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MPs question compassionate nursing in end of life care

  • 9 Comments

End of life experts have reinforced the importance of values-based recruitment for student nurses to ensure they deliver care in a compassionate way, but claimed this quality can later be “destroyed” in the workplace.

As part of a Commons select committee on palliative and end-of-life care, the experts were asked by MPs how to ensure care was compassionate.

“We do need to recognise we are looking for the right person at the beginning [of a clinician’s career]”

Jane Collins

The Public Administration and Constitutional Affairs Select Committee session followed publication of a recent report by the Parliamentary and Health Service Ombudsman about failures in end of life care.

Dr Jane Collins, chief executive of terminal illness support charity Marie Curie, said there were “well-developed” procedures for recruiting people into nurse training who were more likely to be compassionate.

“We do need to recognise we are looking for the right person at the beginning. Because otherwise you’ve got too much shaping to do you won’t necessarily have the outcome you want,” she told the MPs yesterday.

Dr Collins added that clinicians should then be encouraged to use that compassion in their jobs, but noted the strains of the workplace could see this quality “destroy[ed]”.

Sir Mike Richards, the Care Quality Commission’s chief inspector of hospitals, echoed her views and said registrants sometimes failed to use their compassionate skills during periods of staff shortages and heightened stress.

“There is recognition that what used to be the state enrolled nurse role perhaps is one of the missing parts of what’s required on wards and in the community”

Jane Collins

He said the regulator found that when it ordered trusts to close bed spaces due to a lack of staff, patients then reported that nurses were more caring.

Professor Irene Higginson, director of the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation at King’s College London, said clinicians could be taught some skills in how to make people feel they have been treated with compassion.

However, she said it was more difficult to tackle “attitudinal” determinants of compassion.

She said values-based recruitment should be used to select caring people, alongside strategies during training which addressed how students’ personal experiences affect their approach to end of life care.

Sir Mike Richards

Sir Mike Richards

Meanwhile, the experts were asked by Conservative MP for Hertsmere Oliver Dowden whether the move to degree training for nurses had reduced the compassionate element of nursing.

In response, Professor Higginson noted there was “very little” on palliative care included in nurse training and called for communication skills around end-of -life conversations to be made mandatory.

Dr Collins also noted there was a national shortage of nurses across the UK, hinting that there was scope to further develop some healthcare assistants roles – as recently suggested by others.

She said if entry routes into nursing roles were widened for those who did not want to complete a degree then this would “bring in people with different skills that would undoubtedly be of benefit”.

“There is recognition that what used to be the state enrolled nurse – as opposed to the state registered nurse – role perhaps is one of the missing parts of what’s required on wards and in the community,” she said during an earlier part of the committee session.

  • 9 Comments

Readers' comments (9)

  • michael stone

    'In response, Professor Higginson noted there was “very little” on palliative care included in nurse training and called for communication skills around end-of -life conversations to be made mandatory.'

    It isn't just communication - although that is a really serious problem in end-of-life, especially if the patient is in his or her own home - but also poor understanding and acceptance of the law, and a failure to cope with various uncertainties.

    As I pointed out in my piece at:

    http://www.bmj.com/content/350/bmj.h3181/rr-2


    Dr McCartney mentioned uncertainty as well as trust. When I read, as someone with a doctorate in chemistry, contemporary end-of-life guidance
    and policies, I see a marked reluctance to properly incorporate both clinical
    uncertainty and patient self-determination, combined with an 'attitude' that
    professionals are trustworthy but laymen are not trustworthy: throw in some
    added complications involving concepts such as 'patient confidentiality', a
    fairly widespread unease at 'talking about dying', a common interpretation of
    ‘safeguarding’ which thwarts the patient self-determination so fundamental to
    the Mental Capacity Act, etc, and at the moment behaviour sets for EoL home
    death seem to assume an 'idealised model' which is very different from the reality of many EoL home deaths. The guidance and protocols, should be based on the reality of EoL at home, accepting the many complications, and not on 'a guidance-writers' wish-list of how EoL at home should work in a 'perfect and much-simplified world''.

    And 'trust and uncertainty' are two of the main issues which need to be properly addressed, if better and more perspective-balanced behaviour sets are to be created.

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  • michael stone

    Why does text still often appear 'deformated' even if I take the trouble to 'tidy it up' in the 'comment' box before clicking on submit ?!

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  • Another inappropriate picture. "Lie there and try and look as if you're dying, dear. Yes, keep the lipstick on, that'll be fine."

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  • michael stone

    Anonymous | 17-Sep-2015 9:30 am

    I hadn't really looked at the picture. The lady to me looks elderly, but she could be simply asleep and elderly - on the other hand, she could be 'almost anything'.

    Is it the presence of a picture at all which you object to (and I admit, I don't really see why this story needs a picture - I don't see how a picture adds anything), or do you think it is just 'the wrong picture' ?

    On September 8 'THE NATIONAL PALLIATIVE AND END OF LIFE CARE
    PARTNERSHIP' released its 'Ambitions' document and 'presentation' - I 100% agree with this, which is at the end of the presentation:

    'This is the start of our collective engagement to turn ambitions that should by now have been standard, into a reality for all.'

    Things really should already be better than they are - the problems are fairly easy to see, and it shouldn't require a bunch of MPs to be drawing out some of the simpler of the problems.

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  • "Heightened stress" in care homes can be because the providers are busy ensuring profit at the expense of patient care and using agency nurses to ensure this.

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  • "Is it the presence of a picture at all which you object to (and I admit, I don't really see why this story needs a picture - I don't see how a picture adds anything), or do you think it is just 'the wrong picture' ?"

    Good point - generally I gave up needing pictures to illustrate a story in primary school and I don't find that the absence of a picture limits my understanding. Ah well, it's a change from a pair of wrinkled old hands being held by a pair of smooth young ones.

    And of course this particular thing is distracting me from the point of the original article.



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  • michael stone

    anonymous | 18-Sep-2015 4:00 pm

    Some pictures - of a [specific type of] rash for example - make sense. But I'm not sure that one, makes much sense at all.

    I'm not sure there is 'a point to this article' beyond 'a group of MPs have twigged there are problems with end-of-life care', and that various 'EoL Experts' also know that.

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  • As a country that is in theory ruled by elected MPs representing the population, it is relevant that an MP speaks out, Michael.

    At least for those involved in situations where end of life care has been woefully inadequate, there is information available from the MPs re who they might best approach.

    I cannot see that confining issues to the elite is helpful. Rather I would see all and sundry informed and have it shouted from the rooftops that we, the 6th richest nation in the world treat our elderly and frail in a deplorable manner.

    Then perhaps something might change.

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  • michael stone

    Anonymous | 22-Sep-2015 10:14 am

    The HC select committee, has got a somewhat odd concept of 'evidence' (which I pointed out to it, at a previous and similar consultation).

    I am 100% with you regarding your position, and especially for the 'confining to the elite' point:

    'I cannot see that confining issues to the elite is helpful. Rather I would see all and sundry informed and have it shouted from the rooftops that we, the 6th richest nation in the world treat our elderly and frail in a deplorable manner.

    Then perhaps something might change.'

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