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Clinical skills
Recognition of depression in a woman with a brain tumour
Published: 2009 Vol: 3 No: 1 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
Communication vignettes: 'Why am I on a pathway nurse?'
Published: 2010 Vol: 4 No: 1 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 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...
Clinical skills
Don't die of boredom: enabling occupation at the end of life
Published: 2008 Vol: 2 No: 2 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 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 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 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 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
Management of constipation in advanced stages of disease
Published: 2007 Vol: 1 No: 3 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 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
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 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
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 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 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 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 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...
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)....