Nurses need confidence to discuss end of life care

For nurses working with older people, recognition of end of life and providing appropriate support for patients and their families is a core role. There are many aspects to this role, from symptom management and promotion of comfort to family support and counselling.

The discontinuation of use of the Liverpool Care Pathway in 2013 exposed many issues relating to how health professionals manage, and communicate about, end of life care in all settings.

It also revealed a need for more evidence on effective methods of planning and providing care in a structured framework.

Care homes

This issue, in an Evidence & practice article, Anna Cox and colleagues explore issues in developing, implementing and evaluating an end of life care intervention in care homes. Their work involved the introduction of an end of life care toolkit and training, delivered by a specialist palliative care team.

The intervention has led to increased staff confidence in symptom management and a reduction in the number of residents dying in hospital.

Although staff confidence in symptom management has increased, confidence in discussing death and dying with residents and their families has not. Perhaps this is because practitioners gain this confidence through experience as well as training.

With experience and support we learn when to initiate the conversation and how to deal with the issues that emerge. Health professionals’ conversations with patients about death and dying can reveal their wishes for advance care plans (ACPs), preferred place of care and wider support needs.

Nurses need the confidence to discuss these emerging issues with colleagues and ensure they are successfully interpreted into more structured end of life care plans, including ACPs, clinical management plans and admission avoidance.

About the author

Nicky Hayes

Nicky Hayes is a nurse consultant for older people, King’s College Hospital NHS Foundation Trust, London, and consultant editor of Nursing Older People