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Nurses lack skills in end of life care


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.


Readers' comments (5)

  • It is a very sensitive subject that no one likes broaching. OUr trust has CNS in end of life care and that greatly enhances the experience, providing support to the staff and the patients/relatives. It's one aspect of the job that you just have to get right because people will remember it. And no, even as 11 years post qualified in a senior role, I have never had any kind of advanced training - nt even that much basic. It seems to be expected that as a nurse, you 'just know what to say' but that's not the case. I'd jump at the chance for some education on the subject.

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  • This is interesting but i am not sure what point you are trying to take about people with faith. You seem to be suggesting they have problems with end of life care but you do not explore this. Perhaps they just think more about what they are doing and the consequences of the actions they take. Is there anything wrong with this if patients receive well thought out and considered care.

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  • in this climate of nursing and the introduction of the end of life strategy, it is paramount that we as nurses should make it our responsibility to seek out training in this field of nursing. We shouldn't see it as an extention of all the other jobs we do. It is a privelege to look after people at the end of their life, and yes the way we take care of them will be the lasting memory their relatives have of them, so whether you have training or not we have a responsibility to make this as positive an experience as we can. some universityies have an end of care module that can be accessed from your hospital training department or by going direct to the university website yourself.

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  • I have commented about this issue on another page and wish to reiterate that this is one of the most important aspects of what we as nurses do. Sisters and senior nursing staff should be available on the floor to assist junior staff in coping with this area of our job and enable them to deal with death in future.
    Senior nurses should be ward sisters and not ward managers, we should be there to guide staff through difficult situations so they can learn and deal with them again.
    The nurses in the survey talked about requiring training to deal with death and "learn what to say".
    I believe role modelling and support is more effective and economic than setting up, funding and facilitating a study day.

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  • Don't mix professional duties and your religion as patients may not hold the same views. Religion is your own private affair and should never be imposed upon others if it is not solicited. It is not your job to moralise or preach to patients. You are there in the capacity of a nurse, and hopefully a professional one. Hospitals have priests and trained assistantants to deal with pastoral care. As for lack of experience to deal with broach the subject of death with patients, they may not wish to consider this and it is not your duty to put the fear of God into them. It is enough to put anyone off being cared for by nurses or going into a hospital and gives our profession a bad name. If a patient wishes to discuss the matter, appropriately trained professionals from the pastoral services should be called for.

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