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End of life discussions: they're about far more than filling in forms

Nurse tells Patient Safety Congress 2018 preparation helps clinicians have better end of life conversations

Nurse tells Patient Safety Congress 2018 preparation helps clinicians have better end of life conversations


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Nurses need to be prepared for the effect on patients and themselves of having end of life conversations, a senior nurse said.

Patient emergency response and resuscitation team senior nurse Jillian Hartin was speaking on the opening day of the Patient Safety Congress 2018, run by the HSJ in Manchester.

This is about human beings – staff as well as patients and families

Ms Hartin, of University College of London Hospitals Foundation Trust, told a session on end of life care in acute settings it was important to look at patient death and decisions like 'do not resuscitate' as more than just ‘filling out a form’.

‘This involves human beings and feelings,’ she said. ‘Not just for the patient and the relative but also our staff and how it feels to make these decisions and have these conversations.’

To help prepare colleagues, Ms Hartin runs a series of simulations with actors, in which medical professionals are presented with a situation they need to manage. She said these can be intimidating, but most participants find them rewarding.

‘It’s scary but we get good results,’ she said.

A safe place to practise scenarios

‘This is a safe place to go and practise and learn from others and from yourself, and get really uncomfortable.

‘One of our ward sisters was so boosted by it that she started challenging the decisions being made for patients with life-limiting illness in her area, which had never happened before,’ she said.

Four in ten respondents to a survey carried out by Nursing Standard and the charity Marie Curie earlier this year reported not having received any training in difficult conversations.

ReSPECT expert working group co-chair, Peter-Marc Fortune also spoke at the event.

ReSPECT, which stands for Recommended Summary Plan for Emergency Care and Treatment, was developed by more than 30 groups, including the RCN, and aims to provided a standard approach to patients of all ages for use across all healthcare settings, to help practitioners to frame the conversations and give appropriate care based on that information.

ReSPECT pilot projects

One aspect of the process is asking patients to complete a form indicating where they are on a spectrum to wanting to have everything possible done to ensure survival to wanting only symptom control.

Having piloted it in December 2016, Dr Fortune said ReSPECT was now used at eight sites, with 10 more to go live later this year, and a further 80 sites in discussions.

Dr Fortune said end of life discussions should be undertaken by the clinicians who know patients and families best.

‘It might be appropriate it’s a doctor but many times it’s a community nurse that knows that family far better,’ he said.


Further information

Read about ReSPECT


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