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Nurses raise 'profound concerns' about end-of-life care

Nurses are concerned about the quality of end of care life care in the UK, a survey has found. 

Only 10.5% of Royal College of Nursing (RCN) members surveyed said they are always able to deliver the right level of care to patients. 

Many (58.5%) said the wishes of patients could not be fulfilled during the last six months. When asked why, reasons given included a lack of time, and some nurses said they had not been given the right amount of training. 

Half of the nurses (49%) said they do not always have a chance to discuss with patients how they would like to be cared for during their final days. 

Only 36% of nurses working in the community said that their team has the resources to deliver round the clock care to patients who have chosen to die at home.

And 69.4% of community nurses had seen patients having to be taken into hospital in their final hours, against their wishes, because there were not the resources to care for them at home.

One nurse told the RCN: “When it works well it is the most rewarding aspect of nursing care but sadly it can be very frustrating when you are aware it could be better if you had more time and resources available”.

Another said: “I believe care of the dying is a privilege but hospital settings are just so busy these days.  A dying patient and their family needs nurses with experience to oversee them so they can get the best care”.

Dr Peter Carter, chief executive of the RCN said the survey had "touched a nerve" in nursing staff. 

"Hundreds have told us about the honour and privilege of caring for people at the end of their lives. However, many are also profoundly troubled by their experiences of trying to deliver care for the dying, against a backdrop of staff shortages, lack of resources, inadequate training, cost pressures and rising demand," he said. 

Dr Carter explained that sensitive nursing can make an enormous difference to the experience of a dying person and a “good death” with expert care can also make the bereavement process much easier for the loved ones they leave behind.

He added: “Nursing the dying is an art, as well as a science. It cannot be reduced to a process of drug administration or a series of required nursing tasks, however important these things are.

“Nurses need time to listen to what the dying person wants, to recognise their fears and anxieties and to help loved ones to understand what is happening. The nation and the health service need to be better at acknowledging the importance of a good dying process, where our wishes about how we are cared for in our final days are respected and can be delivered when the time comes”.

More than half of those surveyed said that they treated people approaching the end of their life at least once a week, with many doing so on a daily basis. Despite this a quarter of nurses (25%) said that they had received no specific training, either before they qualified or since they had started work.

When asked why patients' wishes had not been a fulfilled, nursing staff cited the following problems:

 - A lack of time (33.7%)

 - A lack of resources where they work (26%)

 - A lack of resources in another area (30%)

 - A lack of training (23.9%)

A palliative care nurse said: “It is an honour and a privilege to be invited into someone's home to care for them and their family at end of life…this is part of my role - having sensitive discussions with patients and their families. It takes time, gentle conversations and an ability to gauge how the conversation is going and when to stop”.

Another told the RCN: “I wish we could have these discussions early on and review often if needed. But not enough staff and too much work does not give you time in the day to start and continue such sensitive matters.”

Another nurse said: “There is nothing more fulfilling or humbling than to ensure the final hours of someone's life is pain free and peaceful... and that relatives and carers are supported fully during this time”.

The RCN is now beginning a large scale programme of work to establish what support nurses need to deliver the care they would like.