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.
Professor 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.