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Communication vignettes: ’Why am I on a pathway nurse?‘
  1. Helen Scott, Editor, End of Life Care and
  2. Vicky Robinson, Consultant Editor, End of Life Care, and Consultant Nurse in Palliative Care
  1. Guy’s and St Thomas’ NHS Foundation Trust, London

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Introduction

The Liverpool Care Pathway for the Dying Patient (LCP) was developed to transfer the hospice model of care for people in the last days or hours of life into generalist settings. It is a multidisciplinary, integrated care pathway to guide the way in which care is delivered to dying people and their families, friends and carers, e.g. whether there is a continued need for invasive procedures and current medications (Ellershaw and Wilkinson, 2003). However, the pathway is only as effective as the expertise of the practitioners using it. Healthcare professionals are required to use their own clinical judgment in the process and continually reassess the patient’s condition (Department of Health, 2008, 2009).

Communicating with dying patients and their loved ones should be in the skills base of every nurse. Effective communication is integral to the success of the LCP. It is essential that the patient (if conscious and capable) and their family/friends are aware of the diagnosis and that the clinical signs indicate that the dying phase is approaching. A recent audit found that the LCP improves the quality of clinical care that people receive in the last hours and days of life. However, certain aspects of care still require improvement. One of these relates to communication with the patient and their relatives/ loved ones during the dying phase (The Marie Curie Palliative Care Institute and Royal College of Physicians, 2009). The audit found that only a third of patients (who were not comatose) were provided with an explanation about their condition at the time the LCP was commenced. Just under three-quarters of carers in the audit sample understood that the patient had entered the dying phase.

This article is the fourth in a series of fictitious communication vignettes wherein conversations that commonly occur within end-of-life care are …

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