Viewpoint: Nurse involvement in CPR decisions

New guidelines on involving nurses' views in decisions over who should receive CPR will benefit doctors and patients, says Dr Simon Kenwright.

New CPR guidelines issued by the BMA, the Royal College of Nursing and the Resuscitation Council state that experienced nurses should be allowed to make decisions regarding the resuscitation of a patient.

These will benefit doctors, and in particular they will benefit those patients for whom attempted resuscitation is against common sense, such as those who are terminally ill.

Pointless treatment

Some anti-choice organisations may see the resolution to allow nurses to make this decision as devaluing life. Such a view ignores accepted good medical practice that we do not offer pointless treatments. We still need someone at the bedside to make the decision about whether or not to give CPR.

Nurses undergo a lengthy training and ongoing assessment and are no less qualified than doctors.

Personal relationship

As a hospital doctor with some 40 years experience, I have known many nurses who have developed excellent professional and personal relationships with their patients.

Dying patients must have the opportunity to talk about their anxieties and be given the chance to take the lead in planning their end-of-life care.

This does not come easily to some patients, and is often made worse by doctors wishing to avoid the subject.

Often a nurse will be better trained and better placed to carry out these discussions which need to cover psychological, social and sometimes spiritual aspects of care as well as medical considerations.

Nurses providing palliative care are often the first port-of-call for patients wanting to confide in someone their feelings on their end-of-life care.

The public generally seems unaware of the distress that can be involved in resuscitation attempts as well as the fact that they are often unsuccessful.

Communication

Where possible, patients and their family or friends should be involved in end-of-life decisions and some hospitals have excellent patient leaflets and information that can be used to introduce a discussion.

Conversations about dying provide an opportunity to discuss with patients the significance of an advance decision, to take effect if they lose their mental capacity.

It is best if a doctor, ideally the GP, is involved at this stage because these decisions are likely to be more disease specific in future.

They should also cover views on general issues such as resuscitation ensuring that the patient's choices are known.

An advance decision form (formerly known as a living will), such as that produced by the campaigning organisation Dignity in Dying, allows patients to specify the treatments they would like to receive as well as those they do not want should they become mentally incapacitated.

Dying at home

It is important that doctors inform their patients of all options available to them.

Many patients want to die at home and these new guidelines should be helpful for GPs caring for these patients.

Patients need to know that the health professionals caring for them will always act in their best interests, regardless of who is physically present.

Appropriate decisions about resuscitation should ideally be made in advance.

However, in some cases, it is not in the best interest of the patient to deny a suitably trained nurse the opportunity to decide whether or not to initiate CPR.

This is especially the case when the alternative is to call the emergency services, who have more urgent priorities.

Shared care

A healthcare system that allows for common sense and patient choice is a fundamental part of creating a patient-centred service.

Shared care does not just refer to interactions between GPs and hospital doctors, but must also cross professional boundaries.

- Dr Kenwright is a retired consultant physician and gastroenterologist in East Kent and a member of Dignity in Dying.

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