Good End Of Life Care Research Articles

The provision of end-of-life care by medical-surgical nurses working in acute care: A literature review

Caring for terminally ill patients is complex, stressful, and at times distressing for nurses. Acute care hospitals continue to be the predominant place of death for terminally ill patients in most Western countries. The objective of the present literature review was to explore and gain an in-depth understanding of the experience of providing end-of-life (EOL) care by medical-surgical RNs working in acute care hospitals, to identify knowledge gaps, and to recommend future research. A comprehensive literature review was conducted using the following electronic databases: CINAHL, MEDLINE, and PsyInfo (from 1992 to October 2012). The findings from the 16 reviewed studies suggest that nurses felt a strong commitment to help terminally ill patients experience a good death. Nurses reported feeling deeply rewarded and privileged to share the EOL experience with patients/families. Organizational and individual factors influenced nurses' experience. Important challenges were associated with managing the divergent needs of a mixed patient load (i.e., curative and palliative care patients) in a biomedical culture of care that is heavily oriented toward cure and recovery. In this culture, nurses' emotional work and ideals of good EOL care are often not recognized and supported. Managerial and organizational support that recognize the centrality of emotional work nurses provide to dying patients is needed. More research exploring ways to improve communication among nurses and medical colleagues is essential. Finally, a critical examination of the ideological assumptions guiding nurses' practice of EOL care within the context of acute care is recommended to help reveal their powerful influence in shaping nurses' overall understanding and experience of EOL care.

P3 Making a difference in care homes

IntroductionThe Hospice undertook a project with 10 local care homes which had the highest rate of admissions to an acute hospital where the patient had died. The inital results in...

P1 Improving End of Life Care (EoLC) in care homes: An action learning and education development programme for care home leaders

In the last decade there has been considerable investment in end of life teaching to the care home sector with particular reference to the Gold Standards Framework and Six Steps...

Death and dying in residential care: a matter of concern

Purpose – The purpose of this paper is to trace the history of official policy on the regulation of care homes in respect of end of life care and to contrast this with the results of research on this important theme, not least in terms of what is required to support care home staff in relation to dying residents and their relatives. A central concern is to argue for the open recognition that care homes now cater primarily for frail people towards the end of their lives. Good end of life care and a good death could become a positive “selling point”. The author concludes that the system of regulation has broadly failed to address a good death or good end of life care in a residential home. Death talk should no longer need to be avoided in care homes. The research suggests that appropriate support for care home staff in relation to dying residents needs careful identification and investment. A cultural shift is required. Design/methodology/approach – Following a review of policy documents on regulation and standards of care in residential homes and a subsequent review of the research literature on death and dying in care homes, the paper illuminates the contrast between the ambitious aims in policy documents with very varied practice in everyday care of frail residents. Findings – The recent systems of regulation have broadly failed to address a good death or good end of life care in residential homes. Open acknowledgement of death and dying should not be avoided in care homes. Appropriate support for care home staff in relation to dying residents needs careful identification and investment. Originality/value – The focus of this paper is to contrast official policy with everyday practice. Whilst policy documents suggest recognition of the importance of dignity and respect from dying residents, the research literature indicates great variation in the practice of everyday care.

Reluctance to discuss death is obstacle to good end of life care

Reluctance to discuss death is obstacle to good end of life care

DOES LAW HAVE A ROLE TO PLAY IN ADVANCE CARE PLANNING?

BackgroundThe role of law in end of life care is vexed. Legal risk (or perceptions of it) can impede good end of life care through defensive medicine, and legal processes...

WHY DON'T GPS DO ADVANCE CARE PLANNING OR END OF LIFE CARE?

Seminal research by Barbara Starfield and colleagues has shown that a strong Primary Care Health system is associated with improved patient outcomes, reduced costs and greater equity in the provision...

Reforming the NHS: an opportunity for palliative care in the community?

254 British Journal of Community Nursing Vol 18, No 5 As Government reforms of the NHS kicked in this April, it is crucial that community nurses realise/ recognise that despite possible improvements, as well as some upheaval and uncertainty in the health and social care landscape, patients’ needs remain constant. Therefore, nurses must cease the opportunity to provide impeccable palliative care to all including patients dying in the community. In recognition of the impact of the NHS reforms, the All Party Parliamentary Group (APPG) on Hospice & Palliative Care and the National Council for Palliative Care (NCPC) came up with a strategy to ensure that palliative and end-oflife care is kept as a national and local priority. On 20 March, they launched a document jointly produced with Marie Curie Cancer Care entitled 10 Questions to ensure good end of life care in your area. These questions are useful for all health professionals, as they offer a guide on what areas to ask commissioners, MPs, GPs and local councillors about how they intend to develop palliative care services. These questions could also be a good basis for research projects that will look into more detail on how palliative and end-of-life care is being delivered in local areas. It is impossible to discuss every question here, so a couple have been selected as examples.

