24/05/23.
We started with the definition of End-of-Life Care (EOLC). It is a form of palliative care or supportive care, or terminal care the individual receives when he/she is close to the end of life.
according to the general medical council 2022, people are approaching the end of life when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:
- Advanced, progressive, incurable conditions.
- General frailty and co-existing conditions that mean they are expected to die within 12 months.
- Existing conditions if they are risk of dying from a sudden acute crisis in their condition.
- Life threatening acute conditions caused by sudden catastrophic events.
The EOLC strategy 2008, define care that: helps all those with advanced, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both the patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual, and practical support.
According to World Health Organization (WHO), they define palliative care as an active approach that improves the quality of life of patients (adult and young) and their families who are facing problems associated with life-limiting illnesses, usually progressive.
It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems whether physical, psychosocial, or spiritual.
In England, the term ‘end of life care’ refers to the last year of life.
we looked at supportive care – it helps the patient and their family to cope with their condition and treatment of it – from pre-diagnosis, through the process of diagnosis and treatment, to cure, continuing illness or death and into bereavement.
I learnt about the Amber care bundle.
- Assessment.
- Management.
- Best practice.
- Engagement.
- Recovery uncertain.
The EOLC pathway comprises of 6 steps, and they are listed below:
Step1: discussion as the end-of-life approaches –
- It is an open, honest communication.
Step 2: assessment, care planning and review –
- Agreed care plan and regular review of needs and preferences.
- Assessing needs of care.
Step3: coordination of care –
- strategic coordination.
- Coordination of individual patient care.
- Rapid response services.
Step 4: delivery of high-quality services in different settings –
- High quality care provision in all settings.
- Acute hospitals, community care homes, extra care housing, hospices, community hospital, prisons, secure hospitals, and hostels.
- Ambulance services.
Step 5: care in the last days of life –
- Identification of the dying phase.
- Review of needs and preferences for place of death.
- Support for both patient and carer.
- Recognition of wishes regarding resuscitation and organ donation.
Step 6: care after death –
- Recognition that end of life care does not stop at the point of death.
- Timely verification and certification of death or referral to coroner.
- Care and support of carer and family, including emotional and practical bereavement support.
I also learnt about the Advance Care Planning (ACP), that it is a voluntary process of person-centred discussion between an individual and their care providers about their preferences and priorities for their future care, while they have the mental capacity for meaningful conversations about these.
There are 5 points they are as follows:
- Think: about the future – what is important to you, what you want to happen or not to happen if you become unwell.
- Talk: with family and friends and ask someone to be your proxy spokesperson or lasting power of Attorney (LPOA) if you could no longer speak for yourself.
- record: write down your thoughts as your own ACP, including your spokesperson and store this safely.
- Discuss: your plans with your doctor, nurses, or carers, and this might include a further discussion about resuscitation (DNAR or Respect) or refusing further treatment (ADRT).
- share this: information with others who needs to know about you, through your health records or other means, and review it regularly.
The 6 ambitions of palliative and end of life care (PEoLC).
- Each person is seen as an individual – I, and the people important to me, have opportunities to have honest, information and timely conversations and to know that I might die soon. I am asked what matters most to me. Those who care for me know that and work to me to do what’s possible.
- Each person gets fair access to care – I lived in a society where I get good end of life care regardless of who I am, where I live or the circumstances of my life.
- Maximizing comfort and wellbeing – my care is regularly reviewed, and every effect is made for me to have the support, care and treatment that might be needed to help me to be as comfortable and as free from distress as possible.
- care is coordinated – I get the right help at the right time from the right people. I have a team around me who know my needs and my plans and work together to help me achieve them. I can always reach someone who will listen and respond at any time of the day or night.
- All staff are prepared to care – wherever I am, health and care staff bring empathy, skills and expertise and give me competent, confident, and compassionate care.
- Each community is prepared to help – I live in a community where everybody recognizes that we all have a role to play in supporting each other in times of crises and loss. People are ready, willing, and confident to have conversations about living and dying well and to support each other in emotional and practical ways.
In recognizing change, there are 4 points:
- Stable from diagnosis – year prognosis.
- Unstable advance disease – months prognosis.
- Deteriorating, exacerbations – weeks prognosis.
- Last days of end-of-life pathway – days prognosis.
Inequality in palliative and end of life care for people with learning disability.
I learnt that, according to CIPOLD; Mencap, people with learning disability are three times as likely to die early than the general population (CIPOLD;Mencap, 2007).
They are more likely to experience poor general health, and to have high levels of unmet physical and mental needs (Emerson et al, 2011).
The health inequalities for people with a learning disability also extend into palliative and end of life care.
Although people with a learning disability still die at a younger age than the general population, the median age of death for people with a learning disability is increasing (public Health England, 2017)
The ageing process seen in the general population, including the onset of frailty, will become more apparent in those with a learning disability.
In delivering high quality end of life care for people who have a learning disability, the aim is to support commissioners, providers, and clinicians to reduce inequalities in palliative end of life for people with a learning disability.
To focus on the ‘The Ambitions for palliative and End of Life care’.
KSB ADDRESSED
KNOWLEDGE:
K1: Understand the code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC 2018), and how to fulfil all registration requirements.
K4: Understand the principles of research and how research findings are used to inform evidence-based practice.
K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care.
K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.
K7: Understand the importance of courage and transparency and apply the Duty of Candour.
K8: Understand how discriminatory behaviour is exhibited.
K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.
K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.
K11: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.
K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical, and behavioural health, and well-being.
K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours, and lifestyle choices to mental, physical, and behavioural health outcomes.
K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care.
K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.
K17: Understand commonly encountered mental, physical, behavioural, and cognitive health conditions as applied to delivery of care.
K18: Understand and apply the principles and processes for making reasonable adjustments.
K19: Know how and when to escalate to the appropriate professional for expert help and advice.
K20: Know how people’s needs for safety, dignity, privacy, comfort, and sleep can be met.
K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.
K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health.
K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care, and skin integrity.
K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.
K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life.
K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.
K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies.
K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.
K29: Understand the different ways by which medicines can be prescribed.
K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.
K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.
K36: Understand the roles of the different providers of health and care.
K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives.
K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings, or services.
K41: Know the roles, responsibilities, and scope of practice of different members of the nursing and interdisciplinary team, and own role within it.
SKILLS:
S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC, 2018), and fulfil all registration requirements.
S2: Keep complete, clear, accurate and timely records.
S5: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).
S17: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).
S18: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent.
S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress, and reporting outcomes.
S23: Work in partnership with people, to encourage shared decision making, to support individuals, their families, and carers to manage their own care when appropriate.
S25: Meet people’s needs for safety, dignity, privacy, comfort, and sleep.
S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health.
S27: Meet people’s needs related to mobility, hygiene, oral care, wound care, and skin integrity.
S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.
S30: when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings, and escalating as needed.
S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams.
S35: Accurately undertake risk assessments, using contemporary assessment tools.
BEHAVIOUR:
B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy, and preferences.
B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice.
B3: Be adaptable, reliable, and consistent, show discretion, resilience, and self-awareness.