Many more nurses should be helped to improve their communication with dying people and their families, according to a report published today.
The report, published by the NHS's National End of Life Care Programme (NEoLCP), calls for greater use of free or lower-cost training options such as e-learning – as well as access to advanced communication skills training where appropriate.
Talking about end of life care: right conversations, right people, right time brings together the lessons of 12 pilot sites.
The report concludes that wider access to high quality training would lay the groundwork for the "cultural change" that is required if people approaching the end of life are to help shape and plan their care.
Patient involvement is expected to grow with the development of a 'a choice offer' in end of life care. The pledge for such an offer was included in the NHS White Paper, Equity and excellence: Liberating the NHS. Improved communications would also fit with the white paper's core message of "No decision about me without me".
Anita Hayes, Deputy Director of the NEoLCP, said: "When nurses and other health professionals have early conversations about end of life care with their patients they provide them with control and choice over their care. It is an opportunity to start advance care planning and can improve the co-ordination of care across different agencies. Delaying those conversations increases the likelihood of complaints, late referrals to palliative care services, unplanned admissions and inappropriate interventions in response to a sudden deterioration.
"Communications training in end-of-life care could therefore potentially save money as well as improving patient care. Targeted training in this challenging area equips nurses with the skills and confidence to initiate these conversations and maintain that communication throughout a patient's journey on the end of life pathway."
Ms Hayes concluded: "Over the next 20 years the number of deaths will rise significantly due to demographic change and services are seeking to meet the wishes of an increasing number of people to die in a setting other than hospital. That means a wider range of nurses will be actively involved in the provision of end-of-life care from the early stage through to death. Effective, early and regular communication will be vital in providing that care."
We asked if you feel more training is needed in end-of-life care. Your comments (terms and conditions apply):
"Yes most definitely" - Dorothy Flanagan, Rossendale
"Yes I do, in particular with people with dementia" - Sue Wrintmore
"Yes! Especially with regard to communicating to family members and about the dying process. Some are wont to believe or suspect that it is the nurse's mistake anyhow that may have hastened the death of a loved one and follow with law suits. This may be based on what they have heard from the nurse at some point earlier in the course of care. The nurse needs to be trained on when to be very honest with what information to pass on and how and when is the most appropriate time" - Tunde Osungboye
"Yes, I am. Working with frail elderly and I am not enough prepared for end of life care" - Simona Aconstantinesei, London
"Although I am 35 years old I wish I could have trained in the 60s or 70s. I have been in community care for numerous years now and would have loved to have gone into nursing. Patient care really seems to be out of the window. I enquired at my local College to do an Access course but was told as I was working part time, I would need to pay the full fees for £1,500 (never had that amount of money in my life going spare!!) That's before you even apply to University for a course. It is not fair for people who really care. I have decided that I will gop for a job eventually as a Health Care Assistant and make a career of this" - Adele Smith, Coventry
"NHS Education for Scotland is developing a an online learning portal that includes an Advance & Anticipatory Care Planning (ACP) Toolkit and a work-based learning resource on the Principles and Practice of Palliative and End of Life Care.
http://www.aurionlearning.com/newsDetail.asp?newsId=66" - Noleen Turner, Northern Ireland
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