A topic I am up-to-speed on: to save repetition, I’ll use web-links and hope they work ! I’ll start with: http://www.dignityincare.org.uk/Discuss_and_debate/Discussion_forum/?obj=viewThread&threadID=692&forumID=45 The first questions I discussed in there, were ‘'what does terminal mean' and 'do terminal patients, need to be told the detail of their prognoses'.’ The point I made, was that death affects [continuing after death] wider-life issues, so: 'End-of-life patients, must be given the opportunity to take heed, even if individual patients choose not to take heed'. There are fundamental issues afflicting the ‘discussion of the dying bit’ – see my post on the BMJ website: http://www.bmj.com/content/347/bmj.f4085/rr/652862 Moving on to the consequences of not telling relatives that their loved ones are dying, under the title ‘Should hospital nurses and doctors be keeping the relatives of patients informed ?’ I posted a piece about that, roughly a week ago, at: http://www.dignityincare.org.uk/Discuss_and_debate/Discussion_forum/?forumID=45&obj=viewThread&threadID=721 The post pointed to by the link directly above, points out that it was prompted by an unsolicited contact from a person who had a very upsetting experience when a parent died in hospital, and recently I’ve been in the somewhat weird situation of acting as an intermediary for a reply from Bee Wee, who is leading on the ‘Liverpool Care Pathway Replacement Work’, to that person. Bee sent an e-mail yesterday, and this is extracted from it – it isn’t controversial, as it is clear that this was the position of the Consultation Document: ‘When a person’s condition deteriorates or change, they must be reassessed and a judgement made about whether that change is potentially reversible or whether they are likely to die in the next few hours or days from their condition. Decisions about what actions to take, e.g. further tests or treatment, focus on comfort care, etc. are made depending on the clinical assessment of the person, and discussions with the person (if they are able and wish to discuss) and their family. As a clinician, I would always want to review those decisions and discussions so that plans are modified as necessary. These are often not black and white situations, and the level of uncertainty about what’s likely to happen is something that clinicians have to learn to communicate and discuss properly with patients and their families. In my experience, most people can understand and accept that there are uncertainties (even if they find it hard), provided this information is shared and discussed with them. In the Alliance’s description of what good care in the last days to hours of life should look like, communication and involvement in decision making are both important priorities.’ That bit, was Bee’s reply to a phone call via ‘Bee’s office’ that this upset person had made (the person spoke to someone, who passed details on to Bee: Bee and the person did not speak directly), but I had sent an e-mail to Bee before the phone call, telling Bee that I had given the person a phone number for Bee, and I commented in that e-mail: ‘So you might get a phone call to that number – she is really disturbed by what happened to her parent (and as usual, to my mind it stems from the clinicians not properly discussing things like DNACPR and LCP with the family – as her mum was long-term demented, you would think when such a patient is admitted those conversations would definitely happen, but apparently not)’ Bee also commented on my comment in the e-mail: ‘I agree with the point you make, Mike, that it is often the lack of discussion (or perhaps the inadequacy of it) that is often at the heart of what goes wrong in decisions and actions taken.’
Comment on: Minister backs 'assisted dying' bid
I tend to be in favour of what I insist on calling Assisted Suicide - even if only during terminal illness, I think you need 'suicide' to be clear about who makes the decision (the patient and nobody else - 'dying' seems to muddy the waters). But it depends on the detail in the Bill/Act. However, there are plenty of other things around terminal illness and end-of-life that need sorting out, as a lot of it is currently an unsatisfactory dog's breakfast of muddle, conlfict and confusion.
imango | 7-Mar-2014 4:20 pm I like your picture. I can't help think that something is being missed here. If all 'nurses' are eductated to degree-level and also have a very broad clinical education, but some HCAs have got very little 'formal/technical/academic/specialised' training, then there is an absolutely HUGE skill gap between the two. It surely makes sense, to try and upskill all of the HCAs who wish to improve their skills, in much the same way that nurses can specialise and develop their skills, etc. And if an HCA starts out knowing very little, but keeps learning, at some point this HCA would, in rough terms, be 'equivalently skilled' to a newly-qualified graduate nurse, surely ? I'm not for one minute suggesting that everyone who could competently work as an HCA could upskill and competently work as a nurse - but surely some could: there are lots of academically able people, who for one reason or another can't go to university. The suggestion that upskilling HCAs to become nurses would involve identical training to nurses who simply work through the 'degree route' is also flawed - the 50:50 thing isn't anything like as relevant if someone is already working in healthcare, on the same wards as nurses work, for example. However, if the 'powers that be' try to use this sensible 'increased opportunity for HCAs to become nurses' to downgrade the role/skills of nurses, then THAT I would be set against !
Anonymous | 8-Mar-2014 4:57 pm There was a report about this in the Times (see my post at 7-Mar-2014 2:36 pm) and, although it wasn't entirely clear, it appears that the report might have recommended: 'Hospitals must come clean about their mistakes but patients should not be able to use any admissions in court, a government-ordered review recommends.' Some of us, don't like that !
Anonymous | 8-Mar-2014 4:55 pm Is your CCG on the list ? Neither my local hospital trust, nor my local CCG seems to have signed up, unless I've missed them.