Nurses have hit back against suggestions in the national media that they were leaving end of life care patients so dehydrated they were resorting to sucking water from sponges.
Members of the nursing profession said there was a “misunderstanding” over the use of sponges as a hydration tool, in the wake of a renewed focus on end of life care this week.
“A lot of nurses say there is a complete misunderstanding about this”
Earlier this week the National Institute for Health and Care Excellence published draft guidance on end of life care, designed to partially replace the discredited Liverpool Care Pathway.
The draft guidelines highlighted that patients in their last days of life should be encouraged to drink “if they wish to and are able to” and that, if considered beneficial, should receive assisted hydration.
Widespread media coverage of the guidance drew attention to the controversial Liverpool Care Pathway, which was withdrawn last year following an independent review.
The pathway was repeatedly described on BBC Radio 4’s Today programme on Wednesday as having resulted in “some people being deprived of food and water in their last few days”, with patients becoming “so dehydrated they tried to suck water from the sponges used to moisten their mouths”.
Presenter John Humphys subsequently told listeners that the radio station had received “an awful lot of emails from nurses” who were concerned about the description.
“A lot of nurses say there is a complete misunderstanding about this,” he said. In particular, he quoted a message received via email from a sister called Julie Vine.
“Please do not let families think that giving fluids on a sponge is wrong”
She said her ward was currently providing care to a dying patient whose swallowing was “very poor” and needed thickened fluids as a result.
“I was giving her fluids by teaspoon, but it kept moving round her mouth and coming out,” she said. “She didn’t have the strength to suck up a straw, so I gave her fluid on a mouth care sponge and she could suck the water from that.
“Everyone is an individual, so please, please do not let families think that giving fluids on a sponge is wrong,” she said.
John Humphrys describes nurse concerns in full:
“We’ve had an awful lot of emails from nurses who are concerned that people have been complaining about the care of people in their final stages, who were so weak and were not being rehydrated that they were sucking water from the sponge that was being used to moisten their lips.
Well a lot of nurses say there is a complete misunderstanding about this.
Julie Vine says: ‘I’m a sister, and we’ve a patient dying on the ward at the moment. Her swallowing is very poor, she needs thickened fluids. I was giving her fluids by teaspoon, but it kept moving round her mouth and coming out.
She didn’t have the strength to suck up a straw, so I gave her fluid on a mouth care sponge and she could suck the water from that. I asked if that was better, she said “yes”, it gave her great relief – and her eyes smiled.
Everyone is an individual, so please, please do not let families think that giving fluids on a sponge is wrong.’”
Earlier in the programme, Mr Humphrys had interviewed Mark Baker, director of NICE’s Centre for Clinical Practice, about the draft guidance.
Making the case for improvement, Mr Baker said: “We take meticulous care in bringing people into life, we need to take as meticulous care in helping them to leave life comfortably.”
“The science of medicine helps us live longer, but the art makes its delivery comfortable”
He noted that the Liverpool Care Pathway “had a place in improving the experience of dying” when used by specialists and “managed sensitively”. But he acknowledged that its use in non-specialist hands was “too easily abused”.
Asked if this meant there was a need to “end the technology approach of nursing”, Mr Baker highlighted that clinical care involved both art and science.
“The science of medicine helps us live longer, but the art makes its delivery comfortable,” he said. “Perhaps in some places and at some times we focus too much on the science and have lost the art.”
Pushed by Mr Humphrys on whether nursing had “to change”, he highlighted the need for patient-centred care and good communication from all health professionals, as set out in the draft guidance.
“I think all the professions need to be assured that they are always working in the patient’s best interests and that requires them to find out what the patient’s interests are,” said Mr Baker.
Mr Humphrys went on to question the need for guidelines, arguing that decisions on end of life care should be left to nurses to make through “humanity, common sense and decency”.
Mr Baker stated that there were “basic values and philosophical issues which ought to be intrinsic to the ways of working of all the health professions”, but that guidelines brought consistency.