Community nursing teams have acquired extended roles in palliative and end-of-life care during the pandemic. Despite increased caseloads, they have continued to provide face to face care for dying people at home and in care homes, say researchers in an article published in the British Journal of Community Nursing.
Ben Bowers at the University of Cambridge, writing with Kristian Pollock, Crystal Oldman and Stephen Barclay, describes how radical changes in delivery models for end-of-life care and palliative care in the community have impacted on community nursing. The team emphasise the need for evaluation of the changes, in work funded by NIHR.
With larger numbers of people dying at home and changes in policies and procedures, the researchers explain that district nurses and care home nurses are leading more end-of-life care.
While GPs and specialist palliative care nurses have moved to predominantly remote consultations, community nursing teams have continued to provide face-to-face care for patients and have acquired newly extended roles. They are increasingly able to complete Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms, make medical care decisions with remote GP support, and verify expected deaths during the pandemic.
In some areas, end-of-life drugs can now be prescribed remotely and direction to administer instructions sent electronically. Unused drugs can be repurposed in care homes with patient and prescriber permission. There remains ongoing concern about appropriate prescribing of anticipatory syringe pumps, as described in this Letter to BMJ Supportive and Palliative Care: ‘Anticipatory syringe pumps: benefits and risks‘.
National guidance aiming to enable family caregivers to safely administer end-of-life drugs has been published. Often, it’s the community nursing teams providing the training and support for those family caregivers willing to take on greater responsibility for care.
COVID-19 has heightened awareness of the importance of advance care planning to enable patients to express their wishes for their care. One of the lasting legacies of COVID-19 may well be that community nurses become increasingly skilled and empowered to lead end-of-life planning conversations and associated care.”
– Ben Bowers, lead author, Cambridge Palliative and End of Life Care Research group
The authors emphasise that thorough evaluations of the rapid changes in practice, with input from community nurses and GPs, are vital to inform future care during and beyond the pandemic.
Read the article
B Bowers, K Pollock, C Oldman, S Barclay, ‘End-of-life care during COVID-19: opportunities and challenges for community nursing, in British Journal of Community Nursing, 28 December 2020 https://doi.org/10.12968/bjcn.2021.26.1.44
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Ben Bowers is NIHR SPCR PhD Student at the Cambridge Palliative and End of Life research group, and Queen’s Nurse.