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EDITOR’S COMMENT

'Nurses need support to discuss end of life care'

  • 15 Comments

I am not normally a big fan of the awareness days and weeks that seem to exist for everything and anything. But for me, the following event is different, because the issue it highlights is so fundamental, not just to nurses but to all of us – namely end of life care.

Dying Matters Awareness Week runs from 18-24 May and is run by a broad coalition of organisations, including charities, care homes and hospices. A new survey timed to coincide with the event reveals that the public recognise that they need to talk more about death and planning their final wishes, but sometimes find this difficult. 

In an interview with Nursing Times, Claire Henry, chief executive of the National Council for Palliative Care and herself a former nurse, has said that the survey contains “important messages” for healthcare professionals, who she says have a “huge role” to play in starting these conversations with patients.

However, I cannot imagine this is always easy. My mother recently slipped into a conversation that she had sorted out her funeral arrangements. To her, it seemed to be the practical thing to do. In contrast, I was left feeling uncomfortable and wanting to change the subject.  

Health professionals may also have been left thinking twice about broaching the subject of dying with their patients by the intense media focus on end of life care in recent years. It certainly feels like the newspapers are especially waiting to pounce on problems in this area of care. The media furore that led to the demise of the Liverpool Care Pathway was followed last year by a series of negative stories focused on the use of DNR questionnaires by district nurses.

But enough is enough. Quite rightly, Ms Henry acknowledges that it is vital nurses have access to the right support and training to discuss end of life care options with patients and to deal with any resulting practical issues.

It is high time nurses stopped being bashed for the wider failings of the health and social system on end of life care. Instead, they must be given the tools to help their patients have a “good death” and, perhaps most importantly, the time to do so. There is only one chance to get it right.

Steve Ford, news editor

steve.ford@emap.com

Follow me on Twitter @SteveJFord

 

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  • 15 Comments

Readers' comments (15)

  • Dear Steve,
    It would be useful if the Nursing Times reconised the excellent work being done by the Nursing fraternity in Care Homes across the Country .There are over 400000 elderly people being cared for with the majority receiving "end of life " and this figure will increase by approx.25% over the next decade.

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  • Steve Ford

    Absolutely agree with you. Nurses in care homes are too hidden from view, in terms of policy and public awareness. They are effectively the frontline when it comes to dementia.

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  • michael stone

    Steve,

    Getting these decisions about 'dying' from the patient, is very difficult at the best of times. But it becomes increasingly necessary - and is an increasingly urgent requirement - the close the patient is to dying.

    Currently, the NHS wants what I would describe as 'a formalisation of the discussions', which is very difficult even if the patient is in a hospital or hospice, and as an approach that is ABSOLUTELY HOPELESS if the patient is dying in his/her own home.

    The problems differ for mentally-capable and long-term demented [end-of-life] patients: but I won't go into how, here.

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  • the Liverpool care pathway was scrapped due to the media- nurses will be too scared to administer morphine in case the patient dies and the nurse done for murder

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  • As a nursing assistant that works with people diagnosed with dementia I tend to have this conversation a lot. It can be quite hard as you need to speak to someone early to ensure they can make choices whilst they still have capacity, but you don't want them to think you are telling them that their life is over when they have so more more time left to enjoy and live fully.

    I am very well supported in doing this and I hope my clients would say I approach this tactfully and sensitively whilst giving them a sense of fulfillment that they can make their own choices.

    It is an essential part of nursing, especially in dementia care and I look forward to more training in the future

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  • michael stone

    Anonymous | 20-May-2015 1:53 pm

    The issue of 'pain relief which MIGHT hasten a death' is just one of the things, which needs to be sorted out: in my opinion, so long as the situation is 'might' and not 'definitely will', then provided the patient is informed of the risk and asks for the pain relief, there should not be an issue (but the police, who seem to have a limited grasp of legal concepts, might disagree).

    I was reading the PHSO report 'Dying with dignity' yesterday evening:

    http://www.ombudsman.org.uk/reports-and-consultations/reports/health/dying-without-dignity

    I have asked the PHSO, if it would make clearer what it was saying about 'Mr J' - this is my e-mail to the PHSO:

    phso.enquiries@ombudsman.org.uk


    Dear Sir or Madam,

    I heard the Ombudsman talking about your report 'Dying without dignity' on BBC Radio 4 yesterday morning, and I read the report yesterday evening (because I am engaged in 'this EoL debate').

    Can you please clear something up for me ?

    When you describe the 'Mr J' case, on page 15, you tell us that:

    'Two months later, Mr J was admitted to hospital because he was struggling to breathe. Once he was on a ward, his pain relief was stopped because it was thought he was becoming too dependent on it. He was started on pain relief again the next day, but by that point Mr J was severely agitated and in pain. He died in the early hours of the following morning. '

    In your 'findings' you state:

    'Mr J’s pain relief was inappropriately stopped'

    I would like to be 100% clear, about what you are saying (further on, you write 'In addition, we found that the clinicians treating Mr J recognised that he was at the end of his life but did not explain this to his family in a way they could understand.').

    Are you stating, that THE CLINICIANS WHO 'stopped his pain relief because they felt he was becoming too dependent on it' KNEW WHEN THEY WITHDREW the pain relief, that Mr J would die within a few days ?

    Because IF THEY DID, then my comment is more 'visceral' than your 'inappropriately' - I've just sent an e-mail to Bee Wee at NHS England about 'Mr J' (see below my sign off),

    Regards, Mike Stone

    The PHSO says:

    'Mr J’s pain relief was inappropriately stopped ' AND later 'we found that the clinicians treating Mr J recognised that he was at the end of his life '. It isn't 100% clear, whether the PHSO are saying that the clinicians who withdrew the pain relief, knew that Mr J was in the final days of life - I intend to ask the PHSO (which doesn't mean I'll get an answer).

    I don't apologise for my language, if they did - how the hell can someone be 'too dependent on pain relief' during the final days of life !!!








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  • We have a real issue with death in our society,especially,it seems,the nursing staff who are meant to be looking after someone in their last days on earth ! We faff about trying to avoid saying dead ,death,died,dying.I have had many conversations on the subject and the people who I have had this conversation with are now dead and interestingly THEY new that death was inevitable because as humans we are ALL aware that death follows life and when life gets too hard due to old age and general deterioration of our bodies,its just a matter of time.My job is to make sure they don't get sent to a busy A&E to die there and to stay where they are with analgesia,a warm hand to hold and the taste of their favorite tipple on their lips.

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  • https://www.nursingtimes.net/michael-stone/1509869.publicprofile

    go back to sleep!

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  • michael stone

    Julie Laidlaw | 26-May-2015 4:12 pm

    I largely agree with you Julie - although not all dying people come to 'accept' that they are dying (which is another part of the web of complications).

    Anonymous | 27-May-2015 8:11 am

    And do you have an on-topic comment ?

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  • No

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