Is educating community nurses about end-of-life care a waste of resources?

Abstract

British Journal of Community Nursing Vol 18, No 2 77 The health system—and palliative care in particular— are facing difficult financial times due to spending cuts. It seems that when times are this hard one of the first things to go is staff education, which is disturbing considering that it takes years to train community palliative care nurses to function at specialist level. Attendance at courses, conferences and study days/seminars are all affected, which leaves one asking whether palliative care education among community nurses still has currency needed to enhance patient experience. However, despite these negative outcomes the Government has confidently stated that a positive patient experience is an important quality health outcome. The financial situation and the Government’s aspiration create tension, in that, to create a positive patient experience, there must be a well trained workforce to deliver the best services and care possible. But the Willis report (2012) concurs that there are no ‘major shortcomings’ in nursing education to affect the quality of care given to patients. The report goes on to recommend under theme 4: continuing professional development that all relevant bodies including employers and universities should recognise, fund, promote and support nurses development. This would include community nurses as a way of investing for the future. The issue may be how education is translated into practice to benefit patients. It was encouraging when, in January, the prime minster pledged £40million funding for ward managers, community team leaders and senior nurses to gain necessary skills to provide compassionate care. For community team leaders, compassionate care is even more crucial to patients at the end of their lives. However, considering the number of groups this money is intended for, one wonders whether it will be enough to see real change for all patients. Education of community nurses in palliative care is crucial if all patients are to be afforded a dignified and unique death. Education of community nurses ensures that patient experience can be enhanced at point of care delivery. Community nurses need to understand the patient’s needs, concerns, wishes and fears. Community nurses need to be equipped with skills that help them support the patient physically and emotionally. When death is impending, most patients want information so informational care is vital. The national cancer patient experience survey (2010) reported 43% of patients want more information about their diagnosis than what they are given (Department of Health, 2010). Informational care helps patients understand better their disease, its progression and palliative treatment plan where possible. Educated community nurses can provide evidence-based information, which has been tested for validity. However, in order to do so they need to be able to understand the evidence to decide on its clinical relevance. Education is one sure way of achieving this. The knowledge that death is imminent often evokes emotional responses for patients, and a community nurse may be the first professional to visit them at home, following confirmation of the diagnosis. Patient experience would be enhanced if the nurses recognise and address the emotions being expressed in a non-judgemental way. Emotions are expressions of feelings and at times a cry for help, which can be managed through information or a platform to talk and alleviate anxiety, worries and fears. Evidence from Armes et al (2009) suggests 50% of people (150 000 per year) experience anxiety and depression following a diagnosis of cancer. In order to support patients with emotional needs, community nurses’ communication skills need to be effective and this can be enhanced through training and refresher workshops. Some employers afford their staff sufficient education and training and demonstrate continual professional development. However, in some organisations—and I have experienced it personally—it is quite frustrating for nurses who are funded to attend palliative care courses, conferences and seminars to find that when they return, there is no appetite from management to implement the new evidence or facilitate knowledge exchange with other staff. Putting this into the context of real cost and time, it translates to a waste of resources, educating these nurses in this way. Similarly, when community nurses have completed a research project as part of their degree, there is no incentive to disseminate findings and implement changes in practice. A clear strategy is essential to ensure that such vital knowledge is put to good use that will benefit patients at the end of their life. One in five people develop significant long-term emotional difficulties (Macmillan Cancer Support, 2012), seriously affecting their quality of life, so it is vital community nurses are supported to improve the patient experience and do it right first time. BJCN