scholarly journals Getting anticipatory prescribing right in end-of-life care

2019 ◽  
Vol 24 (6) ◽  
pp. 274-277 ◽  
Author(s):  
Ben Bowers ◽  
Alison While
Keyword(s):  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Life Care ◽  
High Quality ◽  
Home Setting ◽  
Safety Issues ◽  
Controlled Drugs ◽  
District Nurses

There is a growing number of people who need access to high-quality endof-life care in the home setting. This requires timely assessments of needs, ensuring good symptom management and recognising the roles undertaken by carers. For some patients, a range of medications may need to be put in place to relieve end-of-life symptoms, using ‘anticipatory prescribing’. District nurses must ensure that they acknowledge the patient's voiced preferences and be mindful of the safety issues that arise with the supply of controlled drugs in the home. This article highlights the challenges faced by district nurses providing or dealing with anticipatory prescribing during end-of-life care.

The nursing management required to provide effective end-of-life care in a care home setting: a case study

2021 ◽  
Vol 23 (2) ◽  
pp. 1-7
Author(s):  
Simona Hickey ◽  
Mary Williams
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Care Home ◽  
Life Care ◽  
Home Setting ◽  
Nursing Home Setting

Background: This case study is a practical experience example from a nursing home setting. It will describe how a holistic approach to care, provided to a resident living with dementia at end of life, ensured a peaceful death. Aims: The importance of advance care planning and effective pain and symptom management in end-of-life care will be explored. The psychosocial issues experienced by the resident and their family and any ethical issues associated with the delivery of care will be addressed. The factors and challenges that need to be overcome in order to ensure effective pain and symptom management for the dying patient, particularly in a nursing home setting, are discussed. Finally, this article will make recommendations for future practice. Methods: This is a case study based on an author's experience while working in a nursing home setting. Findings: Challenges associated with end-of-life care have been identified and recommendations have been made.

The known unknowns of assisted hydration at the end of life

2021 ◽  
Vol 26 (6) ◽  
pp. 284-285
Author(s):  
Arjun Kingdon ◽  
Anna Spathis ◽  
Ben Bowers ◽  
Stephen Barclay
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Shared Decision ◽  
Life Care ◽  
High Quality ◽  
Home Setting ◽  
Known Unknowns ◽  
The Impact

Much is unknown about assisted hydration at the end of life: why rates of usage vary so highly between institutions, cultures and countries, what beneficial or burdensome effects this treatment has, whether there is a place for subcutaneous hydration in the home setting, and how best to communicate about this difficult topic with dying people and their families. In light of a recently published systematic review concerning the impact of assisted hydration at the end of life, this article explores these questions and related issues, concluding that individualisation and shared decision-making are essential aspects of high-quality end-of-life care.

60. Using a pocket card to improve end-of-life care on clinical teaching units: A controlled trials

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
J. Downar ◽  
J. Mikhael
Keyword(s):  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Palliative Medicine ◽  
Clinical Teaching ◽  
Intervention Group ◽  
Comfort Level ◽  
Control Group ◽  
Life Care ◽  
Comfort Levels

Although palliative and end-of-life is a critical part of in-hospital medical care, residents often have very little formal education in this field. To determine the efficacy of a symptom management pocket card in improving the comfort level and knowledge of residents in delivering end-of-life care on medical clinical teaching units, we performed a controlled trial involving residents on three clinical teaching units. Residents at each site were given a 5-minute questionnaire at the start and at the end of their medicine ward rotation. Measures of self-reported comfort levels were assessed, as were 5 multiple-choice questions reflecting key knowledge areas in end-of-life care. Residents at all three sites were given didactic teaching sessions covering key concepts in palliative and end-of-life care over the course of their medicine ward rotation. Residents at the intervention site were also given a pocket card with information regarding symptom management in end-of-life care. Over 10 months, 137 residents participated on the three clinical teaching units. Comfort levels improved in both control (p < 0.01) and intervention groups (p < 0.01), but the intervention group was significantly more comfortable than the control group at the end of their rotations (z=2.77, p < 0.01). Knowledge was not significantly improved in the control group (p=0.07), but was significantly improved in the intervention group (p < 0.01). The knowledge difference between the two groups approached but did not reach statistical significance at the end of their rotation. In conclusion, our pocket card is a feasible, economical educational intervention that improves resident comfort level and knowledge in delivering end-of-life care on clinical teaching units. Oneschuk D, Moloughney B, Jones-McLean E, Challis A. The Status of Undergraduate Palliative Medicine Education in Canada: a 2001 Survey. Journal Palliative Care 2004; 20:32. Tiernan E, Kearney M, Lynch AM, Holland N, Pyne P. Effectiveness of a teaching programme in pain and symptom management for junior house officers. Support Care Cancer 2001; 9:606-610. Okon TR, Evans JM, Gomez CF, Blackhall LJ. Palliative Educational Outcome with Implementation of PEACE Tool Integrated Clinical Pathway. Journal of Palliative Medicine 2004; 7:279-295.

scholarly journals Are Transfusions a Barrier to High-Quality End-of-Life Care in Hematology?

