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- Vol 3 Issue 1 - Winter 2012/13
- Vol 2 Issue 2 - Summer 2012
- Vol 2 Issue 1 - Spring 2012
- Vol 1 Issue 3 - Winter 2011
- Vol 1 Issue 2 - Autumn 2011
- Vol 1 Issue 1 - Spring 2011
Search the End of Life Journal archives
Clinical review
Dyspnoea in COPD: the effect on functional ability and carers
Published: 2011 Vol: 1 No: 1
Chronic obstructive pulmonary disease (COPD) is a complex, progressive, respiratory condition. The primary symptom of COPD is dyspnoea (the subjective experience of breathing discomfort). Worldwide, COPD is a leading cause of morbidity and mortality. Due to the progressive nature of COPD, limitation of functional ability increases proportionally to disease severity, becoming more pronounced as...
Clinical review
Emotional distress in patients with advanced heart failure
Published: 2011 Vol: 1 No: 2
Chronic heart failure (CHF) is a leading cause of death, with a rising prevalence. The disease has a high symptom burden and a negative impact on patients’ quality of life. However, as a result of difficulties in prognostication in relation to CHF, palliative care services do not always become involved in the care of patients with CHF. Emotional distress is especially common in the advanced...
Clinical skills
Encouraging/supporting dying parents to talk to their children
Published: 2013 Vol: 3 No: 2 Communicating with children about the anticipated death of a parent can be very challenging, even for experienced palliative care professionals. It can be particularly difficult for dying parents to discuss the fact that they are dying with their children. Consequently, they may adopt an overly positive stance in order to shield their children from the truth. When unable to understand what is...
Ethics
Exploring in more depth issues of truth telling, deceit and lying
Published: 2011 Vol: 1 No: 2 The ethics article in the last issue (George, 2011; see journal archives) discussed the case of an 80-year-old woman called Martha, with advanced multi-infarct dementia. When Martha suffered infarcts, her cognitive ability temporarily worsened and, for short periods, she forgot that her husband had died. When told that he was in fact dead, Martha would get very distressed. Therefore, during these...
Clinical review
Faecal incontinence in advanced dementia: the nursing role
Published: 2011 Vol: 1 No: 3
Faecal incontinence is one of the prognostic indicators for the terminal stages of dementia. However, there is minimal information on this distressing symptom in the context of cognitive decline. Faecal incontinence in dementia is often under-reported, under-estimated and poorly assessed and managed, despite being a potentially treatable condition. It has a profound negative impact on the...
Clinical review
Heart-failure patients' thoughts and fears concerning dying
Published: 2011 Vol: 1 No: 3
Patients with heart failure experience a variety of reactions to living with a chronic yet terminal disease. These range from acceptance of death to fear of death. Heart-failure patients have a high symptom burden, which adversely affects their quality of life. Patients are very concerned about the burden that their disease places on their informal caregivers. Such concerns can influence their...
Clinical practice development
Incorporating spirituality in end-of-life nursing care
Published: 2011 Vol: 1 No: 3
The palliative approach to care involves individual, holistic, continuous assessment of physical, psychological, spiritual and social problems. The aim is to identify adverse symptoms and associated distress and then to identify measures to help alleviate those symptoms. Spiritual distress at the end of life has the potential to impinge on physical and psychosocial wellbeing, thereby decreasing...
Clinical review
Living with people who have dementia and faecal incontinence
Published: 2012 Vol: 2 No: 2 As the population ages, the number of people with dementia will increase. Although faecal incontinence (FI) is not always present in this patient group, its occurrence, in combination with urinary incontinence, is a prognostic indicator of advanced disease. A previous article explored the topic of FI in the context of people with dementia, highlighting associated causes and risk factors, as well...
Nursing case review
Maintaining dignity at the end of life in the emergency department
Published: 2013 Vol: 3 No: 1 The main aims of nursing care at the end of life include relieving suffering, improving sense of wellbeing and helping patients to die peacefully and with dignity. Dignity at the end of life is a subjective concept. However, there are certain fundamental principles that are deemed essential to the maintenance of a dying patient’s dignity, e.g. holistic assessment and care, privacy, symptom...
