Policy briefing

Ask dying adults about their spiritual beliefs, NICE says

Nurses should ask dying adults about their spiritual beliefs and cultural preferences, new guidance says.  

Nurses should ask dying adults about their spiritual beliefs and cultural preferences, new guidance says 

Spiritual wishes should be documented better during end of life care says NICE
Picture: Getty Images

Essential facts  

Religion should be included in the vital discussions about the care people and those close to them want to receive in the last two to three days of life, according to the National Institute for Health and Care Excellence (NICE). 

Knowing if people hold a religious belief can be important for providing the care they desire. The 2016 End of Life Care Audit reported that spiritual wishes were only documented for one in seven people who were able to communicate their desires. The ways people die and how long this takes vary widely, but about three quarters of deaths are anticipated by healthcare staff. 

Standard improvement

NICE’s new quality standard sets out statements of best practice in four areas of end of life care where improvement is needed. 

Adults with signs they may be in the last days of life should be monitored for further changes to help determine if they are nearing death, stabilising or recovering.  

They should have their hydration status assessed daily and have a discussion about the risks and benefits of hydration options, and prescribed anticipatory medication for symptom control, NICE says. 

The quality standards are published in the light of a major shift in the care of the dying after the use of the Liverpool Care Pathway (LCP) was halted following a government review in 2013.  

The new standards echo the five priorities set out in the 2014 report One Chance to Get it Right by the Leadership Alliance for the Care of Dying People, published after the withdrawal of the LCP. These emphasise the importance of having discussions with dying people about their wishes and including them in their care. 

Expert comment 

Sue Hogston, Sue Ryder chief nurse

‘The most important aspects from this guidance are assessing the signs and symptoms of when a person is dying and having brave conversations with patients and their families about their wishes. Having these conservations is a critical part of a nurse’s work, using communication skills such as active listening and being able to manage conflict in families – to help people express their hopes and fears in a person-centred way. 

‘We have found that human rights can be a useful framework for nurses to pull on to assist when there's conflict, to help provide dignified and compassionate care. While nurses can’t change the outcome for a dying person, by having these discussions they can change the journey and how people feel. 

‘There is a real postcode lottery when it comes to care at the end of life. A lot of deaths happen in hospital and a lot of hospitals are failing the Care Quality Commission standards for end of life care. Nurses need to be supported by hospitals to have these conversations, and they also need to seize the opportunity to have them whenever they can.’ 


Implications for nurses  

  • Provide end of life care that is responsive to the personal needs and preferences of the person who is dying. 
  • Hold discussions with the person to identify any existing expressed preferences for care, such as advance care plans, and explore their goals and wishes, preferred care setting, current and anticipated care needs and any cultural, religious or social preferences. 
  • Record this information in an individualised care plan. Discussions should continue with the patient and family in case any wishes change. 
  • Assess hydration status daily and discuss options with patient and family.  

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