By Erica Techo
University of Alabama at Birmingham School of Nursing Alumnus Darrell Owens is familiar with conversations around end of life decisions. After 30 years as a nurse and 28 years specializing in palliative care, however, those conversations have changed in the face of COVID-19.
As the Section Head for Palliative Care at the University of Washington Medical Center, Northwest Campus, Owens became an attending provider for comfort care patients in response to COVID-19. For two months, he spent significantly more time screening patients in the emergency room, on-call 24 hours a day, seven days a week.
It was a necessary transition to accelerate palliative care discussions.
“In health care, you have to be flexible and know there’s always going to be a new and changing normal,” said Owens, a 2010 DNP graduate from the UAB School of Nursing. “If we tried to stay in the old palliative care mode where my hospitalist colleague calls, and we contact and meet with the family, we would run out of time. Those conversations happen a lot faster now.”
As the University of Washington planned its response to COVID-19, Owens said he stepped up to advocate the role palliative care needed to have. Data showed that older individuals or those in poor health are not likely to benefit from a ventilator or CPR and discussing all of the options could prevent unnecessary spread of the virus and help families stay connected.
“Patients are incredibly open to discussion, especially the ones I’ve been having unknown, countless times in the last few months,” Owens said. “Being able to have upfront, caring, gentle and clear conversations with folks or the surrogates — about how if they continued to get sick, outcomes were poor and CPR wouldn’t save them, or ventilators would not save them — they were open to say, ‘No. No CPR. No life support.’ That’s not how they would want to die.”
Most older and at-risk COVID-19 patients were transitioned to comfort care when it became clear survival was not an option, where visitors are permitted under the proper safety measures.
“As a result, of these conversations, our frail elders who ultimately died of COVID-19, did so on comfort care, which is an absolutely remarkable thing. We had one person die in the ICU, not on comfort care, and we’ve had no young deaths,” Owens said. “We really feel like the screening that started in the emergency department made a huge difference in these people’s lives and their deaths, and it allowed people to focus on those who statistically more morel likely to survive.”
Elderly patients also fully recovered and were discharged, Owens said, noting that a misconception regarding palliative care is people believe choosing to forego certain treatments means choosing death.
“Just because we had early goals of care conversations didn’t meant they didn’t survive,” he added.
Palliative care made a difference at the hospital where he works, Owens said, and he hopes that COVID-19 has shined a light on the impact and importance of palliative care and advance practice nursing.
“Palliative care has to step up,” Owens said. “They have to say, ‘We have an essential and vital role to play. We have the skills and ability to have conversations in a very clear manner and in a very respectful way.’ You should also let advance practice nurses step up. What this pandemic has shown is they are able, as a profession, to take the lead in care and do that well.”
Owens’ education and experience aided in his ability to respond to the pandemic because it provided a foundation for critical thinking and speaking up at the table, as well as an ability to adapt.
“The ability to come to the game at the top of your educational level and feeling like you’re at the top of your educational level with your UAB degree makes a difference,” Owens said. “Knowing that also gives you a certain level of confidence, and it’s really important to look at how you tailor what you know and what you come to the table with for such a unique situation. I had no idea what it was going to be like. I didn’t know I’d screen people 24/7, but I also knew working weird hours and weird shifts were important. I thought, ‘How could you not do it?’”
That mentality is one held throughout the nursing profession, Owens said, and he is proud to see colleagues rise to the occasion during COVID-19.
In 2015, Owens received the Joanne Barnett Award for Compassionate Care from the Nursing Chapter of the UAB National Alumni Society. He is also the 2019 recipient of the University of Washington Distinguished Staff Award.
This summer, he will be inducted into the Washington State Nurses Hall of Fame.
