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Where would you wish to die?

The new end-of-life strategy will give people more choice and control over where they end their lives. Where would you like to spend your last hours?

Lynn Young
Primary Healthcare Adviser for the RCN

Nurses, regardless of where they happen to be working, are set to experience even more change this autumn, as this is when the direction of travel as described by Lord Darzi will commence. I would quite understand why a sense of doubt may be taking its grip and strangling out all sense of energy and enthusiasm, but please, dear readers, try not to feel somewhat cynical about the introduction of yet another Department of Health white paper.
 
Because unfortunately, as nurses, we cannot afford this luxury. It is our discipline more then all others that holds the key to vastly improving the patient experience and quality of care. Being 70% of the healthcare workforce brings its own responsibilities and nurses need to constantly remember that while other health-related disciplines are crucial to good patient care, it is the need for nursing that results in patients staying in hospital overnight. Hospitals and communities are, for the main part, more nursing organisations than any other, which renders the profession vital to achieving best possible patient care.

The Darzi Review has provided a clear picture about the future direction of healthcare. This time the line is quality, quality, quality and more quality. Modern care has to be designed around the individual's needs and preferences, rather than the needs of the organisation, and patients will be encouraged to rate their healthcare experience. In the future it will not be good enough for professionals and staff to simply be clinically safe and competent, quality of care will also have to be exemplary, with patients feeling that their dignity and confidence remain intact, even while the most intimate of procedures is being carried out.

And this leads me on to the inevitable in life - death and taxes. Well just death really - I religiously pay my taxes like all other good citizens, and this article will contain no further detail on this painful subject. But it is time to talk about death and end-of-life care.

We now have an end-of-life strategy, produced by the Department of Health, which is receiving additional funding from the government to help successful implementation. Excellent end-of-life care is so important and there is to be a renewed drive to help patients die at home, with their belongings around them, family and friends at their bedside, and the family dog there too if wanted. Living in modern times has its advantages. Many a well-read novel contains heartbreaking accounts of how people have suffered the most horrible, agonising and lingering death. Thankfully this does not need to happen today, but unfortunately far too many people die in hospital, which is a far from ideal environment to do so. While the hospice movement provides a miraculous service, to die well at home is the ultimate wish of many.

Symptom and pain control can invariably be managed well with the appropriate use of modern drugs, and nurses, such as district and Macmillan nurses, are available to visit patients at home. We know that in many areas end-of-life care is of the highest quality, but this needs to be the case in all areas.
Hence the end-of-life strategy, which will, in time, help all patients who wish to be at home in their own bed when they die, actually do so. Once patients and their carers are reassured that expert help and advice is on hand it is unusual for them to request a hospital admission when things get a little difficult.
 
Many years ago, when I was a complete novice nurse in the community, I accompanied an experienced and wise district nurse to the house of a gentleman who clearly had little time left to live. I was completely bowled over by the utterly personalised care provided by this particular district nurse and how brilliant the nursing was in this rather impoverished house. Impoverished it may have been, but the patient, his wife and children were relieved to have their husband and father at home, so that they could carry out the nursing, but with all the help they wanted from the local district nurse.

Such memories last and I was reminded of this particular incident when I heard that the new end-of-life strategy had been produced - we all look forward to its implementation.