National end of life care programme update
New arrangements for the National End of Life Care Programme and recent publications
Published: 2013 Vol: 3 No: 2
Introduction
On 1 April 2013, a new improvement body, NHS Improving Quality, was established. It is hosted by the NHS Commissioning Board and brings together the combined knowledge and experience of a number of NHS improvement organisations:
National End of Life Care Programme
National Cancer Action Team
NHS Diabetes and Kidney Care
NHS Improvement
NHS Institute for Innovation...
Professional issues
Non-invasive ventilation: new challenges for hospice nurses
Published: 2011 Vol: 1 No: 2 Specialist palliative care units such as hospices are increasingly providing care for patients with nonmalignant conditions. However, that means that palliative care nurses require education and training in the care of people with a variety of conditions, not just cancer. Also, palliative care nurses need to understand that they cannot be expected to know how to manage all conditions and...
National end of life care programme update
Overview of new guidance for staff who are responsible for care after death
Published: 2011 Vol: 1 No: 1
The nurse’s role at the end of life extends beyond death. It also involves providing care for the deceased person and giving support to their families, friends and carers. However, there has been a lack of clarity regarding the detail of care after death and the associated care practices have sometimes been surrounded with ritual.
Clinical review
Patients' experiences of fatigue in the end stages of renal disease
Published: 2011 Vol: 1 No: 2
The number of patients diagnosed with end-stage renal disease (ESRD) is increasing annually and will continue to rise as a result of the ageing population. Research exploring the symptom burden in ESRD has shown it to be equal to that of the symptom burden experienced by patients with terminal cancer. Fatigue is one of the most prevalent symptoms experienced by ESRD patients. It is very...
Clinical practice development
Perception of dignity in older people and at the end of life
Published: 2013 Vol: 3 No: 2 The impact of illness, age, treatment and a terminal prognosis can erode a patient’s sense of dignity and reduce quality of life. Maintaining patient dignity has always been considered synonymous with nursing practice. However, there is minimal information relating to how best nurses can promote and maintain a patient’s sense of dignity among different patient populations and care settings....
Professional issues
Problems associated with care at the end of life in acute hospitals
Published: 2011 Vol: 1 No: 1
Many more people die in acute hospitals than ever before. An integrative literature review was undertaken to explore end-of-life care (EoLC) delivered in non-palliative care settings. It showed that providing EoLC in acute hospitals is difficult, given the emphasis on life extension and cure. EoLC pathways can assist with the planning and delivery of care. According to an international report,...
National end of life care programme update
Route to success: achieving quality for lesbian, gay, bisexual and transgender people
Published: 2012 Vol: 2 No: 2
Introduction
In the UK, accurate numbers of people who identify themselves as lesbian, gay, bisexual or transgender (LGBT) are hard to establish. Official figures vary between 750,000 (Office for National Statistics, 2010) and 3.6 million (Parliament UK, 2009). In 2009, the number of people who had sought gender reassignment treatment was estimated at 12,500, with the expectation that this...
Clinical skills
Talking about death in dementia
Published: 2013 Vol: 3 No: 1 In this issue of the journal, Julie Watson highlights how people with dementia often become depersonalised. As dementia progresses, carers may stop seeing the human being behind the condition, attributing all behaviour to pathology. However, despite behavioural change and loss of cognitive function, people who have dementia retain their sense of uniqueness and individuality (Sabat, 2001, 2010)....
National end of life care programme update
The 'route to success' in end-of-life care: achieving quality for social work
Published: 2012 Vol: 2 No: 2 Approximately 30% of people use some form of local authority-funded social care in their last year of life. Evidence suggests that any reduction in the availability of social care services might increase demand on hospital services (National End of Life Care Intelligence Network, 2012). For example, it is known from test sites around the country that financially modest, preventive social care...
Clinical review
The barriers to organ and tissue donation in palliative care
Published: 2012 Vol: 2 No: 2 Discussions about organ/tissue donation are now expected to become part of end-of-life care discussions, when appropriate. It is commonly perceived that terminally ill people are not eligible to donate their organs/ tissues. However, that is not the case. Palliative care patients can donate various tissues, including corneal tissue, and in some cases organs. Donation rates from palliative care...
National end of life care programme update
The development of an electronic, palliative care, coordination system
Published: 2011 Vol: 1 No: 2 Effective coordination of care, sharing of information and partnership working are principles that define high-quality, end-oflife care. Technology is now being adapted to support these principles in order to improve, and put individual patients at the centre of, care at the end of life. The concept of an electronic, palliative care, coordination system (EPCCS), also known as a ‘locality register...