More than one in four nurses involved in end of life care do not feel competent to broach the subject of death with patients, a Nursing Times reader survey has revealed.
The findings suggest a major skills gap and lack of support for nurses, despite recent drives to improve end of life care, such as the 2008 national end of life care strategy.
Nursing Times surveyed more than 900 nurses, 25 per cent of whom described themselves as acute sector staff nurses, on their views on end of life and palliative care.
Two thirds of respondents said they had been involved in nursing a dying patient on the Liverpool Care Pathway.
However, 27 per cent of nurses who had used the care pathway admitted in the anonymous survey that they did not feel competent to discuss end of life care issues with patients. That proportion rose to 33 per cent among all respondents.
The lack of confidence directly affects the quality of care for the dying as nearly half of respondents - 48 per cent - said nurses at their organisation were unable to provide relatives with sufficient support and explanation when a patient entered the dying phase.
Most nurses cited a lack of basic or advanced training as the reason. Only 4 per cent said end of life care was irrelevant to their job.
The survey findings support research by the NHS national end of life care programme that found most healthcare professionals had some involvement in end of life care but the majority had not received communications skills training beyond a very basic level (news, page 3, 28 September).
Overall, around two thirds of respondents rated end of life care at their organisation as good or very good, and the standard of nursing skills in end of life care as good or very good.
That was described as disappointingly low by Sarah Booth, a community palliative care nurse specialist at the Sue Ryder Wheatfields Hospice in Leeds.
She suggested every ward needed a champion who knew where to find specialist support on palliative care issues.
Susan Munroe, Marie Curie’s director of nursing and patient services, said nurses needed specific training on end of life care communications.
“Healthcare professionals don’t have the skills and confidence to have these conversations,” she said, acknowledging it could be “difficult and stressful” for nurses.
Claire Henry, former nurse and director of the NHS National End of Life Care Programme, said end of life care scenarios should be included in pre-registration nurse training modules on communications.
The survey also shows religious belief has a small but significant impact on nurse attitudes towards end of life care.
It asked nurses whether they would consider themselves as an “active member” of an organised religion or faith group. One third said they did.
The results indicated those nurses had significantly more concerns about the Liverpool Care Pathway than other nurses (see graph below).
For example, 46 per cent of nurses who said they were not active members of a faith group said the pathway “overall reduces suffering for the majority”. Among the religious nurses, however, support was significantly more muted with just 38 per cent concurring.
Additionally, 17 per cent of religious nurses were uncomfortable about withdrawing medication or fluids from patients compared with 11 per cent of other nurses.