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Training for a good death

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The skills needed to provide good end-of-life care cannot be underestimated. With the government supporting specialist training, Kathy Oxtoby looks at how care home nurses can develop their skills.

For some health professionals, healing is the sole focus of their practice. But end-of-life care is also an integral part of nursing.

Martin Green, chief executive of the English Community Care Association, believes ensuring people have a ‘good death’ is ‘one of the most important things a nurse can do… it’s about making every necessary clinical intervention and every effort to understand a person’s personal needs, so their passing is as smooth as possible.’

Care homes are uniquely placed to do this, adds Andrew Makin, nursing director at the Registered Nursing Home Association: ‘People mostly come to us for the rest of their lives. It’s a terrific chance to get to know someone and what they want for the end of their life.’

Dedicated end-of-life training is available for care home nurses

Care homes nurses who want to improve their end-of-life skills now can look in two places.

The Gold Standards Framework Centre in Walsall runs a dedicated care homes programme, and is currently working with over 600 homes. Each home sends two staff members – usually nurses – to complete the course and become end-of-life care coordinators. The process takes 18 months.

To get involved, care homes can either send staff to the centre’s open programme, which takes place in Birmingham, or get in touch with the centre to locate the nearest regional programme.

Nikki Sawkins, lead nurse for GSF Care Homes, says: ‘The programme is about changing practice, making sure everyone is involved – from the handyman to relatives.’ She emphasises that nurses who take the course ‘are not on their own, there’s a lot of handholding.’

The Marie Curie Palliative Care Institute, which runs training on the Liverpool Care Pathway, is developing an LCP training package for care homes in partnership with Bupa. Like the GSF, this requires the participation of the whole home. However, training is also on its way for nurses wanting to improve their skills individually. The institute is devising a package of self-directed learning that nurses can complete on their own, which will be available early next year.

Deborah Murphy, associate director of the institute, says: ‘We have found care home nurses are eager to learn but can’t always get released to attend courses. This can be accessed by a care home nurse without pulling them out of their work.’

To specialise in end-of-life care, you need considerable communication skills as well as clinical expertise. ‘One of the most rewarding skills in nursing is knowing the value of holding someone’s hand, when to speak and when not to say a word,’ Mr Makin explains.

Picking up on details is vital. He adds: ‘It’s remembering to put their favourite brooch in their coffin, or knowing what music to play when they’re dying. It’s important to get these things right because we only get one chance.’

Despite care home nurses being skilled in end-of-life care, career options have been quite limited. Mr Green thinks this
is because the high level of expertise needed to work with older people is neither widely understood nor acknowledged.

Care home nurses do not need specific qualifications in end-of-life care, but initiatives like the Liverpool Care Pathway for the Dying Patient and The Gold Standards Framework in Care Homes training programme – which aim to improve quality of care for residents – are helping to formalise nurses’ skills. Care home nurses will need to develop these further now the Department of Health has put support for the dying on the national healthcare agenda.

Launched in July 2008, the End of Life Care Strategy promotes high-quality care for all adults and seeks to provide more choice about where they want to be cared for and die.

Lots of people die in care homes each year; those who often deal with this, including care home nurses, should receive support to develop their skills through CPD or further specialist training. According to the strategy, a basic knowledge of end-of-life care should also be part of all undergraduate and pre-registration training.

Care home nurses should get support from their managers to develop their skills and have time to attend courses. However, they should also lobby their employer to make sure they get the training they need.

The strategy’s emphasis on training and development gives care home nurses the chance to improve their career options by moving into management, taking on specialist palliative care roles or transferring their skills to work in specialties such as community nursing. Mr Makin sees them becoming recognised experts in this area, sharing good practice with other staff and specialties, with some choosing to work as trainers.

The strategy will help bring older people’s services, ‘out from the shadows and into the mainstream’, Mr Green predicts. End of life could become a specialty in its own right. And, hopefully, care home nurses will receive greater recognition for their skills in supporting residents to have a ‘peaceful death’.

Helping nurses to support the dying

The resident knew he was dying but he wanted to spend his last days in familiar surroundings, not in a hospital bed.

Gail White, a palliative care specialist nurse for care homes at Sunderland Teaching PCT, was able to make sure his wish was fulfilled, by helping staff to support him at the end of his life.

Ms White provides training and supports staff in palliative and end-of-life care in care homes across Sunderland – one of the few nurses in the UK to carry out such a role. She has a clinical caseload, and gives pain and symptom management as well as emotional support. Residents are referred to Ms White from care homes via GPs, by consultants prior to a patient’s discharge from hospital and by social workers.

Ms White helped to inspire the post’s creation nearly four years ago while working as a community Macmillan palliative care specialist nurse. The Northern Cancer Network was employing nursing staff to improve the palliative care knowledge of district nurses in the area.

‘I wanted care home nurses to have access to a similar service, so my manager and I put together a proposal to the PCT for a palliative care specialist nurse post for care homes.’
Her role combines clinical work and delivering education to care home staff and healthcare assistants. This allows her to work alongside staff, and give advice ‘which is probably as beneficial as any educational session’, she says.

Working with the PCT, Ms White is also helping to pilot support and palliative care standards in care homes, focusing on areas such as communication and bereavement, so that ‘everyone is singing from the same hymn sheet’.

Shortages of equipment and a constrained training budget are some of the challenges she faces. She hopes the End of Life Care Strategy will encourage managers to make sure care-home nurses receive the training they need.

Ms White’s passion for the post is fuelled by the strong belief that she can make a real difference to people’s quality of life and death. She says: ‘It’s about supporting people to live until they die, in the best possible way.’

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