Nurses difficult job anticipating patients’ needs

by Professor Jane Seymour Sue Ryder Professor in Palliative and End of Life Studies, University of Nottingham Jane_Seymour

Our new research, funded by Marie Curie, has investigated nurses’ roles in ‘anticipatory’ or ‘just in case’ prescribing for patients at the end of life. The findings suggest that nurses need more support in anticipating the needs of patients.
We interviewed 61 nurses about their experiences of administering anticipatory medications – where a GP writes out a prescription in anticipation of it being needed by a patient to ensure that medications can be accessed ‘out-of-hours’ and hospital admission can be avoided where possible. Anticipatory prescriptions give considerable responsibility to community nurses, who must make decisions about their use. We already know that community nurses have a central role in assessing dying patients’ needs for pain and symptom control and making sure they have access to appropriate medications. This research identified four conditions that nurses felt should be met before they could administer an anticipatory prescription:

  1. Symptoms are irreversible and the patient is approaching the end of life.

  2. Patient is unable to take oral medication.

  3. The patient has given consent where possible.

  4. The decision is independent of influence from a patient’s relatives.

Some of the nurses we interviewed felt that these decisions placed an emotional burden on them and they had worries about distinguishing between pain and agitation. What the research tells us is that nurses require education, training and support from the multidisciplinary team to reduce the risk of emotional burden when administering anticipatory medications. Read the full paper