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The death of a loved one can trigger a range of feelings and emotions, among them anger, denial, guilt, sadness and shock. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To appreciate the risks and benefits of medicines use in older people approaching end of life • To enhance your knowledge of deprescribing with older people • To learn about a framework for challenging conversations that can support deprescribing discussions with older people It is essential for all healthcare practitioners, including nurses, to recognise and respond to people's wishes and preferences for end of life care as part of a person-centred approach. Older people approaching the end of life are significant consumers of prescribed medicines and are at increased risk of adverse drug events. As such, prescribers and other healthcare practitioners should offer older people the opportunity to be involved in decisions about their medicines. This article focuses on older people and deprescribing in the last year of life. It provides an overview of the personalised care agenda, explores the risks and benefits of medicines among older people with advanced illness, and describes some of the most widely used deprescribing tools. The article emphasises a person-centred approach to end of life care and makes suggestions for holding discussions about deprescribing with patients and their families and/or carers. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To enhance your awareness of the symptoms that patients with end-stage kidney disease may experience • To understand what conservative management of patients with end-stage kidney disease entails, including symptom management and advanced care planning • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) The prevalence of end-stage kidney disease is increasing, particularly among older people and those with multiple comorbidities. Typically, patients who develop end-stage kidney disease receive renal replacement therapies such as dialysis; however, this treatment can significantly affect quality of life and may not prolong life in older patients. Therefore, some patients may choose not to undergo dialysis and instead choose conservative management, which involves a palliative approach that focuses on maintaining quality of life and advance care planning. This article details the steps involved in a conservative kidney management pathway for end-stage kidney disease, including symptom management and advance care planning. It also discusses the importance of a palliative approach for patients receiving dialysis. [ABSTRACT FROM AUTHOR]

Many people will have symptoms of bladder or bowel incontinence when they are in the final few weeks or days of life. [ABSTRACT FROM AUTHOR]

It is the privilege of nurses to be present at the beginning and the end of life, says RCN professional lead for community and end of life care Carolyn Doyle. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness of the challenges and facilitators in providing effective end of life care to dying patients in the intensive care unit (ICU) • To consider your role in enhancing important aspects of end of life care, such as timely communication and patient involvement in decisions about their care • To be aware of the emotional challenges involved in caring for dying patients and how effective communication practices can be a source of support for yourself and your colleagues Caring for patients who are at the end of their lives is an essential aspect of practice in intensive care units (ICUs). While intensive care is one of the fastest-growing healthcare specialties as a result of technological and scientific advances, a significant proportion of patients admitted to an ICU in the UK will not survive their ICU stay. Therefore, it is important to examine ways to enhance practice in this area and the factors that might affect the care provided to patients and their families. Aim: To identify the challenges and facilitators that members of the ICU multidisciplinary team encounter in the delivery of end of life care to dying patients in ICUs. Method: A scoping literature review was undertaken. Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus with full text, MEDLINE Complete and the EBSCOhost E-Journals Database were searched electronically to identify literature from April 2007 to April 2017, alongside hand-searching. Critical appraisal tools were used and thematic analysis was undertaken to analyse the data and identify themes. Findings: Ten articles were included in the literature review, which identified various challenges and facilitators in providing effective end of life care in ICUs. The main themes identified were: communication, family involvement, personal factors and the ICU environment. Conclusion: All of the studies included in the literature review identified several important challenges related to communication, such as time constraints, disagreements among healthcare professionals, and a lack of knowledge among healthcare professionals about how to conduct challenging conversations with patients and families. Future developments in practice should consider the role of effective multidisciplinary team-working in end of life care. [ABSTRACT FROM AUTHOR]

A team of nurses and carers are helping hospital trusts to improve end of life care by following the difficult journey of dying patients and their families. Nurses Claire Henry and Marie Cooper are working with people whose loved ones have died in hospital to gain a 'fresh eyes' perspective on the experience of patients and their families. [ABSTRACT FROM AUTHOR]

Homelessness is a complex and multidimensional issue often involving a combination of personal vulnerability, the limitations of social housing, and inadequacies in welfare support. Providing palliative and end-of-life care to people experiencing homelessness is challenging, both to individuals receiving care and nurses aiming to meet their complex needs. This article discusses what is understood by the concept of 'homelessness' and examines the barriers to accessing effective healthcare for people who are homeless and have life-limiting conditions. The authors review the research into end of life care for people experiencing homelessness and identify areas for further investigation, notably the lack of evidence regarding the end of life care priorities of these individuals. There is a focus on the availability of healthcare services for people who are homeless at the end of life, as well as the factors that should be considered if evidence-based healthcare services for this group of people are to be improved in the future. [ABSTRACT FROM AUTHOR]

