END OF LIFE CARE.      

Lesson started with the learning outcomes, whose mean aim is:  

•  To understand the concept of End-of-Life Care in the context of the dying adult person in their last days of life.  

• To gain awareness of management of symptoms: how to manage common symptoms without causing unacceptable side effects. To maintain hydration in the last. 

• To gain knowledge of the nurses’ role within the individualised person-centred care 

• To gain an overview understanding of Advance Care Planning. 

Having gone through the learning outcomes, we the class shared the understanding of end of care. This simply means according to my perspective, support given to a dying individual by making him/her comfortable, supporting with care, respect, dignity, and love, above all fulfilling his/her last wish. The recommendations apply to all people at the end of life, whether they are conscious or unconscious. The main aim is to improve end of life care for people in their last days of life. 

End of life care is a multi-professional clinic team approach requiring judgement for when a person is likely to die. (Usually within a few 2-3 days of death). 

Having a good death depends on:  

• The way in which people die and how long this takes varies widely, because of: 

.  The underlying diseases responsible but also the  

. Person’s robustness or frailty, and their social setting. 

• Some continue to be mobile and largely self-caring, continue with oral intake (medication until death) 

• Others may die suddenly and unexpectedly after a significant trauma or catastrophic medical event (gastric bleed). 

• Some may not experience any of the symptoms 

• Some experience a gradual decline. (Principle of communication, shared decision-making and pharmacological care can be applied far earlier in their care).                      

• Others have progressive disease. (Cardiac, pulmonary/neurological disorders, dementia to name but a few.) 

In recognising when a person is entering the last days, for some people who are in their last days of life, mental capacity to understand and engage in shared decision-making may be limited. This could be temporary or fluctuating, e.g. caused by: 

• Delirium its associated with an infection or a biochemical imbalance such as dehydration or organ failure. 

• Permanent loss of capacity from dementia or other similar irreversible conditions. 

For healthcare professionals, should be able to: 

• Recognise when a person is entering the last days of life or may have stabilised or be improving temporarily. 

• To communicate and shared decisions respectfully with the dying person and people important to them. 

• Healthcare professionals must be able to recognise when a person may be entering the last days of their life, or if they may be deterioration, stabilising or improving even temporarily. 

• If it is thought that a person may be entering the last days of life, gather and document information on: 

 

~  the person’s physiological (pain, fatigue), psychological (their wishes), social  

(With families, homeless), and spiritual (religious, cultural) needs. 

~ current clinical signs and symptoms (their clinical observations). 

~ the person’s goals and wishes. 

 

The following signs and symptoms of deterioration: 

• Agitation 

• Cheyne -strokes breathing. (Gasping between breath. 

• Deterioration in level of consciousness (unconscious). 

• Mottled skin 

• Noisy respiratory secretions  

• Progressive weight loss 

• Increasing fatigue and loss of appetite. 

The following information should be provided: 

• Accurate information about their prognosis (unless do not wish to be informed). 

• Any uncertainty. 

• An opportunity to talk about any fears and anxieties, and to ask questions about their care in the last days of life. 

• Avoid false but optimisms. 

• Information about how to contact members of their care team 

The role of the nurse, the delivery of meals, equipment, care at night, volunteer support or assistance from an organisation and their availability. There is a clear individual nursing care plan that includes:   the dying person, personal goals and wishes, preferred care setting, current and anticipated care needs, preferences for symptom management, needs for care after death, resource needs. These individualised care plan discussions and decisions should be clearly recorded, continually updated as situation may change as condition deteriorates or as they accept their prognosis. 

In providing individualised approach to anticipatory medicines for people who are likely to need symptom control in the last days of life. Specify the indications for use and the dosage of any medicines prescribed. 

Assess what medicine the person might need to manage symptoms likely to occur during their last days of life. (Agitation, breathlessness, nausea and vomiting, noisy respiration to name a few). 

Discuss any prescribing needs with the dying person, those important to them and multi-professional team. 

Always ensure that suitable anticipatory medicines and routes are prescribed as early as possible. These should be reviewed as the dying person needs change. 

Before these anticipatory medicines are administered, review the dying person’s individual symptoms, and adjust the individualised care plan and prescriptions as necessary. 

Advance care planning (ACP) is the term used to describe the conversation between people, their families, and carers, and those looking after them about their future wishes and priorities for care. 

There are policies to ensure that ACP is offered to adults who are approaching the end of their life. Policy should consider under-served and vulnerable groups. 

Patient should be supported with ACP if the person approaching the end of life agrees. 

Patient should be considered if there is lack of capacity to make decisions in line with the Mental Capacity Act 2005.  

Do not attempt cardiopulmonary resuscitation (DNACRR) decisions. 

                                                                                                                       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. 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice. 

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 factors that may lead to inequalities in health 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. 

K14: Understand the importance of health screening.  

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, genomic. 

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. 

K36: Understand the roles of the different providers of health and care.  

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs.  

K38: Understand the complexities of providing mental, cognitive, behavioural, and physical care needs across a wide range of integrated care settings.  

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.  

K43: Understand the influence of policy and political drivers that impact health and care provision Skills.  

 

                                                                                                             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. 

 S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.  

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and wellbeing. 

 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: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings, and escalating as needed. 

 

 

                                                                                                            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.