There have been disturbing accounts in the media of nurses discussing end of life care with elderly patients in a blunt and impersonal way, particularly patients’ wishes concerning resuscitation.
This morning I spoke to Roy Lilley, who described the experience his mother had. It was not good, upsetting and should not have happened. As a nurse I was very disappointed to hear that story.
There are thousands of great district and community nurses delivering compassionate care in a wide range of environments every day. They would never dream of asking patients where and how they would like to die in an insensitive or bureaucratic way.
This is one of the most important questions a person ever faces. However, it needs to be part of an ongoing discussion that develops out of a meaningful relationship between a nurse and patient and their families. The aim is not simply to work through a document and tick it off, but to ensure that every patient’s questions, concerns and options have been addressed.
The document ‘Avoiding unplanned admissions enhanced service: Proactive case finding and care review for vulnerable people’ is intended to help GPs, nurses and other health and care staff develop personalised care plans with those who are most vulnerable and have complex health and care needs.
The template includes lots of important questions from gathering information about allergies and current medication to also collecting people’s emergency contacts.
There is one question on the form relating to emergency care and treatment and it mentions resuscitation as a possible discussion point. Clearly if this conversation is appropriate for the patient, and as the form suggests it might not be, then it should be handled with great care.
Just as it is important for nurses to listen to patients, it is important for the NHS to listen to patients and patient organisations.
We will review the form again, with patients and clinical staff, in the light of the poor experiences described in the media and make any changes that are needed.
Compassionate care should be at the heart of all conversations and relationships between a nurse and patient. Poor implementation of a document by individuals is no excuse for causing distress to our most vulnerable patients and their families.
Crucially, care plans should be developed with full consideration of all the issues involved. A care plan is not a document in itself; it is only as good as the conversations that patients, nurses and GPs have together.