Many nurses and healthcare professionals will be working over the Christmas holiday period and Marie Curie nurses are no different. In fact, Christmas is busier than any other time of year for the Marie Curie Nursing Service.
Research has shown that around two thirds of people would choose to be cared for and die at home if they had a terminal illness and this number rises significantly at Christmas. However, more than half of deaths still happen in hospital, the place people say they would least like to be. Nobody wants to spend Christmas in a hospital, especially if they know it is going to be their last.
Marie Curie Cancer Care recently commissioned research that showed 87 per cent of MPs believed that people should have the right to choose where they die. Almost the same proportion of MPs - 86 per cent - said this would only be possible with more community nursing care, particularly out of hours.
Marie Curie nurses give patients who are at, or close to, the end of their life a choice to be at home for Christmas - in familiar surroundings with family and friends close by.
A Marie Curie nurse will spend their entire shift with one patient and their family, looking after their physical, social, spiritual and psychological needs. They will provide care at any time of day or night and fit in with the plans that the family have in place, both as carers of the patient and for family festive celebrations.
‘Enabling people to have a happy Christmas can include helping the patient to conserve energy, looking after their symptom management, or making their favourite eggnog’
Never are their skills more taxed than at Christmas. It can be a difficult time of year as patients and families struggle to come to terms with terminal illness and death, when there are so many other pressures as well as expectations of a “merry Christmas”.
Nursing Times published survey results recently indicating that more than one in four nurses did not feel competent to broach the subject of death with patients. The results highlighted a major skills gap and lack of support for nurses.
Many of the survey respondents were hospital staff nurses, which may go some way to explain why so many patients who don’t want to die in hospital end up doing so. If nurses do not feel able to broach the subject of telling their patient that they are dying, how can their patient know that they are dying and begin to make plans and decisions about where they want to die?
All Marie Curie nurses are given training on end of life care communications and continue to develop those skills through their work.
A key part of what they will be doing this Christmas is helping patients and their families speak to each other about the death, to voice their fears and hopes and to express the feelings that can be so difficult to communicate but help so much in the bereavement process. It’s a time of mixed emotions as families share what they need to with a loved one - memories and stories that fill the house with laughter, mixed with the sorrow of contemplating life without that person.
But don’t go off with the impression that it is all sadness and tears. Most people want their last Christmas to be a happy one and the Marie Curie nurses do everything they can to ensure this happens. This can include helping the patient to conserve energy and advising the family about how to support the patient to do that best, looking after their symptom management to get them through the big day, or making their favourite eggnog or G&T.
Last year, one nurse recognised that her patient, who desperately wanted to celebrate her last Christmas with her family, was not going to make it until then. So she advised the family to arrange an early party and joined them to celebrate an early Christmas. The patient had a very happy time and died peacefully the next day.
Earlier this year, I heard from a daughter who lost her father last Christmas. His last festive wishes were to see his daughter Jayne’s 50th birthday and spend Christmas at home with all his family, including his new great grandson who was just two months old at the time. Thanks to our nurses, he was able to get both his wishes. Jayne said they had the best Christmas ever, even though it was their last, and she will always remember them all snuggling up on her dad’s bed - including the nurse - with her dad laughing and telling stories with his favourite tipple of whisky in his hand.
Marie Curie nurses tell me that they feel very privileged to be able to help patients and their families at such an important time in their lives. They get a huge amount of satisfaction and professional fulfilment from being able to provide the level and quality of care to individual patients that they were trained to do.
I want to pay tribute to all Marie Curie nurses across the country who will be doing a wonderful job this Christmas. Especially because they will be spending time away from their own families and friends to help more people achieve their wish of being able to spend their last Christmas at home, surrounded by their loved ones.
Susan Munroe is director of nursing and patient services, Marie Curie Cancer Care