Nurses are at the very heart of providing end of life care with care of the dying being integral to practice. In almost 40 years’ of nursing, I have not met a nurse who does not pride their self in end of life care or does not prioritise caring for the dying and therefore complying with the NMC Code stating that nurses should "... recognise and respond compassionately to the needs of those who are in the last few days and hours of life".

With possibly 70-80% of deaths considered expected and almost 60,000 deaths per year in Scotland, care of the dying is a significant aspect of nursing. Nurses undoubtedly make the greatest contribution to caring for the dying in all settings. Ensuring they are adequately supported to do this to the highest quality requires organisational systems that are conducive to facilitating excellent care coordination and provision. This includes appropriate staffing levels and access to relevant education in key areas such as symptom control and communication skills. Being able to communicate effectively is the most fundamental of skills required to provide compassionate care. It also requires access to resources such as equipment in a timely manner, especially for those in the community setting. 

With approximately 60% of care home residents requiring care from registered nurses and an estimated 7,000 deaths in care homes per year, we need to understand the educational support and resources required to deliver the right care, by the right person, at the right time, to the right quality standard with the right outcome to the residents in care homes. We must also be mindful of the increasing complexity of need amongst the residents in care homes. If we do not have sufficient numbers of registered staff in the care homes, there is a major risk of unnecessary suffering and inappropriate admission to hospital. 

The vision in the national Strategic Framework for Action on Palliative and End of Life Care states: “By 2021, everyone in Scotland who needs palliative care will have access to it.” To achieve this vision and the recommendations within the Strategic Framework we need to continue to support staff in all areas. We need to particularly support staff in care homes if residents are to remain in care homes and not be admitted to an acute hospital environment inappropriately in the last few days of life. However, dying in an acute hospital should not always be portrayed as negative: staff in the acute environment do an amazing job and dying can be so complex that there are some people  who absolutely need to be there (my own mother included and I was so grateful for the wonderful care she received.) We also need to help staff identify the changing need as the person’s condition deteriorates and recognise dying. Scottish Care in their report about bereavement in 2017, highlights that lack of bereavement support for staff is contributing to the high numbers of carers who leave the caring role. There are tools but expert teams need to be able to provide the training of staff in the care homes. 

Nursing is integral to providing end of life care but staff need support in both practical and emotional terms. It’s vital we look after those who look after us. 

Sandra Campbell

National Clinical Lead for Palliative and End of Life Care/Nursing

Health Improvement Scotland

https://www.rcn.org.uk/news-and-events/blogs/sandra-campbell-end-of-life-care-14-may-2019 

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