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Exclusive: Nursing Standard survey reveals huge concern over end of life care provision

Two thirds (67%) of nurses think they have too little time to provide high quality care to dying patients, a Nursing Standard and Marie Curie survey has revealed.

Two thirds (67%) of nurses think they have too little time to provide high quality care to dying patients, a Nursing Standard and Marie Curie survey has revealed.

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Staffing pressures and time constraints are the biggest barriers to good palliative care, according to the 996 nurse and healthcare assistants (HCAs) who responded to the poll.

As well as having too little time, other significant barriers to providing care to dying patients identified by the respondents include staffing levels (68%), lack of specialist palliative care support (33%) and lack of community service provision (33%).

Growing workloads are making it more difficult to provide the best care, one community nurse warned. ‘Because of increasing paperwork, larger caseloads and large numbers of recently qualified staff working in the community, high quality end of life care is much less common than it was when I first worked in the community about 12 years ago. It’s very worrying,’ she said.

One hospital nurse commented: ‘Lack of staff, task-orientated wards, time constraints. It feels awful. I wish it was different.’

Delays

The survey also shows that most nurses are aware that dying patients remain unnecessarily in hospital because of delays in funding and provision that would allow them to be cared for in the community. More than half (59%) of respondents said that they have ‘often’ seen or heard of this happening, while only 6% said they are unaware of such occurrences.

For many patients, wishes about place of death are not met, partly due to overstretched services, the survey reveals. 

Only 5% of respondents said that these requests are always fulfilled, adding that planning hospital discharge and arranging appropriate support in the community can be too slow to allow patients to go home.

RCN professional lead for long-term conditions and end of life care Amanda Cheesley said the results show the impact of an overloaded health system. ‘It is a reflection of the huge pressures there are due to staff not being replaced and the lack of funding. 

‘For staff it is frustrating and distressing because they want to do the best they possibly can. For patients it has horrendous consequences, with people not getting the treatment or interventions that they need at the right time.’

Encouraging

Marie Curie director of nursing Dee Sissons said: ‘The findings show the challenges of providing high quality care to people at the end of life in the pressure cooker of the NHS. 

‘While it is encouraging to see that many nurses are confident talking to patients about their needs and wishes at the end of life, we can’t dispute the evidence that the majority of nurses don’t feel that they have time to provide high quality care to their dying patients. 

‘It is also worrying to see that many dying patients with limited time left are stuck unnecessarily in hospital due to delays in funding and community provision to support them.’


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