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Nurses can expect key role in new hospital end of life care initiative

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Ward managers and other senior hospital nurses will be asked to help lead the implementation of a new end of life care planning initiative, Nursing Times understands.

Joint guidance for acute trusts is expected to be published at the end of this month by the NHS Institute for Innovation and Improvement and the NHS National End of Life Care Programme.  

Nursing Times understands the forthcoming guidance will apply the institute’s Productive Ward model to end of life care and is expected to highlight the important role of ward leaders and other senior nurses. 

It will also urge each trust to give an executive director – potentially the director of nursing – responsibility for overseeing implementation of the the guidance.

The guidance follows two other documents published earlier this month on end of life care.

The National End of Life Care Programme published an updated booklet for patients and carers on advance care planning for end of life care. Planning for your Future Care – a Guide notes that issues might range from a preference for sleeping with the light on to major decisions around refusing life-saving treatment.

Meanwhile, research by the National End of Life Care Intelligence Network revealed that patients living in deprived areas were more likely to die in hospital than those living in affluent areas.

The network’s report showed that 61% of deaths among people living in the most deprived fifth of the population occurred in hospital, compared to 54% among each of the two least deprived fifths of the population.

Claire Henry, director of the National End of Life Care Programme, which runs the network, said such a “stark variation” in place of death between deprived and more affluent areas could not be ignored.

“This report confirms there are equity of access issues which need to be taken into account when services are commissioned,” she said.

“Good assessment and advance care planning by clinicians working with individuals and their families or carers can also help identify potential problems in accessing community services and support.”

Reducing the number of deaths occurring in hospital was a key goal of the Department of Health’s national end of life care strategy, based on consistent evidence that most people would choose to die at home or in a hospice.

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Readers' comments (1)

  • michael stone

    I have just downloaded that pdf booklet, and flicked through to the 'refusing treatment bit, where I read:

    'An advance decision to refuse treatment (sometimes called a living will or advance directive) is a decision you can make to refuse a specific type of treatment at some time in the future. This is to be observed if you can’t make your own decision at the time the treatment becomes relevant.
    Sometimes you may want to refuse a treatment in some circumstances but not others. If so, you must specify all the circumstances in which you want to refuse this particular treatment.'

    Note 'Sometimes you may want to refuse a treatment in some circumstances' - but you might just want to refuse a treatment, in ALL circumstances.

    Currently many clinicians do not believe that 'I refuse CPR whatever caused the CPA' is adequate and valid on an ADRT (it is - but simply describing that correctly, as this booklet does above, won't necessarily be enough to alter existing flawed beliefs).

    There is also a separate problem which hinges on the requirement that an ADRT refusing a life-sustaining treatment must be in writing (this requirement seems to be sensible until you see the confusion it leads to - bit of a sod, that one): equally obvious when you think about it, and equally confusing to many clinicians !

    At least Eol is improving, if too slowly for my liking.

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