Past Issues

Personal narrative

A daughter's experience of her mother's death in hospital

Published: 2013 Vol: 3 No: 1
Author(s):
Anonymous
Key to improving palliative and end-of-life care is recognising the end-of-life phase. Without training relating to identification of signs and symptoms indicative of the terminal phase of disease, care of dying patients and their relatives/loved ones will not improve. Analysis of individual deaths may improve systems of care provision and identify local educational and service requirements. This...
Personal narrative

A palliative holistic approach to MND using music therapy

Published: 2012 Vol: 2 No: 1
Author(s):
Dr Helen Mackinnon, Elizabeth (Liz) Upham
This article details the role of music therapy (MT) in the palliative care of a 66-year-old woman (Liz) living with severe disabilities caused by motor neurone disease. It forms part of a small but growing body of case-related evidence designed to support the use of MT in palliative care. It describes how music gave Liz a renewed sense of meaning, purpose, control and usefulness that she...
Clinical practice development

A rehabilitation training programme at the end of life

Published: 2011 Vol: 1 No: 1
Author(s):
Frances Cane, Rebecca Jennings, Jenny Taylor
Terminally ill patients face many challenges with regard to increasing physical dependence on others to meet their practical needs. Progressive weakness, profound fatigue and gradual deconditioning make daily tasks increasingly difficult to perform. Rehabilitation techniques do not lie solely within the role of physiotherapists and occupational therapists. They are an integral part of holistic...
National end of life care programme update

Achieving quality end-of-life care in the acute hospital setting: the new 'How to' guide

Published: 2012 Vol: 2 No: 1
Author(s):
Anita Hayes
Introduction Since the publication of the national End of Life Care Strategy (Department of Health, 2008), a number of initiatives, tools and publications have been produced to support improvement in end-of-life care service provision. In 2010, the National End of Life Care Programme (NEoLCP) published The Route to Success in End of Life Care: Achieving Quality in Acute Hospitals to raise...
National end of life care programme update

Achieving quality end-of-life care within the prison population: new guidance

Published: 2012 Vol: 2 No: 1
Author(s):
Anita Hayes, Tes Smith
Introduction Over 85,000 people are currently being held in prisons across England and Wales (Ministry of Justice, 2011; Berman, 2012), and this figure is expected to rise to nearly approximately 95,000 by 2017 (Ministry of Justice, 2011). The number of older prisoners is therefore expected to increase and predictions indicate that this will lead to more deaths from natural causes in prisons...
Ethical/legal discussions

Advance decisions to refuse treatment in cases of dementia

Published: 2013 Vol: 3 No: 2
Author(s):
Joanna Davies, Rob George
Evaluating someone’s mental capacity in relation to advance decisions to refuse treatment can be a challenge for health professionals, particularly in cases of dementia. The Mental Capacity Act 2005 clarifies and formalises the functional assessment of capacity. It aims to protect individual autonomy and counter the assumption that, just because an individual does not have capacity regarding one...
Clinical skills

Altered sense of body image in palliative and end-of-life care

Published: 2011 Vol: 1 No: 1
Author(s):
Amanda Stamper
In palliative and end-of-life care, holistic patient assessment involves considering patients'; physical, psychological, social and spiritual concerns. As part of psychological assessment, it is important to discuss with patients their perception of body image and whether it is affecting their interactions with others and their ability to live their life in the way they want. In both general...
Nursing case review

Assessment of a breathless patient in end-stage heart failure in A&E

Published: 2012 Vol: 2 No: 1
Author(s):
Marie Ranson
Breathlessness is a common reason for the hospitalisation of people with chronic heart failure (CHF). It is a distressing symptom for both patients and their informal carers. Breathlessness in CHF derives from physical, psychological, social, spiritual and environmental factors. Optimal management of breathlessness in CHF requires both pharmacological and non-pharmacological interventions. This...
Clinical review

Assessment of depression when patients desire a hastened death

Published: 2011 Vol: 1 No: 1
Author(s):
Helen Scott
Patients’ mental health status is an important element of palliative and end-of-life care. However, depression is often under-recognised in terminally ill cancer patients. That is because symptoms of depression can mimic those of advanced cancer and clinicians often think that patients’ low mood is an understandable reaction to terminal illness. Depression has been associated with patients...
Personal reflections

Barriers to effective end-of-life nursing care out-of-hours

Published: 2014 Vol: 4 No: 1
Author(s):
Nicola Hillman
The End of Life Care Strategy recommended that terminally ill patients living at home must have access to community out-of-hours end-of-life care services. The Strategy particularly emphasised that rapid-response community nursing services should be made available in all areas, 24 hours a day, 7 days a week. The lack of end-of-life care out-of-hours services can lead to terminally ill and dying...
Nursing case review

