Call for 'urgent guidance' on end of life care for nurses
The Nursing and Midwifery Council has come under the spotlight for not providing guidance for nurses who deliver care to terminally ill patients.
An independent review into the Liverpool Care Pathway, published yesterday, concluded there was a “lack of guidance”, particularly for nurses.
The review, chaired by crossbench peer Baroness Julia Neuberger, calls for the Nursing and Midwifery Council (NMC) to “urgently” provide guidance for nurses caring for people in the final weeks and days of their lives.
“There is no specific NMC guidance for nurses caring for patients at the end of life or who are dying, although such guidance from the GMC (General Medical Council) exists for doctors,” the review’s report stated.
“This may explain, at least in part, why the review panel heard so many examples of poor quality nursing for the dying. The NMC must provide such guidance as a matter of urgency,” it said.
Baroness Neuberger added: “The GMC has taken the lead on this and nurses are by far the largest part of the health care work force.
“We think it’s a crying shame that there has not been more nurse leadership around these issues,” she said.
The review heard evidence of nurses shouting at relatives of patients placed on the pathway for attempting to give them drink.
The review panel said that nurses should demonstrate “proficiency in caring for the dying” as part of the revalidation process - set to be rolled out by the NMC by the end of 2015.
Care and support minister Norman Lamb said he would write to the NMC to “highlight both the need for effective guidance on supporting nutrition, hydration and sedation for the dying, and also to stress the importance of professional regulation issues raised by the report”.
The panel said it had uncovered issues “strongly echoing” those raised at the public inquiry into appalling care of patients at Mid Staffordshire Foundation Trust.
The report stated: “Among the similar themes arising were a lack of openness and candour among clinical staff, a lack of compassion, a need for improved skills and competencies in caring for the dying and a need to put the patient, their relatives and carers, first, treating them with dignity and respect.”
The review also raised concerns that the accompanying documentation used when a patient was put on the pathway was not always filled in properly.
It said: “There may have been reasonable explanations for this, but it provided resonances with the Mid Staffordshire Public Inquiry’s findings, and the review panel recommends that the professional regulators must take stern action with individual doctors and nurses where there is evidence of the deliberate falsification of any document or clinical record, in order to deflect future criticism of a failure of care.”
An NMC spokeswoman said: “This is an important report in a sensitive area. We will consider the report and its recommendations carefully with our partners and respond in due course.”
She added: “We take very seriously any suggestion that nurses have falsified records relating to discussions about end of life care, and other allegations of unacceptable practice. We will follow this up with the review team.”
Dr Peter Carter, general secretary of the Royal College of Nursing, said: “We are pleased that this independent inquiry has looked so thoroughly into the principles and experiences of the Liverpool Care Pathway.
“The RCN is working with other organisations and professions to produce guidance to help nurses deal with this difficult area, and this report contains a great deal of practical advice and insight to help inform this.
“We would also welcome the opportunity to be involved with the development of these proposed changes, using the experiences and expertise of our members to benefit patients and relatives.”
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