Jennifer Worth - In the Midst of Life

Treatment interventions that are unlikely to be successful should not be offered.

The CPR guidelines state that each resuscitation decision should be discussed, where appropriate, with the individual or their representative (BMA et al, 2007). However, ‘discussion’ does not necessarily mean asking the patient or family to make a decision. Discussion may involve talking things over, finding out what the person’s understanding of the current situation is, and outlining the treatment aims (Bass, 2006). This can be achieved by asking the question, ‘What is your understanding of what has been happening to you/your relative up to now?’ Alternative questions such as ‘Are you the sort of person who likes to know what is going on?’ can be helpful.

These questions may show that the patient understands much more than first thought, or that they would rather you discussed interventions with someone else, for example their family or carers.

Patients may have heard what has been said but have not retained the information. They may have difficulty taking in what has been said either because they cannot believe it, or they do not understand the terminology used. It is important to check a patient’s understanding and provide written information if appropriate to reinforce what has been said.

Using appropriate terminology

It may not be appropriate to use the term ‘resuscitation’ when discussing end-of-life care with patients. Simple phrases stating that at the time of death you will not attempt ‘anything heroic’, but will ‘do all we can to make sure you are comfortable’, are extremely useful.

By making sure we communicate well, and by using tools such as the GSF, LCPI, DNAR policies and advance care planning documentation, nurses can ensure that they are supporting their patients at the end of life.

Awareness of when CPR is appropriate and careful assessment and care planning by the multidisciplinary team will ensure that patients are only offered interventions that are beneficial.

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Acute respiratory failure 2 - nursing management. 16 September 2008

An audit of nursing observations on ward patients. 24 July 2008

Guidelines focus on improving patient safety in mental health. 28 November 2008

National Patient Safety Agency issue an alert on mental health resus. 2 December 2008

Should patients who are at the end of life be offered resuscitation? 23 January 2009

Palliative care is governed by certain principles, which guide the care given. It:

Provides relief from pain and other distressing symptoms

Affirms life and regards death as a normal process

Intends neither to hasten or postpone death

Integrates the psychological and spiritual aspects of patient care

Offers a support system to help the family cope during the patient’s illness and in bereavement

Uses a team approach to address the needs of patients and their families, including counselling, if indicated

Will enhance quality of life and may positively influence the course of the illness

Is applicable early in the course of the illness, in conjunction with other therapies that may prolong life, such as chemotherapy or radiation therapy, and includes investigations needed to better understand and manage distressing clinical complications. (World Health Organization, 2004)

Other principles of palliative care promote:

Quality of life: palliative care tries to enhance this as much as is realistically possible