Past Issues: Vol 1 Issue 3 - Winter 2011

Clinical review

Faecal incontinence in advanced dementia: the nursing role

Published: 2011 Vol: 1 No: 3
Author(s):
Nykki Hetherton
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 practice development

Lymphoedema management in palliative and end-of-life care

Published: 2013 Vol: 3 No: 3
Author(s):
Catherine Kreckeler
Lymphoedema is a progressive, chronic condition that can have profound adverse effects on the physical and psychosocial wellbeing of sufferers. It tends to be ineffectively managed in palliative care clinical settings and the condition often goes unrecognised and untreated. Multi-layer, compression, decongestive therapy remains one of the cornerstones of lymphoedema management. However, minimal...
Clinical review

Heart-failure patients' thoughts and fears concerning dying

Published: 2011 Vol: 1 No: 3
Author(s):
Kimberley Reeman, Helen Noble
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 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...
Research

End-of-life care for the British Asian Hindu community: Preferences and solutions

Published: 2013 Vol: 3 No: 3
Author(s):
Sarah Frearson and Jane Henderson with Bharti Raval, Charles Daniels, Geraldine Burke, Jonathan Koffman
Abstract Background: In the UK, most people prefer to die at home but many still die in hospital. People from black, Asian and minority ethnic groups are even more likely to die in hospital. Little is known about their preferences for location of care at the end of life. Aim: To explore preferences for place of care and death among the British Hindu community and to identify barriers preventing...
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 practice development

Incorporating spirituality in end-of-life nursing care

Published: 2011 Vol: 1 No: 3
Author(s):
Sarah Spencer-Adams
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...
Personal reflections

Role modelling GSF principles of end-of-life care to care homes

Published: 2013 Vol: 3 No: 3
Author(s):
Barbara Kenyon
Residents in care homes providing nursing care are becoming increasingly frail and dependent, with 80% having dementia or severe memory problems. Currently, 19% of the UK population die in care homes each year. Care homes (especially care homes providing nursing care) have an important role in the care of dying residents and are now expected to provide good end-of-life care (EoLC). Implementing...
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

St Christopher's Hospice Clinical Guidelines: Anticipatory end-of-life care medication for the symptoms of terminal restlessness, pain and excessive secretions in frail older people in care homes

Published: 2013 Vol: 3 No: 3
Author(s):
Julie Kinley, Louisa Stone, Jo Hockley
The term ‘frail older people’ has been defined as people over 75 years of age with geriatric syndrome, i.e. the presence of numerous chronic diseases and signs and symptoms such as incontinence, falls, cognitive impairment and reduced mobility (Saavreda Muñoz and Barreto Martín, 2008). However, some older people are ‘frail’ before the age of 75 years. Therefore, frailty in older people should...
Clinical research/audit

Implementing stock end-of-life medication in UK nursing homes

Published: 2013 Vol: 3 No: 3
Author(s):
Kathy Morris, Jo Hockley
Background: In nursing care homes (NCHs), the use of end-of-life care (EoLC) medication has traditionally been requested and prescribed on an individual basis during each resident’s last days of life. However, some GPs are reluctant to prescribe EoLC medication in anticipation of symptoms occurring if, at the time of their visit, the resident is symptom-free. Even when prescribed, care home staff...

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