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'Nurses have the power to change lives – and deaths'


The greatest privilege a nurse can have is to look after patients in their final days.

That is what so many nurses tell me - and tell me with a light in their eyes, proud at knowing how they have cared for and supported a person to die in the way they wanted.

The Liverpool Care Pathway has now been replaced by Priorities for Care (see news, page 2). The LCP was heavily criticised by some for being a tick-box exercise that didn’t pay enough attention to patients’ wishes and those of their loved ones and, when used incorrectly, led to inappropriate withdrawal of nutrition and fluids.

I was at Salford Royal Foundation Trust last week and met Fiona Murphy in the trust’s bereavement service. Inspired by a patient’s poor experience of witnessing another’s death in the hospital, she has made care of the dying and their loved ones a priority for every-one at the trust. Fiona has made it OK to break the rules - washing out patients’ mouths with their favourite tipple, doing a risk assessment so they can enjoy their final cigarette or bringing in their pets for a last cuddle. The emergency assessment unit even arranged a wedding within its busy department.

Fiona has created cotton bags that contain all the overnight comforts and toiletries needed by a loved one who wants to stay with a patient. Each one contains a tag made by local children with learning disabilities that reads simply: “This is a little gift for your comfort and to show that people care”.

The belongings of patients who have died are returned to relatives in a cotton bag decorated with a swan, the Romans’ symbol for a happy death. More special than a plastic bag, some relatives use them to store condolence cards, rendering them “a memory bag”. And hospital staff are trained to identify the swan logo so, as the relative leaves the hospital, they know they may need extra support. All this stemmed from one nurse’s desire to prevent one patient’s experience being replicated. It shows the power of nursing. It shows nursing at its best.

What Fiona has done is outstanding but it should be the norm, not the gold standard. Rules and guidance are all very well but, ultimately, it is the small things that matter. Nurses have the skills and power to deliver those and change patients’ lives - and deaths. That power should be used so all patients have the best possible death - and the death they choose.

Jenni Middleton, editor Follow me on Twitter @nursingtimesed


Readers' comments (23)

  • michael stone

    It isn't just the 'small things' that matter - getting the 'big things' right matters even more.

    But treating patients and their familys as 'individuals', and adapting behaviour to fit the patients, as opposed to trying to shoehorn the dying into some sort of 'one-size-fits-all system', is the only way that you can get EoL right.

    Nurses are indeed critical to getting this right.

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  • thank you michael stone. professional nurses already know this. it is not the fault of nursing if others come and take over, and even those without any nursing experience, and guidelines are foisted upon them without any choice but removal of their own choice on the autonomous care they wish to deliver to fit the individual needs of their patients. nurses managed this before all of the nonsense so why should they not manage it again. just leave them alone to manage their own profession and delivery of care in collaboration with all of their other interdisciplinary professional colleagues and you will find every patient is well looked after.

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  • Nurses need to be reminded of the effect on relatives when poor/appalling end of life care is delivered . I am a nurse of 34 years service and I witnessed and fought against the care given to my mother, who herself was a nurse of 50 years service.I am still suffering flashbacks and nightmares over some of the care given, the care required was what people would class as "basic care", to my mind no nursing care is basic it is what is expected by patients and rightly so.

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  • Anonymous | 2-Jul-2014 4:43 pm

    effects on the relatives? what about the patient?

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  • I nursed my mother on the ward once I became aware of the poor care. Depending on the staff mix I also stayed at night. I made sure where I could that my mother was unaware of the poor standard of care.I was very lucky to have been with her till the very end. The point I was trying to make was the lasting effect on the relatives,I was not trying to take it away from the patients.

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  • michael stone

    Anonymous | 2-Jul-2014 2:25 pm

    just leave them alone to manage their own profession and delivery of care in collaboration with all of their other interdisciplinary professional colleagues [AND FAMILY AND FRIENDS] and you will find every patient is well looked after.

    Anonymous | 2-Jul-2014 4:43 pm

    Yes, quite.

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  • I note with interest so many comments made this a reflection of some fear of retribution? just curious, I left UK 23 years ago because of a changing NHS...has it really got this bad that you can't speak up?

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  • I work at a hospital which my mum was in last year before she died with dementia. This made me want to cry because I know nurses truly want to care they just need the right support to be able to do it. What Fiona Murphy has done is fantastic as it just recognises the little things that make a difference to patients and families. Thank you

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  • So, I want to offer something of value....I hope....nurses will continue to be undervalued as long as they continue to undervalue themselves....from a human behaviour perspective using the Extended DISC model, nurses are generally ( generaly with exceptions ) S ( stability ) types...i.e. mother archetypes who don't want to "rock the boat" , this is a huge over simplification of the model and I invite nurses to research will then understand where I'm coming from. Nurses MUST engage, collectively, their D energy to get the outcomes they want for themselves and their truly is a MUST....and this applies not only individually but also organisationaly....D = Dominant masculine energy...fight for what you believe in!!
    I hope this has rattled some of you who are in your- perceived - cages.

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  • michael stone

    Tony Judson | 3-Jul-2014 1:16 pm

    Made me smile - you might attract a response from Tinkerbell.

    We've discussed 'could nursing do with more Y chromosmes' previously on NT.

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