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OPINION

'Partnership working is the key to improving end of life care'

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Nurses can improve end of life care coordination by working more closely with occupational therapists

Having long battled for recognition of their own skills, nurses sometimes overlook the full potential and expertise of other health professionals.

Quality end of life care is based on assessment, co-ordination of care and advance care planning

The role that occupational therapists (OTs) have in providing end of life care is a classic example.

For too long, nurses and other care professionals - often including OTs themselves - have not appreciated and used the skills these allied health professionals can deploy in the care of people nearing the end of life and the co-ordination of that care.

Many nurses whose work brings them into contact with people nearing the end of life - which is most of us - would find it beneficial to be working more closely with occupational therapy colleagues.

Do you know the OT working in your patch or in your local hospice or how to contact those working for social care organisations?

Quality end of life care is based on assessment, co-ordination of care and advance care planning. OTs’ training, skills and background equip them to deliver on these fronts - and take the practical steps that flow as a result.

A general nurse in an acute hospital helping to plan the discharge of a person home to die will work more effectively if they can answer yes to that question. The same goes for the district nurse who has visited a person nearing the end of life and becomes aware that the person needs an additional assessment or additional support or equipment.

As a new framework setting out the potential OT role in end of life care makes clear, our colleagues in occupational therapy are particularly skilled in assessment and planning care. They also have a very practical role - such as ensuring the right equipment is in place at a person’s home so they can be discharged to spend their remaining time at home.

The framework, The route to success in end of life care - achieving quality for occupational therapy, includes several examples where nurses have referred people to OTs or vice-versa. This effective partnership working has enabled people to be cared for and die at home or in another preferred setting outside hospital.

OTs can work across all settings where people are likely to receive end of life care and at each stage of the end of life care pathway.

They can transform a person’s quality of life as that life nears its end.

Beginning with a holistic assessment of both needs and functional ability, the OT can help the person and his or her family identify and achieve particular goals before death. This might take the form of arranging for them to have the right equipment at home and can contribute to the effective management of symptoms such as pain and fatigue. The individual might even be helped to find more appropriate housing or have their own home adapted - with the OT acting as the fast-track link into housing and adaptations services.

A district nurse encountering an individual facing growing difficulty climbing the stairs can set that in motion with one call to the relevant OT.

Unfortunately, the examples of such contact and relationships outlined in the framework mentioned above are the exception rather than the rule.

Communication and co-ordination underpins quality end of life care. Nurses are well placed to grab the opportunity to improve both by recognising that forming partnerships with their local OTs will be a giant step towards achieving that - and transforming the experience and quality of end of life care.

  • 1 Comment

Readers' comments (1)

  • 'Quality end of life care is based on assessment, co-ordination of care and advance care planning.'

    I agree with that - and with the piece in general - but it must be remembered that a patient has no previous experience of the path towards death: so, any 'advance care plan' cannot be viewed as set in stone, but needs to be flexible to allow for a patient whose actual wishes, differ from the wishes he felt he would have when he was only anticipating the future (not experiencing it).

    This type of co-operation, while absolutely necessary, is, I suspect, harder to arrange when the people involved are not working at a common location: so it is easier to organise co-operation within a hospital, than between disparate professionals whose 'physical connection' is only 'the patient's own home' (not sure if I expressed that very well !).

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