The phasing out of the Liverpool Care Pathway and the introduction of the Leadership Alliance for the Care of Dying People’s (LACDP’s) five priorities of care has enabled clinicians working in end-of-life care to step back and re-evaluate their practice (LACDP, 2014). The review of end-of-life care services, More Care, Less Pathway (Neuberger, 2013) highlighted areas that needed urgent improvement. These included recognising when a person is dying but understanding the need for ongoing assessment; having a senior named clinician for all patients; and improving the communication skills of all clinicians involved in end-of-life care through the development of educational programmes. Non-malignant diseases are particularly challenging and in these cases it can be hard to recognise when a person is nearing the end of his or her life. Community matrons have their own unique relationship with the people on their caseload and can often provide untapped expertise and support as their condition deteriorates.
End of life can be a frightening and uncertain time for patients and families and the role of the community nurse can be vital in easing this phase of life. This article outlines some of the issues that community nurses should be aware of when caring for a patient who is dying at home. It identifies the signs which signify that death is approaching, and explains the need for a change in care emphasis at this point. The author also outlines some key management aspects that can improve the quality of a patient’s death, including communication, care coordination, symptom and pain control, and support for nurses and carers.
In each issue of the Journal of Community Nursing we investigate a hot topic currently affecting our readers. Here, Jason Beckford-Ball looks at an issue that refuses to go away — end-of-life care — and asks the question...
End of life care became the focus of media attention in 2013 when the Liverpool Care Pathway was found to be not fit for purpose. This article looks at the policy background to end of life care in the UK, as well as the current state of provision, from a community nursing perspective. It also focuses on pressure ulceration, a key complication for patients at the end of life, offering advice on how to approach skin care for this patient group. Finally, the author examines the implications for treatment of mental capacity legislation, and how concepts such as 'advanced decisions' and ethics affect nurses trying to treat patients at the end of life.
Although many people say they would like to die at home, only 20% actually do, with the majority dying in hospitals, hospices and care homes. As a student nurse, Ilhan Wardhere found reflection helpful in working through clinical challenges. Here she shares her experiences of dealing with end of life care in the community.
