’s family, this means that the nurse enacts a relational practice that is characterised by curiosity and humility, concern and commitment, investment and action’
Singer P et al (1999) Quality End-of-Life Care: Patients’ Perspectives. Journal of the American Medical Association 13. 281(2): 163-168
Whilst the Lantern Model is, without apology, a model of nursing, we believe it remiss if we were not to consider the essential contribution of other members of the multi-disciplinary team to the care required by the person who is dying and their family.
‘Integrating the spectrum of expertise of different individuals into the palliative care plan increases the likelihood that patients are managed in a holistic manner. Working in a team can positively influence individual members through reinforcing interpersonal relationships, providing opportunities for professional appraisal and sharing of experiences, responsibilities and worries’
Fernando GVMC and Hughes S (2019). Team approaches in palliative care: a review of the literature. International Journal of Palliative Nursing. 25(9)
In our introduction to the Lantern Model we describe a close relationship between the character of the nurse, how they enact processes of nursing care and the outcomes they achieve on the part of the dying person and those close to them. By ‘character’ we mean the way that the nurse thinks, feels and behaves in relation to their job and their relationships.
‘Suffering is only intolerable when nobody cares’
Saunders C (1960). The management of patients in the terminal stage. Editor: Raven R. First published in Cancer. 6: 403-17
Even with strong personal characteristics, the impact of the nurse will by limited without sustained organisational commitment to end of life care and the particular contribution of the nurse within it.
‘The majority of factors causing stress in the hospice workforce could be alleviated by good management practice. The quality of the work environment has a significant impact on stress levels and most situations could be improved by effective leadership, a participatory culture and good line management of staff and volunteers’
Pryce-Jones J (2010). Happiness at work. Maximising your psychological capital for success. Wiley-Blackwell. West Sussex
Two important principles sit at the base of the Lantern Model that anchor and shape the model in its entirety.
‘You matter because you are you, and you matter to the last moment of your life. We will do all that we can not only to help you die peacefully, but also to live until you die’
Saunders C, cited by Twycross R (2006). A tribute to Dame Cicely Saunders. Memorial Service. Westminister Abbey. London UK
Joint Chief Executive, St Christopher’s; Honorary Professor in the International Observatory on End of Life Care, Lancaster University
Heather Richardson works as one of the Joint Chief Executives of St Christopher’s Hospice, London. She has previously held the role of National Clinical Lead for Hospice UK, and worked as Clinical Director, then Strategy Advisor to St. Joseph’s Hospice in east London prior to her move to St Christopher’s.
Heather is a registered general and mental health nurse and has worked in hospice/palliative care since 1988. She has a PhD, her research concerned with users’ experience of day hospice. More recently, she has developed a research interest around public health and end of life care. She currently serves as an honorary professor in palliative care at Lancaster University.
In the past, she has received the International Palliative Nurse of the Year award issued by the International Journal of Palliative Nursing and other awards related to her role in innovation in healthcare.
Project Lead for Celebrating Palliative Care Nursing
Marie is a nurse with 40 years’ experience of clinical leadership with an expertise in practice development across a range of care settings. Having delivered change in her previous roles, she now supports others to do so. Her particular area of interest is in working with nurse leaders to develop high performance teams and practice. Such opportunities have given her a clarity about the many issues nurse leaders and those engaged in palliative care delivery face today.
From 2014 to June 2019, Marie was Practice Development Lead for Hospice UK, which enabled her to work with hospice clinical leaders and national organisations to champion the delivery of high quality, accessible palliative care.
Since June 2019, Marie works freelance and in addition to her other work she is the Project Lead at St Christopher’s Hospice for the Celebrating Palliative Care Nursing programme. This is an exciting programme which includes developing a contemporary Model of Nursing and bringing together pioneering nurses who are shaping palliative care across the world into a vibrant community.
Nursing in palliative and end of life care has a rich history and remains a central element of its delivery.
We want to shine a light on its contribution past and present, and consider its future shape so that it remains pertinent, visible and impactful.
Pioneering nurses from around the world
Nominations are now closed, but you can still find out how we are identifying and showcasing our pioneering nurses.
20 January, 04 February, 24 March and 31 March 2021 – FREE
Focusing on the Lantern Model, the first new model of palliative and end of life care nursing for 20 years.