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Pathway 'improves nurse confidence in palliative care'

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A practice-based educational pathway has been found to improve nurses’ confidence in delivering end-of-life care to patients.

The pathway involved assigning a mentor from a specialist palliative care team to community and district nurses from South Tyneside NHS Foundation Trust.

The scheme focused on four care areas: communication skills; advanced care planning; assessment and care planning; and symptom management, maintaining comfort and wellbeing.

Nurses taking part in the Northumbria University study said that their main concerns with regards to palliative care was communication, but reported that their concerns eased during the project due to exchanges with experienced colleagues.

Each nurse created their own development plan, which included formal and informal education, following a training needs analysis.

The study findings, which were published in the journal Primary Health Care, showed that participants’ confidence with regards to communication skills and symptom management improved.

It was also found that developing mentoring and support networks between community services and end-of-life care specialists could be a powerful approach to educating community nurses.

The study authors recommend a larger study to examine the duration of increased confidence and the extent of knowledge and skills gained. They also said nurses and their managers should lobby their local organisations for support in setting up similar training initiatives.

They stated: “Such practice-based education may offer a powerful and convenient approach to EoLC education for community staff.”


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  • 1 Comment

Readers' comments (1)

  • michael stone

    I'm pleased to see that communication comes first in:

    'The scheme focused on four care areas: communication skills; advanced care planning; assessment and care planning; and symptom management, maintaining comfort and wellbeing.'

    I sent an e-mail to Susan Summers, who is Head of Long term Conditions, Nursing Directorate, NHS England, yesterday in response to an e-mail she sent to me a couple of days ago. I mentioned in the e-mail, my concise ‘guiding principle’ for assessing end-of-life care:

    ‘Good care’ is care that the patient would have considered to have been good, if somehow he/she could retrospectively express a view. It is that simple - behaviour that the patient objects to, and non-communication that leads to
    huge conflict and resentment and anger, isn‘t normally ’good care‘.

    My e-mail to Susan included the forwarding of a recent e-mail to a couple of other people, in which I had included the below as part of the foreword – it is ‘not telling people what is happening’, that leads to things like the 90-minute phone call I had yesterday evening, from someone whose demented ‘but not dying’ mother was taken to hospital after ‘choking’ in 2011, was dead a week later, and because the staff were not talking properly to the family during that week, my phone caller clearly thinks ‘the NHS deliberately killed my mum’.

    The extract from that foreword (with what was bold in the e-mail, altered to caps here):

    Please bear in mind, that my basic contention is that the improvement in ‘talking to the laymen’ that most clinicians [and others] who have thought about the problem believe is necessary, will best be promoted by proving to [senior] clinicians (and then the guidance authored by these senior clinicians stating) that ‘not holding the necessary conversations, looks very dubious legally’. It is very clear to me, that ‘the law around death’ already troubles a lot of HCPs, many simply do not properly understand it (and some of them realise that), AND THEREFORE IF THEIR GUIDANCE SAID ‘you really must talk to either the patient or, if the patient can’t talk, to the friends and relatives, or else you are on very dodgy ground, legally’, THEN THEY WOULD TEND TO DO THAT.

    I also think that talking, even though sometimes problematic, would in an overall sense, lead to less stress all around: and I think the ‘stress and anger’ resulting from HCPs avoiding ‘difficult conversations’ tends to disproportionately fall onto bereaved relatives, usually after their loved-ones have died, when it becomes very difficult for those relatives to continue to [sensibly] interact with the ‘system’. Currently, an awful lot of ‘bad consequences’ disproportionately fall on to live-with relatives in particular.

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