Nurses to decide on resuscitation

Experienced nurses should have the authority to decide if patients should be resuscitated, according to new guidelines to health professionals.

Until now only consultants and GPs were allowed to decide on resuscitation.

The guidelines were issued by the British Medical Association (BMA), the Royal College of Nursing and the Resuscitation Council.

The Patients Association welcomed the move, saying nurses were better placed than doctors to know patients' wishes.

The Resuscitation Council said resuscitation may only work in 5% of cases, and that the guidelines aim to avoid "undignified and unnecessary" resuscitation of patients who would not benefit from it.

But Dr Vivienne Nathanson, head of BMA science and ethics, said: "This is about a decision that should take place when a cardiac arrest is likely to happen but the key is still - if in doubt, if you haven't had a chance to get any knowledge - you must resuscitate."

The guidelines recommend that only "suitably experienced" nurses should be able to make the judgement.

The Resuscitation Council said that through television dramas people had been led to believe the resuscitation procedure is both more effective and more pleasant than it is in reality.

Dr David Pitcher, the council's honorary secretary, said: "The updated guidance states clearly that it is not always appropriate to distress a person who is dying, perhaps in the last few days of life, by discussing attempted resuscitation when clearly CPR [cardio-pulmonary resuscitation] would not be successful.

"The survival rate may be as low as 5% in certain individuals. The outcomes are extremely variable but they are nothing like what we see on TV.

"Sometimes it is a prolonged and traumatic procedure and is not always successful."

A Patients Association spokesman said: "Nurses have always been closer to patients who are severely ill than doctors.

"They will know more about the personality of the patient and their attitude towards death during a severe illness."

Nick Moore, of Dignity in Dying, which campaigns for greater patient choice at the end of life, called the changes "common sense".

"Unnecessarily resuscitating a patient in the last weeks of their life can often prolong suffering," he said in a statement.

The Patients Association said its helpline received calls from patients who were concerned that, in the event of a decision having to be made over whether or not to resuscitate, those making it would not be aware of their feelings.

The association called for "much more accurate information given to the public about the issues surrounding resuscitation and the quality of life for people who have been resuscitated".

Dr Nathanson said distribution of resuscitation information could be made easier through an electronic health register.

However, in the case of someone being brought to hospital from the street, a clinical judgment would still have to be made without that information.

The Patients Association spokesman said: "End of life is inevitable for all of us. We need to be reassured that we can reach it and die with dignity in as much comfort as possible with the respectful care of qualified health professionals." ( BBC )

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