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Hospital nurses should be 'systematic' about end-of-life care

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Hospital nurses should adopt a more “systematic approach” in helping patients choose where they die, according to a senior Department of Health official.

DH national deputy director for end of life care John Ellershaw told Nursing Times nurses should be taking a leading role in advanced care planning, improving communication, assessment and early discharge.

He was speaking as the National End of Life Care Programme produced guidance outlining six steps for improving end of life care in acute hospitals, including effective holistic assessment, advanced care planning and rapid discharge from hospital (see box).

End of life care was also highlighted in the revised NHS operating framework 2010-11 as an area where payments could be linked to best practice along clinical pathways.

Professor Ellershaw said: “People with end of life care needs and their relatives need a lot of time and support which is often delivered by nurses.”

Hospital nurses needed to be ready to receive any documents related to patients’ care plans arising from discussions with community health workers, he said.

He added: “For most patients it’s wanting the most appropriate treatment and to get home as soon as possible. The more we enable nurses on the wards to have those conversations and discussions with patients and relatives, the better care will be.”

The guidance highlights a nurse led tool being piloted at London’s Guy’s and St Thomas’s Foundation Trust. The AMBER care bundle has enabled 78 per cent of patients to die in their place of choice since the pilot began in January.

Th tool was developed by the Modernisation Initiative End of Life Care Programme, funded by Guy’s and St Thomas’s charity, which aims to improve end of life care services for people living in the Lambeth and Southwark areas of South London.

Nurse Michelle Morris, senior clinical facilitator for the initiative, said: “Patients still receive active treatment but conversations around what will happen if treatment is unsuccessful are initiated much earlier so that patients can make clear choices about their care.”

“Patients have a clear medical plan, and early discharge planning can be facilitated if the patient wishes to go home. The tool has also helped improve communication between doctors and nurses and ensures that everybody understands exactly what is happening with the patient,” she said.

For more information on the AMBER tool go to:  


1. Discussion as the end of life approaches

2. Assessment, care planning and review

3. Coordination of care

4. Delivering high quality care in an acute setting

5. Care in the last days of life

6. Care after death

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Readers' comments (1)

  • End of life care is obviously a very difficult area of nursing and I agree it is definately an area to improve upon to allow better choices. I deal with many patients faced with end of life decisions and it is really hard to be able to spent enough time with them to deal with all the issues and discuss end of life care. Quite often medical staff are more delayed in accepting end of life, which makes discharge discussions and planning very difficult. We do utilise the fast track system to enable patients to go home, but there are gaps in the implementation and coordination in many cases. It is not feasible for acute ward nurses to be able to manage these situations, with 25 other patients to manage. Palliative care nurses are often invaluable in such instances.

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