Call for better end of life care for people with liver disease

Call for better end of life care for people with liver disease

Palliative care for patients with gastrointestinal cancer dying under surgical care: A case for acute palliative care units?

Background and aimsPatients with advanced gastrointestinal cancer may present late to hospital services and die under surgical care. The aim of this study was to examine end of life care in patients dying of gastrointestinal cancer in Scottish hospital surgical wards. MethodsThe Scottish Audit of Surgical Mortality prospectively peer reviews all inpatient deaths under the care of a consultant surgeon. Patients who died with gastrointestinal cancer under surgical care from 1994 to 2006 were evaluated for operative interventions, adverse events, and palliative care provision. Data was compared with inpatient data from the Information Statistics Division of NHS Scotland. ResultsA total of 8019 patients died with gastrointestinal cancer on a surgical ward over 12 years. For 4350 (54%), no operation or endoscopy was performed during the final admission and adverse events were identified in only 86 (2%) of these patients, most commonly due to a complication of an interventional procedures. Specialist palliative care was provided to 57% of patients and was not influenced by cancer site. ConclusionA substantial proportion of patients die with gastrointestinal cancer on general surgical wards without operative or endoscopic intervention and may receive better end of life care in an acute palliative care setting.

The role of specialist palliative care services in stroke – views from an acute stroke unit

BackgroundStroke is the third commonest cause of death and causes significant symptoms and disability. In the UK, acute stroke care occurs in hospital. National Stroke Strategy guidelines recommend that patients...

A training initiative to improve end of life care in the care home setting

BackgroundThe End of Life Care Strategy (DH, 2008) emphasised the need to raise the quality of care provided to people dying in care homes. Many residents die in hospital following...

How many doctors? Relational continuity in end of life care

BackgroundContinuity of care is important to patients and is a key factor in providing good end of life care. Relational continuity describes the continuity of care provided by seeing the...

What end of life care do pancreatic cancer patients receive at a tertiary hepatobiliary unit?

BackgroundFor patients who present with advanced pancreatic cancer, prognosis is poor irrespective of treatment. Good end of life care is therefore essential.AimTo examine specific elements of care given to patients...

A good death.

Definitions of a good death often include being at home. Dying at home may be optimal for the patient but could place a significant burden on families and leave them with traumatic memories. Death in hospital should not mean that it is a 'bad death'. How someone dies is more important than where they die and nurses should be taught to provide good end of life care in all settings.

Measuring the quality of end of life management in patients with advanced kidney disease: results from the pan-Thames renal audit group

Despite a recent increased awareness of the need for quality End of Life (EOL) care for patients with advanced kidney disease, there is no established method for measuring or auditing outcomes relating to EOL care in this population. We designed a one-page proforma, which was used to collect data on various aspects of EOL care relating to all deaths of patients on dialysis and patients dying on specialist renal wards, over a predefined 8-week period in 10 hospitals in London and South-East England. One hundred and thirty-eight deaths were recorded over the 8-week study period. The majority of patients (83%) were receiving maintenance haemodialysis prior to their terminal presentation. About 69% of deaths occurred during an in-patient hospital admission-of these, 36% were considered 'unexpected' and most quality markers of good EOL management were significantly less likely to be achieved in these patients, including use of palliative care strategies, good symptom control and overall quality of death. Thirty-six per cent of patients were from various ethnic minorities, and in this group, there was a trend towards lower use of palliative care pathways and lower rates of withdrawal from dialysis. This study confirms that it is possible to measure many important outcomes relating to quality of EOL care using a proforma completed at the time of death. Our findings suggest that many aspects of good EOL care are under-achieved in our region. This, in part, is due to a failure to recognize the worsening trajectory of the deteriorating patient, resulting in missed opportunities for EOL care planning and appropriate symptom control. Our observations suggest that there is a need for improved education and training in this area, particularly in detection of the dying patient, the value of advance care planning and the utility of tools such as the Liverpool Care Pathway.

What is good end of life care after stroke?

IntroductionStroke is the third commonest cause of death and causes significant symptoms and disability. Acute stroke care in the UK predominantly occurs in hospital. Guidelines recommend that patients should be...

The ACT children's palliative care handbook for GPs

ACT recognises that as long term family practitioners, GPs are ideally placed to facilitate good communication in and between multi-disciplinary and multi-agency teams. The GP has a major role to...

An audit around preferred place of death: one UK hospice experience

IntroductionAccording to the End of Life Care Strategy, good end of life care includes choosing a place of care for one's death. It is easy to assume that all hospice...

Place of death: is home always best?

Place of death is now a quality marker of end of life care. Decisions around place of death are complex. This article considers the extent to which place of death is an appropriate way to determine good end of life care.