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What are the key priorities for end of life care?

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10 January, 2013

Article: Percival J et al (2013) End-of-life care in nursing and care homes. Nursing Times; 109: 1/2, 20-22.

5 key points

  • The majority of people living in a nursing or care home will die there
  • Better end-of-life care in homes is one of the National End of Life Care Programme’s critical success factors
  • Good-quality end-of-life care involves an individualised approach and making time for residents
  • Staff need to develop good working relationships with relatives
  • Training is needed to help staff build confidence in this area of practice

Let’s discuss

  • What factors influence good quality end-of-life care in nursing and residential care homes, from the perspectives of staff, residents and relatives?
  • Why do you think residents with dementia who need end-of-life care are particularly at risk of inappropriate hospital admission?
  • What are the key priorities for end of life care identified in this research?
  • The researchers found that “in the context of homes as communal settings, residents commonly voiced concern at the information vacuum that can surround the death of fellow residents, when they are given no information about how their life concluded or the care they received”. What would you do to resolve this problem?
  • How should care home staff be supported when a resident dies?

Readers' comments (13)

  • comfort, feeling safe and valued, ideally being in the place where you wish to die, being with friends and family, if you are alone then having staff who care about you.

    being pain free, calm, warm and well cared for.

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  • michael stone

    I'd need to read the paper, to comment about it - but the first post covers most of it, I think, and almsot all of it for residents with dementia.

    For mentally capable patients, you can throw in 'and not doing things the patient does not want you to do' - for some reason, the principle of patient self-determination somehow tends to get weakened for EoL (without any legal basis for that weakening).

    As for:

    The researchers found that “in the context of homes as communal settings, residents commonly voiced concern at the information vacuum that can surround the death of fellow residents, when they are given no information about how their life concluded or the care they received”. What would you do to resolve this problem?

    then I think the solution to that one, is probably to tell people if they ask for the information - I suppose, to get round 'clinical confidentiality', some sort of earlier discussion of that issue would be necessary, because 'after I've gone, you can tell my friends what happened' from whoever had died, would probably help ?

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  • I would say adequate prescribing for symptom control and the establishment of multidisciplinary, multispeciality palliative care wards at all nhs trusts to prevent variation.

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  • Compassion care comfort

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  • using all of one's communication and observational skills to the very best of one's ability to continuously assess the patient's changing individual and holistic needs and meeting them as far as possible. Continuously evaluation of the effectiveness and quality of care. Just like the care delivered to any patient.

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  • I recently sat with a dying patient in the community. She was not on my caseload, I was supporting another team. She had a syringe driver running. I stayed with the patient until she died. All the time I constantly reassured her that she wasn't alone by talking quietly, holding her hand and sometimes even by singing (not loudly!). She died very quietly and peacefully, in her own home. I felt sad but at the same happy that I had been there for her.

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  • Anonymous | 14-Jan-2013 7:49 pm

    I believe giving your time and your full attention is one of the finest gifts one can give to another and to oneself as well. It is something often forgotten in our hectic times but I also think, work apart, it is important to think what we are really doing and why when we are rushing around in a frenzy often without even allowing ourselves time to pause for thought.

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  • tinkerbell

    Anonymous | 14-Jan-2013 7:49 pm

    Bless you. You can't give kindness away it always comes back.

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  • tinkerbell | 15-Jan-2013 8:01 am

    without wishing to put a damper on this highly significant gesture of this nurse, when it was not part of her case load and there was probably nobody else available at the time, we must not forget this is part of our job. I am sure she is a highly professional and empathic and sensitive nurse who puts the needs of her patient first and would have done it whatever the circumstances.

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  • The aims of EoL care and it's use needs better communication with the wider public as well as indivdual patieints and their families to avoid the alarmist headlines in the press about it being a death pathway, something to be feared and health care staff causing death.

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  • I believe that effective and open communication with the patient and their families significantly contributes to a 'good death'. Unfortunately, I have witnessed staff nurses 'avoiding' this, leading to much anxiety. I can understand the avoidance but its neglectful and I believe that all nurses should address their own views on this subject and reflect on how they and their own families would like to be treated in a similiar situation.

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  • Karen Jackson | 15-Jan-2013 12:03 pm

    I agree but why not call it what it is, care of the dying, instead of 'EoL' which doesn't sound very synonymous with any type of care!

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  • Well I am totally fed up by the reports in the Daily Fail and other newspapers about patients being "starved" and dehydrated" to death.

    Therefore, it is essential that the relatives be provided with their choice of KfC/McBurger and large Cokes so they are able to noursish and cure all these dying people that the NHS so disgacefully fail to "save".

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