DNACPR: nurses need training to improve vital conversations
Posted 14 March 2024 - 14:30
Nurse play important role as challengers around DNACPR decisions but should have scenario-based training and guidance on end of life conversations, says report
Nurses and doctors need improved training to better navigate conversations around 'do not attempt cardiopulmonary resuscitation' (DNACPR) recommendations, according to the health service Ombudsman.
Scenario-based training could support healthcare professionals to respect individuals' rights through emphathetic and thorough conversations, says the report by Ombudsman Rob Behrens.
Poor documentation and record checking mean decisions are not always being followed, and improvements including communication surrounding the process are needed so doctors and patients and their loved ones can make informed choices about their care, Mr Behrens found.
Patients and their families are not always told when such a decision has been made, with older patients and those with learning disabilities particularly affected, he says in the report End of Life Care: Improving DNACPR Conversations for Everyone.
The report recommends that nurses should have end of life conversations with patients earlier as they ‘often happen in emergency settings, which is often too late and carried out under extreme stress.’
A patient’s age or disability should not affect their right to be treated with respect and care
The report states: ‘It is particularly important for older people and disabled people that care and consideration is given to end of life conversations, to avoid any perceptions that bias has affected decision-making.
‘A person’s age or disability should not impact their human right to be treated with appropriate respect and care, especially on such a critical issue as end of life care.
‘Sadly, there is a lot of misunderstanding and confusion around DNACPR and the NHS needs to make urgent improvements and look at past mistakes when it comes to DNACPR process.’
The report includes the story of Sonia Deleon, who was admitted to hospital three times during the COVID-19 pandemic and a DNACPR decision was made without her family being informed.
RCN urged to help create guidance on end of life conversations and standardising care
Following her death, her sister Sally-Rose Cyrille complained to the Ombudsman after discovering the reasons for the decisions being made included frailty, having a learning disability, poor physiological reserve, schizophrenia and being dependant for daily activities.
Ms Cyrille said : 'To find out doctors didn’t think it was worth even trying to resuscitate Sonia because she had learning difficulties and schizophrenia was just the most unbelievable, devastating bit of information that came out of what had happened.’
The report suggests that the RCN should collaborate with the Royal College of General Practitioners and the Royal College of Physicians to create guidance for nurses and doctors on promoting end of life conversations and standardising care.
It also calls for CPR training for doctors and nurses in all settings to include scenario-based training on DNACPR, co-designed with older and disabled people.
Patients should expect CPR discussion regarding their preferences, wishes and needs, says NHS England
The report also underlines the need for more accessible material to help improve conversations with people with learning disabilities, along with more resources from NHS England for more acute liaison nurses.
It states that nurses are vital for potential challenges to decisions: ‘Nurses already play an important role as interpreters and challengers around DNACPR decisions. They are vital to conversations taking place in more appropriate formats and settings.’
An NHS England spokesperson said: ‘Patients should expect discussions regarding CPR resuscitation to take place as part of a wider conversation regarding their preferences, wishes and needs related to their future care, most likely following diagnosis of a life-limiting or life-threatening condition.’
RCN professional lead for care for older people and dementia Sally Wilson said: ‘The recommendations are right to support greater guidance, and expanding the number and type of staff who can formally support DNACPR. Delays in conversations can be devastating and urgent improvements are needed.'
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