Breathlessness, thirst and anxiety in the end stages of heart failure

Published: 2013 Vol: 3 No: 2
Author(s):
Clare Young
Heart failure is associated with a high symptom burden, which can have a negative effect on the life of the person with heart failure as well as their relatives/loved ones. One of the main symptoms of heart failure is breathlessness, which reduces the ability of the person to maintain independence and is associated with anxiety, fear and distress. When a patient in heart failure is approaching...
Nursing case review

Caring for a head-injured patient with terminal agitation in A&E

Published: 2012 Vol: 2 No: 2
Author(s):
Fran Gallosi
The predominant culture within accident and emergency (A&E) departments is to save lives. Consequently, end-of-life care (EoLC) may be given low priority in the A&E setting. As death approaches, patients may become restless, agitated or delirious. All potential causes of agitation at the end of life should be considered, assessed and treated if possible. The source of agitation can be...
Legal discussions

Case law on artificial nutrition and hydration since Bland

Published: 2012 Vol: 2 No: 1
Author(s):
Dr Martin JR Curtice
The legal basis and principles for the lawful withdrawal of artificial nutrition and hydration (ANH) from people in a persistent vegetative state (now termed permanent vegetative state), was laid out in the case of Anthony Bland, who sustained catastrophic and irreversible brain damage as a result of being crushed during the Hillsborough stadium disaster in 1989. Anthony Bland was medically...
Professional issues

Challenges of domiciliary carers when providing end-of-life care

Published: 2011 Vol: 1 No: 3
Author(s):
Heather Watson
Given the choice, most people would prefer to be cared for and die at home, if they are assured of high-quality care and proper support for their families/carers. Domiciliary care workers play a large role in the care of terminally ill people at home. However, the experiences of patients and their informal carers regarding domiciliary care can be variable. The training needs of domiciliary care...
Clinical skills

Communication Vignettes: 'Being with' a patient who is distressed

Published: 2012 Vol: 2 No: 2
Communicating with dying people means more than just imparting information. It is about being physically and emotionally present with patients. The following communication vignette deals with the issue of ‘being with’ dying patients, as defined by Dame Cicely Saunders, the founder of the modern hospice movement. Dame Cicely Saunders wrote that practitioners should ‘learn not only how to free...
Clinical skills

Communication Vignettes: 'What have I done to deserve this?'

Published: 2011 Vol: 1 No: 2
Author(s):
Helen Scott and Vicky Robinson
Patients who ask ‘What have I done to deserve this?’ are usually articulating spiritual distress. However, nurses often feel uncomfortable discussing spiritual concerns and have difficulty recording spiritual assessments (The Marie Curie Palliative Care Institute and Royal College of Physicians, 2009). That may be due, in part, to the fact that spirituality is a difficult concept to understand (...
Clinical skills

Communication vignettes: 'What if I meet "Old Nick", nurse?'

Published: 2013 Vol: 3 No: 3
Author(s):
Helen Scott
Regardless of whether or not older people have a life-limiting illness, they are aware that they are in the final stages of their lives. The very end phase of life can be a significant cause of distress (Lloyd-Williams et al, 2007; Gott et al, 2008). Death remains a mystery and, as it approaches, people may start to feel fearful of the unknown (Saunders, 1987). However, forthcoming death may also...
Clinical skills

Communication Vignettes: 'You must get her out of bed, nurse!'

Published: 2011 Vol: 1 No: 3
Author(s):
Helen Scott and Vicky Robinson
Introduction The advanced stages of disease can be associated with a great deal of distress for patients and their loved ones (Lobb et al, 2006; Murray et al, 2010; Candy et al, 2011). For example, families/friends of terminally ill people can become confused, fearful, experience despair and helplessness (Maher and Hemming, 2005) and feel very isolated (Thomas et al, 2002). When people are in...
Clinical skills

Communication vignettes: She wants her misery to end, nurse!

Published: 2011 Vol: 1 No: 1
Author(s):
Dr Bruno Bubna-Kasteliz
It is a popular belief that people with terminal illness are more likely to be driven to despair and, as a result, commit suicide. In fact, only 2–4% of people with such a diagnosis actually kill themselves (Clark, 1992). The experience of hospice staff is that, if people with a terminal illness are given empathetic and structured support, the wish to end life may only be fleeting (Block, 2005...
Clinical skills

Communication Vignettes: Telling a child that her dad is dying

Published: 2012 Vol: 2 No: 1
Author(s):
Vicky Robinson and Nathalie Asmall
Traditionally, palliative care emergencies are associated with physical, often reversible, clinical signs (e.g. spinal cord compression and hypercalcaemia). However, palliative care practitioners can sometimes find themselves in a situation where there is an urgent need to communicate with a family member or friend of a terminally ill patient (Pickering and George, 2007). Nurses working in...

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