The Role of the District Nurse in End of Life Care

1. The Role of the District Nurse in End of Life Care Carol Alstrom Chief Nurse and Director of Infection Prevention and Control 19th November 2009

2. History of District Nursing William Rathbone and Mrs Robinson Queen Victoria Jubilee Institute for Nurses Queens Nurses trained till 1968 Mandatory District Nurse education Specialist practitioner qualification

3. Role of the District Nurse • To hold continuing responsibility for the assessment and provision of care to a group of patients within a chosen locality • Planning, implementation and evaluation of care • Be leaders and managers of a team of nurses, ensuring effective team working across the boundaries of health and social care

4. The role of the District Nurse in end of life care • Supporting patients in their choice to die at home • Dependent on a network of support from healthcare professionals, family and friends • Excellent communication with all members of the team • Maintaining an up to date knowledge base to provide high quality palliative care at home

5. Caring for a dying person at home is a privilege experienced by every district nurse and to some of us, supporting the dying person and their family in the final days of life is a unique and always remembered experience. The district nurse can within a matter of hours or days become a vital support for the family and quickly become a healthcare professional to be relied on. At the end there is sadness for all, including the district nurse, who will often find herself supporting the bereaved family

6. Gold Standards Framework “Its about living well until you die” GSF is a systematic common sense approach to formalising best practice, so that quality end of life care becomes the standard for every patient.

7. 5 Goals of GSF To provide for patients with any final illness: • Consistent high quality care • Alignment with the patients’ preferences • Pre-planning and anticipation of needs • Improved staff confidence and teamwork • More home based, less hospital based care

8. 3 Simple Steps • Identify Patients who may be in the last year of life and identify their stage • Identify these patients early • Include on GSF register to have early focused discussion allowing better care, more patient control and choice • Identify approximately where they are on their end of life trajectory – helps to estimate likely stage and possible current and future needs, to be able to better plan and provide best care

9. 3 Simple Steps • Assess Current and future clinical needs and personal needs • Assess the likely needs – clinical and personal, current and future • Holistic assessment of patient’s needs • Advanced care planning • Consider carers needs early – practical, supportive and financial

10. 3 Simple Steps 3. Identify Develop an action plan of care • Take the lead on EOLC within the DN team • Plan to avoid crises and unnecessary admissions • Anticipate the patient’s likely needs • Pre-plan to enable a dignified good death in the patient’s place of choice • Fulfilling the patient’s wishes is a priority • Multi-disciplinary meetings • Key worker role • Team working with others • Reflection as a team on how care might be improved

11. Challenges for District Nursing • Lack of 24 hour ongoing care • If terminal phase not pre-empted then required support may not be there e.g. just in case boxes • Care can’t be restricted by documentation and pathways – the patients needs must come first, flexibility and patient centred care is the key

12. Supporting the role of the District Nurse • Education • Advice • Clinical supervision • Resources – equipment, staffing • 24 hour / 7 day a week service provision • Networks and clear guidance

13. Feedback from Nurses “We have had an increase in the number of terminally ill patients. You get involved. I find it very satisfying, but also very stressful. Caring for dying patients is emotionally draining and there’s not much support” “I do find palliative care very satisfying. Although we had support from the Macmillan nurses, it was still very difficult”

14. Caring for the dying person in their own home can be both a pleasure and a challenge, but always the District Nurse must remember she is a guest in the home. She can only advise and recommend and when allowed take the lead, provide vital support and guidance and ensure that it is always about living well until you die

15. Thank you for listening Photographs provided free of charge by Steve Gascoigne Available Light Photography 32 Well Street, Ryde, Isle of Wight, PO33 2SG Tel: 07734 444800 contact@availableloght.cc www.availablelight.cc