The conflicting tasks of treating or managing disease and preparing patients and their families for the end of life are well documented in haematology and palliative care settings. This article is a reflection on practice by a nursing student who was in the fourth year of an internship, and discusses a case study involving a woman at the end of life. It considers the approach to palliative and end of life care adopted in an oncology and haematology ward where there was a reluctance to be realistic about the limitations of treatments among some healthcare practitioners, who did not want to dispel unrealistic expectations of the patient's recovery as a result of continuing treatment. This reflection focuses on the care of a patient at the end of life and the frustration experienced by the nursing student at their inability to alter the direction of treatment from curative treatment to the palliation of symptoms. [ABSTRACT FROM AUTHOR]

The prevalence of nausea and vomiting in patients with advanced cancer varies, but it generally increases towards the end of life. Nausea and vomiting can be distressing and debilitating for patients, and can affect quality of life significantly. This article discusses the assessment of nausea and vomiting, current understanding of the emetic pathways, and pharmacological management of nausea and vomiting in patients with advanced cancer at the end of life. [ABSTRACT FROM AUTHOR]

Compassionate communication is fundamental to nursing. Yet when it comes to breaking bad news or talking through potentially life-changing results with patients and their families, it is common for nurses to feel ill-equipped. [ABSTRACT FROM AUTHOR]

Mouth problems, including a dry or painful mouth, infections and changes in taste, are all common issues in dying patients. Maintaining oral health is an essential part of good care in the final weeks and days of life, but expert nurses warn it is an area that is frequently neglected or not done well. [ABSTRACT FROM AUTHOR]

This article, the second of two, provides healthcare practitioners with an overview of best practice in palliative and end-of-life care, including nutrition, hydration, oral hygiene and pain management. Communication and spiritual care are discussed, as well as care after death. Providing support and education for families is an important aspect of palliative and end-of-life care. Care home nurses should ensure that the person living with dementia is at the centre of decision making, and provide care that is inclusive of their needs and wishes. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. [ABSTRACT FROM AUTHOR]

Mouth care is about keeping someone's mouth clean, comfortable and healthy. It includes cleaning the lips, tongue, roof of the mouth, gums, teeth and any dentures. It may also be referred to as oral care or oral hygiene. [ABSTRACT FROM AUTHOR]

The article discusses findings by nurse researchers in their examination of how parents and staff experience the period when a child with cancer moves from active to palliative care. Topics discussed include how current processes worked and could be improved, different perspectives of the parents and recommendations for staff members in breaking bad news.

INSET: Case study of Hospice at Home care. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of learning disability and district nurses caring for people with a learning disability at the end of their lives. Method: A small-scale semi-structured qualitative study involving interviews was carried out to explore the experiences of healthcare professionals from two specialist healthcare settings. Findings: Healthcare professionals felt that formal guidelines and support were needed in this complex area. The study also revealed that successful provision of palliative care for people with a learning disability requires a person-centred approach. Conclusion: Modifications to existing palliative care services, involving joint working, improved co-ordination and reasonable adjustments, is recommended. This aims to address any inequalities in care provision for people with a learning disability who are at the end of their lives. [ABSTRACT FROM AUTHOR]

The Liverpool Care Pathway (LCP) is an integrated care pathway used to manage terminally ill patients in their final days or hours of life. It was developed by the Marie Curie Palliative Care Institute Liverpool to incorporate 'gold standard' care associated with the hospice setting into mainstream healthcare. The LCP has been advocated by the National Institute for Health and Clinical Excellence and the Department of Health for use in the care of dying patients. A literature review was undertaken to determine whether there is sufficient evidence that the LCP represents best practice in end of life care and whether patients cared for using the LCP receive better end of life care. Eight research articles were selected for inclusion in the review. The key themes of symptom management, communication and documentation were identified, and the research surrounding these themes was analysed. The analysis showed that use of the LCP promotes better care for patients in the terminal stage of illness; however, some weaknesses in the research were identified and recommendations have been made for further research and future practice. [ABSTRACT FROM AUTHOR]

