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Clinical review

Care of families during and after the death of a loved one

Published: 2007 Vol: 1 No: 2
Author(s):
Margaret Reith
Families of dying people feel cared for if their loved one receives quality care at the end of life. Many issues affect families during the protracted illness and death of a loved one. If they are to assist families with grief, nurses must appreciate the richness and structure of families and develop a broad understanding of the concept of the term 'family'. Some deaths cannot be grieved openly...
Clinical review

Signs and symptoms of end-stage Idiopathic Parkinson's disease

Published: 2010 Vol: 4 No: 3
Author(s):
Helen Scott
Idiopathic Parkinson’s disease (IPD) is a progressively disabling, neurological condition, resulting in multiple signs and symptoms and reduced quality of life. It is the second most common neurodegenerative disorder after Alzheimer’s disease. Although not traditionally considered a terminal condition, guidelines recommend the early involvement of palliative care services in IPD management....
Clinical skills

Recognising metastatic spinal cord compression and treatment

Published: 2009 Vol: 3 No: 4
Author(s):
Helen Morgan, Declan Cawley
Recognising metastatic spinal cord compression (MSCC) and knowledge of its management are important skills for health professionals, including nurses, working within palliative and end-of-life care. Metastases to the spine occur in about 3–5% of all patients with cancer, with 10% of these patients developing spinal cord compression. MSCC is considered an emergency because the consequences, if...
Clinical skills

Oxygen Therapy

Published: 2007 Vol: 1 No: 1
Author(s):
St Christopher's Hospice Clinical Guidelines
Aim of guidance To ensure that patients in need of oxygen therapy are provided with the correct measures for treatment and comfort. Objectives To give clear guidance on the clinical indications for the use of oxygen therapy in a palliative care setting. To list the equipment needed for each situation.
Clinical skills

Recognition of depression in a woman with a brain tumour

Published: 2009 Vol: 3 No: 1
Author(s):
Julie O’Neill
This article discusses the psychological symptoms, in particular depression, experienced by Fiona (a pseudonym), a 23-year-old woman with end-stage ependymoma who was admitted to the author’s hospice. The admission was originally to manage her physical symptoms, which included headaches, disorientation, reduction in mobility and worsening eyesight, but she was subsequently diagnosed with...
Clinical skills

The assessment of mental state in advanced stage of disease

Published: 2008 Vol: 2 No: 1
Author(s):
Liz Bryan, Sharon Scott
There have been many advances in the palliation and management of symptoms in advanced disease. However, according to the literature, the assessment and management of psychological and psychiatric disorders, such as depression, anxiety and delirium, are still poor. These disorders, if left untreated, can have a detrimental effect on the patient’s quality of life. They interfere with the patient’s...
Clinical skills

Communication vignettes: 'Why am I on a pathway nurse?'

Published: 2010 Vol: 4 No: 1
Author(s):
Helen Scott, Vicky Robinson
The Liverpool Care Pathway for the Dying Patient (LCP) was developed to transfer the hospice model of care for people in the last days or hours of life into generalist settings. It is a multidisciplinary, integrated care pathway to guide the way in which care is delivered to dying people and their families, friends and carers, e.g. whether there is a continued need for invasive procedures and...
Clinical skills

Verification of death by nurses in community care settings

Published: 2009 Vol: 3 No: 2
Author(s):
Wendy-Jane Walton
The involvement of healthcare professionals, including nurses, does not stop once a patient has died. Caring for dying people at home requires the use of care pathways that include care after death. Nurses are the health professionals most commonly present at the time of a patient’s death. They are therefore ideally placed to verify that a person has died and provide support and information to...
Professional issues

Responding to patients' religious narratives at the end of life

Published: 2010 Vol: 4 No: 4
Author(s):
Helen Scott, Rev Peter Speck
Spiritual care is considered to be the role of all healthcare professionals. Consequently, an increasing evidence base is being created in relation to spirituality in health care. However, less is known about how best to respond to people who have religious beliefs and use religious vocabulary to articulate spiritual and existential concerns and hopes. Some practitioners find it difficult to...
Clinical skills

Key tips in communication skills: when giving information

Published: 2008 Vol: 2 No: 2
How can we improve our communication skills? One complaint often made by patients and carers is that they want and need to be kept better informed so that they can be fully involved in the decision-making process (Fallowfield et al, 2001). However, there is far more to helping someone become more aware of a complex or painful situation than simply imparting information (Fallowfield et al, 2002)....
Clinical skills

St Christopher's Hospice Clinical Guidelines: Managing constipation with laxatives

Published: 2008 Vol: 2 No: 3
Constipation tends to be characterised by infrequent bowel evacuations, hard, small faeces or difficult or painful defecation (Maestri-Banks and Burns, 1996; Thompson et al, 1999; Brown et al, 2006; Longstreth et al, 2006). Patients with an ECOG (Eastern Cooperative Oncology Group; Oken et al, 1982) performance status 3 or 4 are at high risk of developing constipation (Figure 1). Approximately 45...
Clinical skills

Communication vignettes: 'Help her nurse, she's drowning!'

