Support Borrowing and reservations Literature searching and training Keeping up to date Accessibility. End of Life Care. View page. RCN: Getting it right every time: the fundamentals of nursing care at the end of life Online learning resource for nursing staff: View page. Royal College of Nursing Getting it right every time: fundamentals of nursing care at the end of life, London: Royal College of Nursing.
A review of choice in end of life care, London: DH. Department of Health Our commitment to you for end of life care. The government response to the review of choice in end of life care, London: DH. Marie Curie Cancer Care and the Bevan Foundation Death and dying in Wales: an analysis of inconsistencies in access to specialist palliative care and hospital activity in the last year of life, Penarth: Marie Curie Cancer Care.
View PDF. NICE guidance is officially England only.
End of Life Care | Subject Guide | Library | Royal College of Nursing
NICE Evidence guidance search: end of life care Please check that guidance is applicable for your country. RCN: Getting it right every time: nutrition and hydration care at the end of life. She has written numerous journal articles on advance care planning, suffering at the end of life, hospice, and other related topics. The recipient of a Robert Wood Johnson Foundation Executive Nurse Fellowship, Norlander has presented nationally and conducted writing workshops for nurses on end-of-life care. Be the first to review this product.
To Comfort Always: A Nurse's Guide to End-Of-Life Care
More Views. Add to Cart. As such, there is evidence of systemic change alongside concerns regarding a lack of structured dissemination. Literature on multi-disciplinary teamwork emphasizes the potential challenges of inter-professional collaboration owing to distinctive occupational cultures [ 24 , 25 ]. Findings did point to a barrier of a kind between carers and non-carers i. This reluctance, interviewees suggested, stemmed partly from a widespread nursing emphasis on physical health rather than more holistic issues, and partly from the relative failure of Elm House nurses to attend separate end of life training themselves.
As discussed below, this study did not seek the perspectives of nurses themselves — an absence that should be born in mind when interpreting the findings presented above. Nevertheless, it is clear that the professional divide between nurses and carers at Elm House may impact negatively on the incorporation of carer-driven changes in practice. However, findings also furnished evidence of barriers to sustained improvement.
In terms of changes in knowledge and confidence, firstly, the SHA questionnaire indicated a noteworthy A particularly strong advance However, the audit of resident care notes demonstrated a lower level of post-course improvement in terms of meeting care targets in this area Participants, that is, not only became substantially more aware of key medical aspects of terminal symptomatology and relevant care management tools, but also demonstrated an understanding of the need to involve residents and their relatives in dialogue and planning concerning end of life care.
Staff members participating in the ABC course emphasized their increased confidence in discussing the many difficult issues surrounding death and dying both at work and elsewhere, expressed their appreciation of the opportunity to discuss emotive issues in the ABC facilitated workshops, and in general welcomed the e-learning aspects of the course. In many ways, the emotive character of issues raised in end of life care highlights the particular benefits that derive from blended e-learning courses, as opposed to either face-to-face only or e-learning only courses [ 12 ].
As suggested by recent research, e. In terms of barriers to sustained improvements in end of life care, secondly, qualitative findings revealed two key factors that may limit the long-term impact of the ABC course despite management-led systemic interventions to facilitate improved end of life care delivery. The first of these is the lack of structured, regular opportunities for reflection and discussion among staff members.
Ethical Concerns in End-of-Life Care
While this is a common feature of pressurized work environments in which staff work long shifts, it does highlight the possibility that discussion of ABC course learning may be limited to course participants rather than serving as a focal point for change across the wider working community at Elm House. The second key barrier to sustained improvements is that presented by inter-professional tensions, particularly between carers and nurses. In addition to further limiting the dissemination of ABC course learning, this perception also demotivates and demoralizes carers, limiting their enthusiasm to apply their changed understandings in practice.
Consequently, this small-scale case study supports the view that, while blended end of life training for carers can lead to important changes in understanding and confidence, training alone is insufficient to guarantee sustained impacts on care delivery [ 3 , 5 ]. Research suggests that critical factors for successful, long-term change include: communicating a clear vision about the need for change; gaining commitment and participation from all staff members; communicating during the change; and making the change a permanent feature of organisational culture [ 30 , 31 ].
In the context of nursing homes seeking to improve their end of life care, taking account of these factors would entail a joined-up approach to end of life training across the two key staff groups of nurses and carers in order to overcome inter-professional barriers, ensure communication and wider commitment to change through e. It should be noted that this study exhibits a number of limitations.
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With the exception of the audit of deceased resident notes, the study focuses on participant perceptions and understandings rather than direct or indirect clinical outcomes. As mentioned above, the study does not include the perspective of nurses at Elm House, nor does it present the findings of long-term evaluation taking place several months or years following the educational intervention.
Lastly, the study does not separately examine the impact upon educational outcomes of different modes of educational delivery, such as e-learning only, workshops only, and blended e-learning e-learning and workshops. Future research could usefully address these limitations by undertaking evaluation of end of life care educational interventions with larger numbers of study participants across multiple nursing homes with distinct organizational frameworks, by evaluating direct and indirect clinical outcomes as well as educational outcomes, by evaluating different modes of educational intervention, by seeking the perspectives of all staff members including nurses , and by undertaking long-term follow-up evaluation.
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Course participants evidenced more detailed and more holistic understandings of end of life care and greater confidence across a range of end of life core competencies. However, the study also revealed specific areas where further training is needed alongside wider organizational and inter-professional barriers to long-term sustainable change, highlighting the need to address organizational change alongside educational interventions.
A mixed methods enquiry in England. Chan R, Webster J: End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database Syst Rev. Health Soc Care Community. Shemmings Y: Death, dying and residential care. Telemed E Health. Ahmed H: Hybrid e-learning acceptance model: Learner perceptions.
To Comfort Always: A Nurse's Guide to End-Of-Life Care
Decis Sci J Innov Educ. Public Opin Q. Braun V, Clarke V: Using thematic analysis in psychology.
Qual Res Psychol. Watson J, Hockley J, Dewar B: Barriers to implementing an integrated care pathway for the last days of life in nursing homes. Int J Palliat Nurs. J Clin Nurs. Acad Manag J. Peck E, Norman IJ: Working together in adult community mental health services: Exploring inter-professional role relations. J Ment Health.
Matthews M, Doherty G: In the mood: engaging teenagers in psychotherapy using mobile phones. Soc Sci Med. Edited by: Sawyer K. Narine L, Persaud DD: Gaining and maintaining commitment to large-scale change in healthcare organizations. Health Serv Manag Res. Download references. The author is grateful to the ABC course facilitators and the Elm House management for access to the online material and facilitated workshops at Elm House. Correspondence to Conor JT Farrington.
The author was solely responsible for designing, conducting, analyzing, interpreting, and writing up the study described above. All authors read and approved the final manuscript. This article is published under license to BioMed Central Ltd. Reprints and Permissions. Search all BMC articles Search. Open Peer Review reports.
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