6 Steps to success in end of life
care
Residential homes
Pam Williams
Clinical Nurse Educator
End of Life Care
June 2011
Objectives
• Identify good practice for the deceased
resident
• Give practical support and information to
families, significant others, staff and other
residents
• Respect individual faiths & beliefs to
address individual wishes
• Have an action plan to implement a
bereavement policy
Listen to your wishes
Help you think ahead
Talk with you and the people who are important to you about your future needs.
Endeavour to ensure clear written communication of your needs and wishes to those who
offer you care and support
Do our utmost to ensure that your remaining days and nights are as comfortable as
possible
Do all we can to help you preserve your independence, dignity and sense of personal
control
Support the people who are important to you, both as you approach the end of your life
and during
their bereavement.
Royal College of Nursing patient charter 2011
Care of the deceased?
• Last offices;
• Death must be verified before last offices
can commence
• Is there a need for referral to the coroner?
• Discuss any preferences with family i.e.
religious or cultural requests
• Collect all equipment necessary
• Ensure privacy & dignity maintained
Continued…
• Remove anything invasive if appropriate
• ( referral to coroner means all equipment
must be left in situ) i.e. spigott off catheter
& remove bag.
• Remove jewellery unless instructed to
leave on
• Press gently on bladder if patient not
catheterised to allow drainage and
minimise leakage
And…
• Attend to hygiene needs particularly hair,
nails & oral hygiene
• If possible insert dentures , if not ensure
they are clearly labelled and send with the
body.
• Attempt to close eyes using a small piece
of clinical tape
• Dress in shroud, gown or own clothes as
required
Documentation & legalities
•
•
•
•
•
•
•
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Check requirements for body bag
Label patient as necessary
Document everything & complete LCP
Dispose of clinical waste appropriately
Allow family time
Arrange for transfer of the body
Deal with property as per home policy
Inform other agencies of the death as
appropriate i.e. dn, gp,
WHAT DO WE KNOW ABOUT
GRIEF?
•
•
•
•
•
•
•
SOME EVIDENCE;
The stages;
Denial
Anger
Bargaining
Depression
Acceptance
And…
• High risk of increased morbidity and
mortality
Based on;
• Experience of death
• Supportive network
NORMAL & ABNORMAL GRIEF
Normal Grief
• Found in the majority of survivors.
• It describes grief that is eventually lessened as a person
readjusts to their loss.
• Grief is usually not something one “recovers” from
because the loss is never regained or replaced.
• A grieving individual doesn’t return to the person they
were before the loss; rather they usually describe their
lives after loss as “different”.
• For some, it changes their entire identity and they will
divide their lives into “before” the loss and “after” the
loss.
Abnormal Grief
•
Abnormal, often referred to as complicated grief, is found in only 3 to 25
percent of loss survivors.
•
Chronic grief – the grieving person has trouble finding closure and
returning to normal activities over an extended amount of time.
•
Delayed grief – the intentional postponement of grief.
•
Disenfranchised grief – often occurs when a grieving person’s loss can’t
be openly acknowledged or is one that society does not accept as a real.
Examples include losses related to AIDS, miscarriage, or loss of a
homosexual partner.
•
Exaggerated grief – intense reactions of grief
•
Sudden grief – when death takes place very suddenly without warning.
Sudden grief can lead to posttraumatic stress disorder (PTSD).
WHAT CAN WE DO?
OFFER BEREAVEMENT SUPPORT AND
INFORMATION TO THE
FAMILY/SIGNIFICANT OTHERS
What kind of information might they
need?
REMEMBRANCE
• BOOK
• GARDEN
• REMEMBRANCE SERVICE
• FOLLOW UP APPOINTMENT
• ANY OTHER IDEAS?
A BEREAVEMENT POLICY?
• What the bereaved person is entitled to
• The responsibilities of health professionals
• How the home aims to meet these aspects
The Role of the Funeral Director
6 STEPS END OF LIFE CARE
POLICY
• Systems are in place for providing good practice
for the care and viewing of the deceased
• Systems are in place to provide appropriate
information and support to relatives and
significant others, and staff post bereavement
• Other residents are supported following a death
in the care home
• The quality of end of life care is sustained,
audited and reviewed.
SMALL CHANGE BIG
DIFFERENCE
• THOUGHTS FOR IMPLEMENTING
CHANGE
THE PORTFOLIO
• Collecting evidence
• Sorting evidence
• CQC evidence
• Ongoing resource
THE CELEBRATION EVENT
• WHAT DO YOU WANT TO HAPPEN?
• DISPLAYING YOUR ACHIEVEMENTS
ANY QUESTIONS
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