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RCN survey raises 'profound' concerns about care of dying

  • 2 Comments

Nurses are concerned about the ability of health services to deliver high quality care to patients at the end of life, according to a survey by the Royal College of Nursing.

In a survey of RCN members, only 11 % said that they were always able to deliver the right level of care to patients, with 59% saying the wishes of patients could not be fulfilled during the last six months.

When asked why those wishes could not be fulfilled, reasons given included a lack of time, with some also citing a lack of training.

“Nursing the dying is an art, as well as a science. It cannot be reduced to a process of drug administration or a series of required nursing tasks, however important these things are”

Peter Carter

Nearly half said that they did not always have the chance to discuss with patients how they would like to be cared for during their final days, with just 19% of nurses in hospitals saying they felt able to have this discussion.

One nurse said: “When it works well it is the most rewarding aspect of nursing care but sadly it can be very frustrating when you are aware it could be better if you had more time and resources available.”

Only 36% of nurses working in the community said that their team has the resources to deliver round-the-clock care to patients who have chosen to die at home.

More than two-thirds of nurses in the community had seen patients having to be taken into hospital in their final hours, against their wishes, because there were not the resources to care for them at home.

Peter Carter, RCN chief executive and general secretary, said: “This survey has touched a nerve amongst nursing staff. Hundreds have told us about the honour and privilege of caring for people at the end of their lives.

“However, many are also profoundly troubled by their experiences of trying to deliver care for the dying, against a backdrop of staff shortages, lack of resources, inadequate training, cost pressures and rising demand,” he said.

“Nursing the dying is an art, as well as a science,” said Dr Carter. “It cannot be reduced to a process of drug administration or a series of required nursing tasks, however important these things are.

“Nurses need time to listen to what the dying person wants, to recognise their fears and anxieties and to help loved ones to understand what is happening,” he added.

“This report highlights the privilege that nurses feel in being able to care for people at the end of their lives,” he said. “They should feel properly supported in this”

Anne Cleary

More than half of those surveyed said they treated people approaching the end of their life at least once a week, with many doing so on a daily basis. Despite this, a quarter of nurses said that they had received no specific training, either before they qualified or since they had started work.

When asked why patients’ wishes had not been a fulfilled, nursing staff cited the following problems:

  • A lack of time (33.7%)
  • A lack of resources where they work (26%)
  • A lack of resources in another area (30%)
  • A lack of training (23.9%)

Anne Cleary, deputy director of nursing at Marie Curie Cancer Care said: “We echo the concerns expressed that nurses are not always getting the training, support and resources they need to provide the care that they so obviously want to.

“This report highlights the privilege that nurses feel in being able to care for people at the end of their lives,” he said. “They should feel properly supported in this.”

Ms Cleary added: “It’s important to remember that a great deal of the nursing terminally ill people need is provided in their own homes.

“So, it is particularly important that community nurses get first-rate support and training to help them provide the care that terminally ill people and their families need and deserve,” she said.

  • 2 Comments

Readers' comments (2)

  • michael stone

    I've also got some 'profound concerns' about the latest version of the Joint CPR Guidance.

    One point, being exactly what Ms Cleary points out above:

    'Ms Cleary added: “It’s important to remember that a great deal of the nursing terminally ill people need is provided in their own homes.

    “So, it is particularly important that community nurses get first-rate support and training to help them provide the care that terminally ill people and their families need and deserve,” she said.'

    None of the contemporary guidance, starts with the correct logic for EoL pateints who are at home: that normally the live-with relatives are present much more than any of the professionals, so instead of stressing MDTs and 'safeguarded record-keeping', what should be stressed is that GP, live-with relatives and DNs should be working together to support the person who is dying.

    This stress on 'who is a professional and who isn't', is unhelpful.

    And confusing decisions with wishes, is hugely unhelpful as well.


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  • michael stone | 3-Nov-2014 11:58 am

    more profound concerns about your comments here!

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