2018 ◽  
Vol 15 (4) ◽  
Author(s):  
Mark R. Litzow ◽  
Thomas W. LeBlanc
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
High Quality

scholarly journals Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study

2022 ◽  
Vol 19 (2) ◽  
pp. 667
Author(s):  
Helen Yue-Lai Chan ◽  
Cecilia Nim-Chee Chan ◽  
Chui-Wah Man ◽  
Alice Dik-Wah Chiu ◽  
Faith Chun-Fong Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hong Kong ◽  
End Of Life ◽  
Delphi Study ◽  
End Of Life Care ◽  
Care Home ◽  
Local Context ◽  
Life Care ◽  
Home Setting ◽  
Modified Delphi

Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.

scholarly journals Pediatric-Specific End-of-Life Care Quality Measures: An Unmet Need of a Vulnerable Population

2017 ◽  
Vol 13 (10) ◽  
pp. e874-e880 ◽  
Author(s):  
Emily E. Johnston ◽  
Abby R. Rosenberg ◽  
Arif H. Kamal
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Quality Measures ◽  
Care Quality ◽  
Patient Choice ◽  
Decision Makers ◽  
Hospital Death ◽  
Life Care ◽  
High Quality ◽  
National Quality

We must ensure that the 20,000 US children (age 0 to 19 years) who die as a result of serious illness annually receive high-quality end-of-life care. Ensuring high-quality end-of-life care requires recognition that pediatric end-of-life care is conceptually and operationally different than that for adults. For example, in-hospital adult death is considered an outcome to be avoided, whereas many pediatric families may prefer hospital death. Because pediatric deaths are comparatively rare, not all centers offer pediatric-focused palliative care and hospice services. The unique psychosocial issues facing families who are losing a child include challenges for parent decision makers and young siblings. Furthermore, the focus on advance directive documentation in adult care may be less relevant in pediatrics because parental decision makers are available. Health care quality measures provide a framework for tracking the care provided and aid in agency and provider accountability, reimbursement, and educated patient choice for location of care. The National Quality Forum, Joint Commission, and other groups have developed several end-of-life measures. However, none of the current quality measures focus on the unique needs of dying pediatric patients and their caregivers. To evolve the existing infrastructure to better measure and report quality pediatric end-of-life care, we propose two changes. First, we outline how existing adult quality measures may be modified to better address pediatric end-of-life care. Second, we suggest the formation of a pediatric quality measure end-of-life task force. These are the next steps to evolving end-of-life quality measures to better fit the needs of seriously ill children.

District nurse advocacy for choice to live and die at home in rural Australia

2014 ◽  
Vol 22 (4) ◽  
pp. 479-492 ◽  
Author(s):  
Frances M Reed ◽  
Les Fitzgerald ◽  
Melanie R Bish
Keyword(s):  
End Of Life ◽  
Rural Areas ◽  
End Of Life Care ◽  
Research Question ◽  
Empirical Literature ◽  
Life Care ◽  
District Nurse ◽  
District Nurses ◽  
Rural Australia ◽  
At Home

Background: Choice to live and die at home is supported by palliative care policy; however, health resources and access disparity impact on this choice in rural Australia. Rural end-of-life home care is provided by district nurses, but little is known about their role in advocacy for choice in care. Objectives: The study was conducted to review the scope of the empirical literature available to answer the research question: What circumstances influence district nurse advocacy for rural client choice to live and die at home?, and identify gaps in the knowledge. Method: Interpretive scoping methodology was used to search online databases, identify suitable studies and select, chart, analyse and describe the findings. Results: 34 international studies revealed themes of ‘the nursing relationship’, ‘environment’, ‘communication’, ‘support’ and ‘the holistic client centred district nursing role. Discussion: Under-resourcing, medicalisation and emotional relational burden could affect advocacy in rural areas. Conclusion: It is not known how district nurses overcome these circumstances to advocate for choice in end-of-life care. Research designed to increase understanding of how rural district nurses advocate successfully for client goals will enable improvements to be made in the quality of end-of-life care offered.

Sign in / Sign up

Export Citation Format

Share Document