Listening to important questions

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.

Jane Cummings

Professor Jane Cummings is the Chief Nursing Officer for England and Executive Director at NHS England.

Jane specialised in emergency care and has held a wide variety of roles across the NHS including Director of Commissioning, Director of Nursing and Deputy Chief Executive.

In February 2004, she became the national lead for emergency care agreeing and implementing the 98% operational standard. She has also worked as the nursing advisor for emergency care. In January 2005, she was appointed as the National Implementation Director for ‘Choice’ and ‘Choose and Book’.

Jane moved to NHS North West in November 2007 where she held executive responsibility for the professional leadership of nursing, quality, performance as well as QIPP, commissioning and for a time Deputy Chief Executive Officer. In October 2011, she was appointed to the role of Chief Nurse for the North of England SHA Cluster.

She was appointed as Chief Nursing Officer for England in March 2012 and started full time in June 2012. Jane is the professional lead for all nurses and midwives in England (with the exception of public health) and published the ‘6Cs’ and ‘Compassion in Practice’ in December 2012, followed by publishing the ‘Leading Change, Adding Value’ framework in May 2016.

Jane has executive oversight of maternity, patient experience, learning disability and, in January 2016, became executive lead for Patient and Public Participation.

She was awarded Doctorates by Edge Hill University and by Bucks New University, and she is a visiting professor at Kingston University and St George’s University, London.

She is also Director and trustee for Macmillan Cancer Support and a clinical Ambassador for the Over the Wall Children’s Charity where she volunteers as a nurse providing care for children affected by serious illnesses.

Follow Jane on Twitter: @JaneMCummings.

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  1. Barbara says:

    Have you spoken to, or contacted the particular nurse involved in the above incident and listened to her version of events ?? I am sure the nurse concerned did not set out to upset or offend anyone.

  2. Mrs.Anne AShurst says:

    More people should know about the NHS Constitution and their rights before things go wrong in hospital.Patients trust nurses and doctors but they need a voice when vunerable people are going into hospital and they have no family which is deeply concerning and no care plan in advance decisions can be made which might not be in the patients best interests.
    Things need to change so the patient is the first concern and they are treat as an individual and have open and honest discussions that they can understand.

  3. Michael Davies says:

    I wonder if this is an example where professional education has lost some of the common sense that as a student radiographer I was constantly reminded of by my qualified colleagues.

    Don’t get me wrong I’m not a nay sayer against graduate entry into professions. I was with the team that created one of the first in diagnostic radiography. However, our ambitions were to enhance the development of new professionals, not de-humanise them in the drive for the best academic outcome.

    I see the current crop of my profession highly aware of the imaging practicalities but with very little of that ‘nous’ that allows them to interact skillfully with their patient. I learned more about how to do the job from colleagues who’s main skill was communication, than I ever did in the classroom. Education is good, but we must recognise it’s as important in the work environment as it is in the halls of academia.

    Surely in the same vein nurses who have benefited from the interplay of academic and pastoral learning gain the knowledge, skill and ability to shape the conversation with their patients will be capable of having the kind of sensitive conversation with a vulnerable patient that the framework suggests.

    Take the pressure off, ensure our healthcare professional have the skills, time and space to approach these sensitive issue in the most appropriate manner. Stop the form filling approach as a drive for efficiency and lets get back to caring for our patients.

  4. loretta says:

    End of life care is quite a sensitive and painful issue to discuss with patients and their near and dear ones Empathy and body language must play a greater part when imparting nursing care

  5. Clive Bowman says:

    The problem is the lack of understanding (let alone evidence for practice) of the illness “space” between acute/rehabilitative care and dying specifically the medical/nursing role. Have a look at the idea of Formative Care and understand that whilst Palliative care has been brilliant in certain defined cases it is not a panacea for the aged frail. Compassion needs purpose!!

    Formative Care: defining the purpose and clinical practice of care for the frail Clive Bowman and Julienne Meyer J R Soc Med, March 2014; vol. 107, 3: pp. 95-98., first published on December 13, 2013

  6. Rosie says:

    Very glad this template is to be reviewed. Sorry that nurses and other hcps are being implicated in inappropriate implementation. Surely, whoever wrote it and authorised its publication need to account for their actions first?

    Could I suggest that the whole document is also reviewed. In my view, there is extreme danger that this ‘ES’ can become a patientless paper exercise. Nurses could be the right people to help avoid this if they were to be consulted about how it is written.

    Thank you for considering my comments

    Rosie Walker RN

  7. Alan Christopher Creaser says:

    I have “Chronic Fatigue Syndrome”/Fibromyalgia/Myalgic Encephalomyelitis & I’m 60 & live at Hull, & I know that Not enough help is given to people like me with ‘cognative dysfunction’…. 🙁
    – 95% of NHS staff Don’t know the first thing about how Debilitating they are….. … 🙁