By continuing to use the site you agree to our Privacy & Cookies policy

EDITOR’S COMMENT

'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The Liverpool Care Pathway has now been replaced by Priorities for Care (see news, page 2).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

jenni.middleton@emap.com. 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.

    Unsuitable or offensive?

  • 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.

    Unsuitable or offensive?

  • 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.

    Unsuitable or offensive?

  • Anonymous | 2-Jul-2014 4:43 pm

    effects on the relatives? what about the patient?

    Unsuitable or offensive?

  • 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.

    Unsuitable or offensive?

  • 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.

    Unsuitable or offensive?

  • I note with interest so many comments made anonimously....is 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?

    Unsuitable or offensive?

  • 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

    Unsuitable or offensive?

  • 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 this...you 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 patients...it 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.

    Unsuitable or offensive?

  • 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.

    Unsuitable or offensive?

  • I have recently joined the Hospice movement as a Clinical Services Manager after a very inspiring and varied career, and note that what Fiona has put in place is very typical of the care provided by my nursing team here. Nothing is too much of an effort in caring for their patients and families.My HCA's recently set up a dinner party for a dying patient so that she and her family could have a really happy 'typical' family meal without even leaving the hospice. They have recently purchased a whole host of products from bunting and ribbons, to photo albums so that they can provide some happy and lasting memories for the family after their loved one has passed away. Nothing is too much trouble for any member of this amazing specialist team, including the catering, housekeeping and volunteer staff team. It's certainly opened up my eyes to hospice care and what incredible and privileged places they are to work in. If anyone is having a 'down day' on nursing then come and visit us or your local hospice to re-affirm what a great profession it can be!

    Unsuitable or offensive?

  • michael stone

    Gina Namini | 4-Jul-2014 10:17 am

    All 'excellent' - however, the main problems are not when people are dying in hospices: the main problems occur when people are dying in hospitals, care/nursing homes, or in their own homes, where the staff are less expert 'with dying' than hospice staff are.

    Unsuitable or offensive?

  • Comment removed

    Unsuitable or offensive?

  • Removed due to personally offensive nature.

    Please refer to this site's terms and conditions before posting further:
    http://www.nursingtimes.net/terms-and-conditions/

  • michael stone

    Anonymous | 4-Jul-2014 10:05 pm

    Just wondering - are you the person who is prone to writing the equivalent of 'My comment was to Gina' ?

    By the way, I can't find anywhere to sensibly fit this piece of information in, but ...

    The BMJ website, usually has the majority of its articles (almost all of which come as PDF downloads as well) 'permission needed' - in other words, by subscription. The BMJ website has just undergone a revamp, and [on the word of its Letters Editor] it seems the entire website will be open access for about the next month.

    So if anyone who isn't a BMJ subscriber, wants to look at or download stuff from the BMJ 'site, you have got an opportunity.

    Unsuitable or offensive?

  • michael stone | 5-Jul-2014 2:41 pm

    thank you michael we are also informed about our professional journals and have free access through our libraries!

    Unsuitable or offensive?

  • michael stone

    Anonymous | 6-Jul-2014 7:43 am

    Not everyone who reads this website, has got access to clinical libraries, nor would all readers have been informed through professional journals.

    Unsuitable or offensive?

  • michael stone | 6-Jul-2014 12:47 pm

    this is a clinical journal written for professional nurses and students of nursing. if others choose to read it for general interest that is their choice. run along now and play.

    Unsuitable or offensive?

  • My goodness, Anonymous - 12.23pm - you must be very confident in your practice. Sadly, as the Francis Report tells us, not everyone appears to be as competent as you are. I, for one, appreciate Michael Stone's information about the BMJ and his thoughts. In my many years of nursing I have come across all sorts and not all of them good, some I would not want caring for my nearest and dearest or for me! I am very grateful for this example of good practice and 'going the extra mile', let's have more of it please instead of bad news all the time.

    Unsuitable or offensive?

  • Commetn removed

    Unsuitable or offensive?

  • Removed due to personally offensive nature.

    Please refer to this site's terms and conditions before posting further:
    http://www.nursingtimes.net/terms-and-conditions/

  • michael stone

    As it happens - to no particular point - I've got an idea that it isn't 'the British Medical Journal' any longer: I seem to remember (I'm not 100% sure) that it is now 'only the initials'. So BMJ stands for BMJ, and is no longer [according to the BMJ itself] an acronym.

    I think it might have just changed again, to 'theBMJ' - again, not 100% certain. There is an editorial piece about it, but I was more concerned with actually getting some stuff published on the 'site at the time.

    Anonymous | 7-Jul-2014 9:32 pm

    If you are also Anonymous | 7-Jul-2014 12:23 pm (and I'm not sure - I wish people would post with some sort of tag !) then in the first of your two posts you described NT as a professional journal, but in the second you seemed to be describing it as an upmarket equivalent to 'Bunty' (was Bunty the title of a girl's mag ? - never read them, being a boy at the time). I congratulate you on the consistent quality of your posts, on these pages - pity the quality isn't on an upward curve, however.

    Unsuitable or offensive?

View results 10 per page | 20 per page | 50 per page

Have your say

You must sign in to make a comment.

newsletterpromo