When the Liverpool Care Pathway was replaced by Priorities of Care earlier this year, it was intended to ensure that health professionals approached conversations about dying sensitively.
The change resulted from a media backlash against the LCP, which cited cases where it had been used insensitively or incorrectly. Distressed families saw the pathway as a tick-box exercise started with little or no consultation with the patient or family, and used without compassion.
Many experts supported the LCP, arguing that the problem was not with the pathway, but the way in which it was being implemented by clinicians who had received no or inadequate training around talking about dying. They may have been right.
Our story on page 3 reveals shocking accounts of community nurses asking vulnerable older people about end-of-life decisions in a way that is frightening rather than involving and supportive.
Any system to discuss dying is only as good as the people who carry it out. If their training is poor and they are neither confident nor competent in this, patients are almost certain to be distressed.
Chief nursing officer for England Jane Cummings has promised to review a questionnaire that prompts nurses to ask questions of dying patients in a “blunt and impersonal way”. But it may be more than the questionnaire that needs reviewing.
The news that some community nurses have been phoning patients out of the blue to discuss their wishes around resuscitation is shocking. This is not a subject to be brought up without warning or reason - particularly when the nurse cannot see patients, gauge their reaction or read their body language.
There is one chance to get this right. Nurses don’t want to do this badly, they want to do it well, organically and holistically. Nurses do not need to be put into a position where finding out about how a patient wants to be treated if they have a serious condition becomes just a part of hitting another target.
Have we really learnt nothing from Francis? What nurses need is training and support as they develop confidence and experience in this difficult area. And, most importantly, they need enough time to be able to talk about death compassionately and in a way that feels natural and appropriate to patients. They want to be able to do it right.
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