Comment on: ‘Did I do the right thing?’
This is apparently the same issue as something I came across somewhere last year (probably in the Law Commission MCA/DoLS consultation). Some MH workers are, it seems, trying to get patients to indicate in advance consent to things which they might subsequently refuse when they have become psychotic, or whatever. I seem to recall some sort of 'biblical' name for these 'agreements' ('Jericoh' sprang to mind, but I'm no sure it was Jericoh).
The legality of this type of agreement, seems questionable: but the problem, of a patient when 'mentally clear' wanting you to do something, but then saying 'no' after entering some sort of 'mental episode' [and I know I'm probably getting the terms wrong here], is easy to see (but much harder, to solve !).
I feel sure that nursing could make a person political.
I was interested in your 'Twitter opened my eyes' comment, because I posted a piece about e-learning on Dignity in Care yesterday, and the aspect I supported the most, was 'online discussion forums':
What I wrote was:
6) I REALLY LIKE the comments to online pieces, especially when they become a discussion. The BMJ, Nursing Times and here on Dignity in Care, frequently feature discussions about the original piece - those discussions, I find, frequently enlighten me far more than the original article did. The discussions are particularly useful in showing up both different perspectives, and whether or not different people are sharing a reasonably common understanding.
So, I come to my 7) - online courses, need to have discussion forums built in, where the people doing the learning, can discuss things with each other as they go along: I think the presence of a forum to allow discussion, greatly improves the learning process.
I listened to a Radio 4 piece about Buurtzorg and it struck me as a really good approach.
Taking some of these comments, in no particular order, there isn't [so far as I can see] any robust data about how many people would prefer to die in their own homes. But the closest available, seems to be a rather imperfect conclusion which I could sum up as 'if you ask people before they reach the final days/weeks of their lives, 'where would you prefer to die ?', then about 2/3 seem to say 'at home'. The figures we do have, are for how many people do die at home, and that is roughly 1/3. It isn't clear how much of the difference is because people change their mind while they are dying, and how much is because when clinical situations becomes 'emergencies/confused' patients end up being taken to hospital when they don't want that to happen, and then end up dying in hospital [a really unsatisfactory outcome, if for months as a relative you have been supporting your dying loved-one's determination to die at home, then they collapsed, 999 become involved and paramedics scoop your loved-one up and take him/her to hospital].
In the absence of clear data, one reasonable 'approach' is to look at the percentage of patients who die at home, and see if it is increasing or not: it is possible, but not certain, that an increase might indicate that 'the NHS' is facilitating the wishes of at least some of those patients who 'seemed to want to die at home, but somehow do not' (the difference between my '2/3 seem to want to, but only 1/3 do').
The NHS is not a joined-up system - it is debatable how much 'NHS policy' applies during end-of-life: a huge amount of what happens depends on where you live, what your own GP does, how local 999 paramedics have been trained and which individual paramedic you might have to deal with, what sort of local provision there is in terms of hospices, care/nursing homes, etc - and of course at a wider level, some of that depends on how much is being spent especially by the goverment.
I think this goverment seems to be 'wishfully thinking' that if only people would 'live healthier lifestyles' then they wouldn't get ill, and the NHS would need less money spending on it: I'm not at all sure that works for end-of-life (it isn't obvious to me, that a longer and healthier life, might not have at its end a long(er) period of slowly declining health with significant health needs for many years - while an unhealthy life which suddenly ends in a massive heart attack, would have no 'end-of-life' costs).
There is often no 'policy' anyway - a lot of stuff is actually 'stated objectives' without a really clear plan as to how these are achieved, and it is all 'incredibly messy'.
The RCN standing up for itself/nurses/nursing - not always what I see in the media, but a trend which could do with encouragement, I think.
I can knock this 'people are now expected to die at home' one on the head.
I happened to be about to send an e-mail to three people, one of whom was Bee Wee, who is NHS England's lead for end-of-life. I modified my e-mail by adding a forenote, and sent this today at 13:24:
QUICK QUESTION for Bee:
A nurse has just commented on the Nursing Times website ‘Now the latest policy to be launched is that people are to die at home’.
I assume, that is NOT ‘the latest policy’ ?
I responded with a comment starting:
‘I can't disagree with most of your post, but so far as I know the policy is NOT 'that people should die in their own homes' - the policy is that 'people should be enabled to die in their own homes, IF THEY WANT TO'.
If I discover that it has changed to 'people should die at home' I'll be sending a very terse e-mail to Bee Wee (and various others connected to EoL). ‘
Bee got back to me at 14:09
Mike – no need to send me a terse email! I can absolutely assure you that there is not a ‘latest policy’ about ‘people are to die at home’. You are quite right – we want to support people to be able to die in their own homes if that is what they want to, recognising that not everybody wishes to, or is able to, for a variety of reasons.
So ANONYMOUS 29 APRIL, 2016 2:17 PM has got the 'policy' spot-on - it is try and do what the patient wants.