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Clinical skills

Don't die of boredom: enabling occupation at the end of life

Published: 2008 Vol: 2 No: 2
Author(s):
Debbie Pearson
Progressive, chronic, life-limiting illness may affect a person’s ability to carry out activities that are important to their sense of wellbeing and their daily living. Boredom is individually determined and is often not well understood or acknowledged by healthcare practitioners. The impact of illness on a person’s ability to carry out meaningful activity following terminal diagnosis is explored...
Clinical skills

Preparing carees to look after palliative care patients at home

Published: 2008 Vol: 2 No: 3
Author(s):
Julie O’Neill
Nurses are responsible for the holistic care of patients admitted to their wards. This includes care of families and significant others who provide informal care for patients at home. ‘Informal carers’ have a variety of needs, often wishing to continue the care of their relative/close friend upon discharge. It is essential that nurses prepare carers for this role. A review of the literature has...
Clinical review

Nausea and vomiting: end-of-life assessment and management

Published: 2010 Vol: 4 No: 2
Author(s):
Denise Gorman
Nausea and vomiting affect 40–70% of patients with advanced cancer. Both conditions diminish quality of life significantly, particularly in relation to intractable nausea and vomiting. This article discusses key management issues of a woman in the advanced stages of her disease (see Case scenario box) admitted to hospital suffering from nausea and vomiting of complex origin. It highlights how the...
Clinical skills

Care of continence during the terminal phase of illness

Published: 2007 Vol: 1 No: 3
Author(s):
Gaye Kyle
This article will explore the issue of continence care during the terminal phase of life. This period is often referred to as ‘the end of life’ or ‘the last 48 hours’. Patients are thought to be in the dying phase of their illness when they only have hours or days left to live (referred to as the ‘terminal phase’ in this article). Continence care is complex during the terminal phase as it can...
Clinical skills

Communication vignettes: 'She's starving to death nurse!'

Published: 2009 Vol: 3 No: 3
Author(s):
Helen Scott, Vicky Robinson
It is the duty of all healthcare professionals to acquire the knowledge, skills and attitudes to communicate sensitive information to relatives (Thorns et al, 2004). According to Sykes (2004), the crucial area in relation to symptom control at the end of life is ‘preparedness’, e.g. ensuring that all appropriate drugs such as analgesics, sedatives, antiemetics and anticholinergic agents are...
Clinical skills

End-of-life care and people with dementia: Admiral nurses

Published: 2008 Vol: 2 No: 4
Author(s):
Susan Ashcroft-Simpson, Pam Kehoe, Loraine Butterworth, John Keady
Accurately predicting the end of life for people with dementia is a complex and fraught area. People dying from dementia have symptoms and healthcare needs that are comparable with cancer. Drawn directly from practice experience, this article outlines three case scenarios that cover the dying trajectory of people with dementia and the post-bereavement support provided to carers. It is suggested...
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

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 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...
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 practice development

Assessment and management of fatigue in life-limiting illness

Published: 2008 Vol: 2 No: 1
Author(s):
Laura Middleton-Green
Fatigue is a complex symptom commonly experienced by people with life-limiting illnesses. It has been identified in patients with, for example, cancer, heart failure, respiratory conditions, acquired immunodeficiency syndrome and renal failure. It is often rated by patients as having a greater effect on quality of life than pain. This article will explore the manifestations and consequences of...
Clinical review

Trajectories towards death: how people cope when they are dying

Published: 2010 Vol: 4 No: 1
Author(s):
Helen Noble, Julienne Meyer, Jackie Bridges, Daniel Kelly, Barbara Johnson
This article examines major theoretical approaches to the study of death and dying. It presents theories or models that have informed developments in this area and influenced the way care is shaped and delivered towards the end of life. Theories of death and dying are important as the concept of ‘a good death’, and how it can be achieved, is promoted in UK government policy. Two central aspects...
Clinical skills

Communication vignettes: 'should I can cancel my holiday nurse?'

Published: 2009 Vol: 3 No: 2
Author(s):
Helen Scott, Vicky Robinson
Good communication skills are a key element of end-of-life care (Department of Health, 2008). As nurses, we cannot prevent the distress that families/friends feel when they know their loved one is dying. However, we can support them through the process. This involves ensuring that families are aware of what is happening to their loved one, e.g. the signs and symptoms indicating that the person is...
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...

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