The greatest privilege a nurse can have is to look after patients in their final days.
That is what so many nurses tell me - and tell me with a light in their eyes, proud at knowing how they have cared for and supported a person to die in the way they wanted.
The Liverpool Care Pathway has now been replaced by Priorities for Care (see news, page 2). The LCP was heavily criticised by some for being a tick-box exercise that didn’t pay enough attention to patients’ wishes and those of their loved ones and, when used incorrectly, led to inappropriate withdrawal of nutrition and fluids.
I was at Salford Royal Foundation Trust last week and met Fiona Murphy in the trust’s bereavement service. Inspired by a patient’s poor experience of witnessing another’s death in the hospital, she has made care of the dying and their loved ones a priority for every-one at the trust. Fiona has made it OK to break the rules - washing out patients’ mouths with their favourite tipple, doing a risk assessment so they can enjoy their final cigarette or bringing in their pets for a last cuddle. The emergency assessment unit even arranged a wedding within its busy department.
Fiona has created cotton bags that contain all the overnight comforts and toiletries needed by a loved one who wants to stay with a patient. Each one contains a tag made by local children with learning disabilities that reads simply: “This is a little gift for your comfort and to show that people care”.
The belongings of patients who have died are returned to relatives in a cotton bag decorated with a swan, the Romans’ symbol for a happy death. More special than a plastic bag, some relatives use them to store condolence cards, rendering them “a memory bag”. And hospital staff are trained to identify the swan logo so, as the relative leaves the hospital, they know they may need extra support. All this stemmed from one nurse’s desire to prevent one patient’s experience being replicated. It shows the power of nursing. It shows nursing at its best.
What Fiona has done is outstanding but it should be the norm, not the gold standard. Rules and guidance are all very well but, ultimately, it is the small things that matter. Nurses have the skills and power to deliver those and change patients’ lives - and deaths. That power should be used so all patients have the best possible death - and the death they choose.
Jenni Middleton, editor
firstname.lastname@example.org. Follow me on Twitter @nursingtimesed