Reflective accounts

End of life care

Dying is a natural part of life and the goals of palliative nursing care at the end of life are to achieve the best possible quality of life for the patient and to support their family and friends.

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The CPD article provided an introduction to the new guidelines for end of life care. The Leadership Alliance for the Care of Dying People identified five priorities to guide organisations in developing a person-centred and sensitive framework to care for the dying (Leadership Alliance for the Care of Dying People 2014).

These priorities are: recognising the end of life and communicating this to all concerned; sensitive communication between staff and the dying person and those important to them; decisions about treatment and care involving the dying patient and those important to them to the extent the dying person wishes; the needs of those important to the dying person being identified, respected and met as far as possible; and an individual plan of care being agreed, co-ordinated and delivered with compassion.

Organisations delivering safe and effective person-centred care have effective leadership, good teamwork and a culture based on fairness and learning. The article also emphasised the need for named clinicians and nurses in end of life care.

The overview of the 6Cs of nursing was valuable since these principles set out the care people should expect. They are also directly relevant to end of life care. Compassion requires empathy, sensing the feelings and meanings being expressed by patients and responding appropriately. Compassionate care is dignified care and requires a high level of skill and professionalism.

Communication can foster trust between the nurse and the patient and family. Where possible, advanced care plans and wishes can be drawn up and decided. It is important to enable the patient to discuss what is important to them, and where appropriate the nurse should be honest about the realities and the challenges ahead.

Best interests meetings

Nurses should share with families the uncertainty surrounding the predictability of when a patient is at the end of life. Best interests meetings may need to be held to allow for all views to be discussed and to reach a consensus that reflects the patient’s views and best interests.

Caring for people is challenging, and this is particularly true at the end of life where the nurse strives to promote comfort and enable the patient to let go of life with as much dignity as possible.

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