With the recent emphasis of the Department of Health on reducing unnecessary hospitalisation at the end of life and improving community care for people dying at home, it could be assumed that dying at home is the gold standard. However, healthcare professionals should be able to give a patient choice over where they die, whether that is at home, in hospital or in a hospice. This article asks the reader to consider whether location of death has an influence on the quality of death. [ABSTRACT FROM AUTHOR]

This article explores the role of the district nurse in supporting family and friends who act as informal carers for patients who wish to die at home. The district nurse can support carers by promoting patient comfort, assessing carer needs, using communication and counselling skills, providing timely information, planning for anticipated needs, and co-ordinating and liaising with appropriate services and professionals. This requires the district nurse to develop a trusting carer-nurse relationship. The Gold Standards Framework and Liverpool Care Pathway for the Dying Patient are discussed as a means of guiding healthcare professionals to optimise palliative care for patients and carers. The author suggests that the principles discussed are equally applicable to any nurse who cares for dying patients and their families. [ABSTRACT FROM AUTHOR]

Many people who are terminally ill would prefer to die at home. Integrated professional working is necessary to enable patients to remain in their homes for end of life care. This article describes how an integrated district nursing team in Lincolnshire provides end of life care to patients in the community. The team uses the Gold Standards Framework and the Liverpool Care Pathway to provide optimum care to patients and their families and carers at the end of life. [ABSTRACT FROM AUTHOR]

Aims To explore and evaluate the experience of the 'Arts for Life' project among patients or residents with terminal illness in nursing homes and the community, their relatives and practitioners. Method Semi-structured qualitative interviews were conducted with five patients/residents and two relatives. Five practitioners including a music therapist and a digital artist were involved in the study. Findings The evaluation discusses the perceived benefits and challenges of the Arts for Life project from the perspectives of a small sample of patients/residents, relatives, nurses and arts facilitators. The findings suggested that the Arts for Life project provided opportunities for participants to express their creativity and individuality. A range of benefits was identified. Participants described their involvement in the project as providing a means of escapism, relief from pain and anxiety, and as helping them to engage with loss. Conclusion The findings should be interpreted with caution as a result of the small sample size. The evaluation suggests that people with different diagnoses benefit in different ways from participation in the arts. An understanding of the role of the arts enables nurses to appreciate different responses to end-of-life care. Larger scale research is required with focused evaluation objectives to explore further the issues raised. [ABSTRACT FROM AUTHOR]

This article describes the experience of staff in one acute hospital in Northern Ireland who adapted the Liverpool Care Pathway (LCP) for the dying patient to suit their organisation. It focuses on one patient's journey, from diagnosis to terminal care. The patient remained on the care pathway for 12 days. This reflection demonstrates that, as long as patients continue to meet the criteria for the LCP, some may be on the care pathway for more than the recognised average of two days. [ABSTRACT FROM AUTHOR]

Presents a the study on hope in terminally ill patients. Aims of the study; Methods used for the study; Presence of hope regardless of nearness of death; Identification of hope-fostering and hope-hindering categories; Support of the study to Herth's original study (Herth 1990a).

For patients with terminal illness, nausea and vomiting can be very distressing symptoms and can have a negative effect on their quality of life. This article discusses the nursing management of these symptoms, with a view to improving quality of life for these patients. [ABSTRACT FROM AUTHOR]

In most NHS organisations, end of life support is offered to patients, their families and significant others of those expected to die. But offering bereavement support to families of patients who die suddenly or unexpectedly is a challenge, one that many care settings do not meet. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article about palliative care and doctor assisted suicide in Zurich, Switzerland by Celia Manson in the "Letters" section in the February 4, 2016 issue.

The article discusses the National Institute for Health and Care Excellence's (NICE) published standards to improve end-of-life care for children with life-limiting or life-threatening conditions in England as of February 2018. Topics covered include the importance of providing information and emotional support, and the need for a multidisciplinary team to care for the child. Also noted is charity leader Katrina McNamara's view of the value of engaging parents as partners in care.

Having spent a number of years working as a district nursing sister, I remember the sheer frustration of not being able to get enough support for people who were in the last months of life. [ABSTRACT FROM AUTHOR]

Nurses at a London hospice explain to Frances Pickersgill the satisfaction they derive from supporting dying patients. [ABSTRACT FROM AUTHOR]

The article reports on a call by the charity Marie Curie to nurses to identify terminally ill patients in England who may benefit from a fast-track service that helps them receive care at home.

This section offers news briefs relating to health care in Great Britain including the guidance issued by Charity Hospice UK, the expected shortage in care home places by 2022, and the guidance published by the Institute of Health Visiting for health visitors.