Past Issues: Vol 1 Issue 2 - Autumn 2011

Clinical skills

Xerostomia in terminally ill and dying patients: best practice

Published: 2012 Vol: 2 No: 2
Author(s):
Lisa Sheehy, Jasper Shaw
Xerostomia (dry mouth) has a negative impact on health and quality of life. It can increase the risk of oral candidiasis, tooth cavities and infections and cause difficulties with swallowing and communicating. Maintenance of oral hygiene should be an integral aspect of nursing care. Oral hygiene is important within all patient populations, including patients with terminal disease and those at the...
Clinical review

Death and dying in intensive care: emotional labour of nurses

Published: 2013 Vol: 3 No: 2
Author(s):
Lucy Ryan, Jane Seymour
Intensive care unit (ICU) nursing is associated with emotional labour. ICU nurses regularly care for dying patients. End-of-life care (EoLC) can be a major cause of stress in ICU, particularly in relation to the withdrawal of life-sustaining treatment, managing the transition from curative care to EoLC and dealing with the distress of patients, relatives/loved ones. However, ICU nurses receive...
Clinical review

Emotional distress in patients with advanced heart failure

Published: 2011 Vol: 1 No: 2
Author(s):
Christina Ramsenthaler
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

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

Encouraging/supporting dying parents to talk to their children

Published: 2013 Vol: 3 No: 2
Author(s):
Steve Marshall, Julia Manning, Sally Mercer
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...
Clinical review

Understanding nurse and patient perceptions of a 'good death'

Published: 2011 Vol: 1 No: 2
Author(s):
Miranda Paddy
The generally accepted principles of a good death among Western health and social care professionals include that the patient is: pain and symptom free; treated as an individual and with dignity and respect; involved in decision-making; prepared for and accepts the imminence of death; surrounded by loved ones in familiar surroundings and has completed unfinished business. However, patients may...
Clinical review

The barriers to organ and tissue donation in palliative care

Published: 2012 Vol: 2 No: 2
Author(s):
Mary Spencer
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...
Clinical practice development

Perception of dignity in older people and at the end of life

Published: 2013 Vol: 3 No: 2
Author(s):
Julie Vosit-Steller, Jenna Swinkin, Katie McCabe
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....
Clinical review

Patients' experiences of fatigue in the end stages of renal disease

Published: 2011 Vol: 1 No: 2
Author(s):
Kate Critchley
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 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 review

Living with people who have dementia and faecal incontinence

Published: 2012 Vol: 2 No: 2
Author(s):
Nykki Hetherton
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...
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...
Ethics

Exploring in more depth issues of truth telling, deceit and lying

Published: 2011 Vol: 1 No: 2
Author(s):
Rob George
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...
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...
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...
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
Author(s):
Claire Henry
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
Author(s):
Ruth Palmer
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

Route to success: achieving quality for lesbian, gay, bisexual and transgender people

Published: 2012 Vol: 2 No: 2
Author(s):
Bridget Moss, Claire Henry, Tes Smith
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...
National end of life care programme update

The development of an electronic, palliative care, coordination system

Published: 2011 Vol: 1 No: 2
Author(s):
Claire Henry, Anita Hayes
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...
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
Author(s):
Professor Margaret Holloway, Rick O’Brien
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...

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