Published: 2010 Vol: 4 No: 2
Author(s):
Helen Scott, Vicky Robinson
Death rattle is the term commonly used to describe noisy, rattling breathing that occurs at the very end of life. It usually affects terminal patients who are unconscious or too weak to expectorate. Its cause is unknown. It is thought to be the result of the oscillatory movements of secretions/saliva accumulating in the patient’s upper airways (Twycross and Wilcock, 2007; Wildiers et al, 2009)....
Clinical skills

Management of constipation in advanced stages of disease

Published: 2007 Vol: 1 No: 3
Author(s):
Iain Lawrie
There remains a lack of clear evidence to guide the management of constipation in clinical practice, especially at the end of life. Often, clinical approaches to tackle this common and distressing problem are based only on experience and anecdotal evidence. This situation is less than ideal. Constipation at the end of life may present additional problems, as conventional therapies may be...
Clinical review

Withholding and withdrawing artificial nutrition/hydration

Published: 2009 Vol: 3 No: 3
Author(s):
Hildegard Kolb
When a patient approaches the end of life, healthcare professionals are faced with a number of ethical issues relating to the decision to withhold (not start) or withdraw (stop) treatment. These include whether life should be maintained at all costs, using all available means, even if the treatment is a great burden for the patient, or whether it is preferable to accept the imminence of death and...
Clinical skills

St Christopher's Hospice Clinical Guidelines: Epidural/intrathecal analgesia

Published: 2008 Vol: 2 No: 4
Epidural analgesia is the delivery of analgesia via a catheter placed in the epidural space of the spinal column. Intrathecal analgesia is the delivery of analgesia into the cerebrospinal fluid of the subarachnoid space. These guidelines refer to epidural analgesia. Modifications for intrathecal analgesia are highlighted below. N.B. The procedure should only be carried out by an anaesthetist.
Clinical review

End-of-life needs of lesbian, gay and bisexual older people

Published: 2007 Vol: 1 No: 2
Author(s):
Kathryn Almack
The experiences and concerns of lesbians, gay and bisexual (LGB) people relating to ageing and palliative and end-of-life care have received scant attention in research literature. There is increasing recognition that health-related policy and practice should address the needs of minority, hard-toreach and marginalised groups of people. LGB and heterosexual individuals share many concerns...
Clinical skills

Communication vignettes: 'I want to kill myself nurse!'

Published: 2009 Vol: 3 No: 4
Author(s):
Helen Scott, Vicky Robinson
Nurses are the health professionals most commonly confronted with patients expressing suicidal feelings and a desire for an early death. However, it has been found that nurses often do not know how to respond when a patient expresses such feelings. They instead say nothing, turn the focus of the conversation onto physical issues, or change the topic altogether (Hudson et al, 2006a). Common...
Clinical skills

How best to communicate bad news over the telephone

Published: 2007 Vol: 1 No: 1
Author(s):
Elizabeth Taylor
This article examines communication issues relating to breaking the news of a sudden and/or unexpected death to family members. It focuses particularly on the delivery of bad news over the telephone. Often it is the nurse who has to make the call. When dealing with unexpected death, nurses may be unsure what to say and resort to various euphemisms or anecdotal practices without full...
Clinical review

Spirituality and end-of-life care within the context of nursing

Published: 2009 Vol: 3 No: 1
Author(s):
Caroline Tiffen, Allison Bentley
This article explores the concept of spirituality within the context of nursing. The method by which spirituality might be measured and recorded within a modern-day health service is debated. There is exploration of models and tools produced for assessing and meeting patients’ spiritual needs. Signs of spiritual distress are examined along with the qualities and skills nurses require to meet the...
Clinical skills

St Christopher's Hospice Clinical Guidelines: visiting/viewing the body of a deceased patient

Published: 2008 Vol: 2 No: 1
Introduction Nurses have a vital role in enabling relatives and carers to visit the body of a deceased patient. Haas (2003) describes how nurses are the healthcare professionals most likely to be present at the time of death. They are in an influential position and are able to guide relatives through this unfamiliar and disturbing experience. She highlights that, instinctively, nurses may advise...

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