In addition, the nurses recognized that the practice of ACP could be time consuming; a challenge in the context of an already unpredictable workload [19]. Among the greatest challenges that nurses Rapamycin concentration perceived to be associated with ACP were their own and colleagues’

knowledge and skills about communication practice, recording and follow up. A need for careful clinical supervision was perceived, since ACP can raise issues which have the potential to engage with fears and emotions within Inhibitors,research,lifescience,medical nurses’ biographical lives [33]. The inclusion of ACP issues into communications skills training is important if nurses can fulfill their potential as key players in raising and discussing ACP issues with their patients but must be accompanied at the level of practice by appropriate mechanisms of ongoing support and

supervision so that nurses can reflect upon but not be disabled by concerns about illness and death that inevitably surface in ACP work. Not affording formal recognition of the emotional toll of palliative focused work Inhibitors,research,lifescience,medical on district nurses has been Inhibitors,research,lifescience,medical reported as a barrier to the implementation of palliative care [19]. Conclusions Community nurses have a key role in providing palliative care to patients in the community and are well placed to facilitate a process of ACP which has the potential to improve the quality of end-of-life care that patients receive. This paper has highlighted some critical areas of concern if this potential is to be fully realized. Competing interests The

authors declare that they have no competing interests. Authors’ contributions JS conceived and led the study, participated in data analysis and wrote the first draft of this paper. KA and SK assisted Inhibitors,research,lifescience,medical in the conduct of the study, participated in data analysis and edited the paper. All authors read and approved the final manuscript. Pre-publication Inhibitors,research,lifescience,medical history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-684X/9/4/prepub Acknowledgements We gratefully acknowledge funding from the Burdett Trust for Nursing Cytidine deaminase and from Help the Aged (now Aged UK). The funders played no part in the study design, or collection, analysis or interpretation of data or in the decision to submit the manuscript for publication. We also thank our colleagues in the Peer Education Project Group for their role in the wider study which this paper draws upon.
One of the main objectives of a culture is re-orienting death towards life[1]: each person’s death threatens society’s cohesion by casting a shadow on the feelings of safety and continuity on which every human being bases his/her life and finds support and consolation. For ages the “good death” reflected the community’s religious beliefs, and the suffering of the dying person was considered mostly as an unavoidable aspect of the dying process.