SUPPORT INDIVIDUALS AT THE END OF LIFE.
Outline legal requirements and agreed ways of working designed to protect the rights of the individuals in end of life care.
Caring for an individual who is terminally ill or is on end of life care is a challenging and emotional process for all involve in the care of the individual. This requires understanding of the individual as a whole person you have to know their family, social, legal (end of life advance directives) and religious needs. A legal requirement for an individual who is on end of life care is do they have any advanced directives that all staff need to be aware of. The needs and wishes of the individual in your care so you know how they wish to be looked after in after the death has happened these need to be properly documented in a end of life planed care section of their care plan. This will then mean that their rights and wishes even after death have been respected.
Explain how legislation designed to protect the rights of individuals in end of life care applies in own job role.
When an individual is coming to the end of their life you are made aware by the doctor who puts in an end of life pathway (this is a legal document) I would read this to ensure that I know what the individual’s needs and wishes are during end of life. I would ensure all of the needs and wishes are met including any religious beliefs they may have to ensure they are cared for according to their wishes.
Outline key points of theories about the emotional and psychological processes that individuals and key people may experience with the approach of death.
Everyone reacts to death and impending death differently there are similarities in the psychosocial responses to the situation. Kubler-ross (1969)theory of the stages grief when an individual is dying has gained worldwide acceptance in nursing and heath care professionals the stages that you go through are:
Denial is stage one: this isn’t happening to me if I ignore in it will go away. Life makes no sense, because we are in shock we just try to find a way of getting through each day
Anger is stage two: you think why me, why my loved one he/she has done nothing to hurt anyone. Before a loss you would give anything for them not to be dying after a loss you may be angry at the individual who has passed why did they leaved you behind.
Bargaining is the third stage: you would give anything to bring that individual back. You feel like you become lost in a maze of what ifs, if only statements. This is when you want like to return to what it was before. Before they become ill or before they died.
Depression is the fourth stage: this is the emptiness we feel after a loss this is when grief become a much deeper level, deeper than we ever imagined. This stage feels like it will last for ever like you will never feel happy again. It is important that individuals know that this is a normal part of grieving it’s like a fog of intense sadness depression is one of the steps in the healing process of grieving
Acceptance is the final stage, stage 5: this stage is when the grieving realise that their love one has physically gone and this is a permanent realty and they must try to live now and readjust to the reality that we are not going to see their loved one again. That they can never replace their loved one but they can make new relationships and new connections with new people and start to live their life again.
Grieving takes time to get over and each individual is different some may take more time than others but it is important that they are supported through the whole process. People also need to remember that at any stage during the grieving process that they can relapse and start at the beginning.
Explain how the beliefs, religion and culture of individuals and key people influence end of life care.
Religion is a prime source of strength, substance comfort for many people when they are dealing with dying and death different religions have different theories about death and they see it from a different perspective. Spirituality and religiously have been known to lower the anxiety during dying and death. They have a greater strength of conviction and the afterlife.
Explain why key people may have a distinctive role in an individual’s end of life care.
The people who are closet to the individual can ensure that they receive the highest quality care as they come to the end of their life.in a care setting family and friends as well as carers, senior carers, management and other health care professionals will be involved in discussing issues with an the individual supporting and empowering them to make their needs and wishes known supporting individuals to communicate their wishes or participate directly in the care and treatment they wish to or not wish to receive. this can also be done by a power of eternity as they have been give the legal power from the individual who is dying to make that decision and or the court has to make health care decisions due to the individual lacking capacity.
Explain why support for an individual’s health and well-being may not always relate to their terminal condition.
When an individual has a terminal illness that is not going to get better and they gradually decline. This could mean that they are in a lot of pain. As an individual declines their physical ability’s decline as well so they may not be able to feed themselves or drink independently, their body might reject food, they may become incontinent. When assisting a termly ill individual it will most of the time not relate to the illness but it will be about keeping the individual as comfortable as possible and as pain free as possible and free of any symptoms associated with dying. With all the dignity and respect that any other healthy individual in our care has.
Describe the benefits to an individual of having as much control as possible over their end of life care.
By discussing the care that the individual wishes to receive and what the individuals needs are with them then we will be able to give a more person centred approach to their end of life care. The individual will feel more empowered and feel responsible for their own end of life planed care and that will make them less distressed when that time comes knowing everyone knows what they want and everything is sorted out.
Explain the purpose of advance care planning in relation to end of life care.
The main purpose of advanced care planning is to clarify what needs wishes and preferences an individual has so these can all be meet and understood before a individuals loses the capacity to be able to make decisions for themselves. This will also help to plan ahead so the right thing happens at the right time. This enables the individual to document and discuss the future health wishes. When carried out by trained staff it is able to improve end of life care by enabling individual’s wishes to be determined, documented and respected at end of life.
Describe own role in supporting and recording decisions about advanced care planning.
This role can vary according to the role you are in your work setting this is mainly done by senior members of staff and management.
As a deputy manager I have to ensure all paperwork is signed, dated and timed.
All entries must be able to be read easily.
All entries must be accurate with up to date information.
Confidentially must be maintained for all information recorded and obtained.
Confidentially must be maintained for all information shared.
The individual who is voicing their requirements must be supported in a non-influential way and have the capacity to be able to check and sign that the information correct and accurate for their needs and wishes for advanced care planning.
The individual who is collecting the information must have a clear understanding of the information to be collected and how to do so. They must also have a clear understanding of the paperwork to be completed and how to do so.
I have to know what end of life care planning setting tools to use in the place of work for example we use the gold standards frame work.
Outline ethical and legal issues that may arise in relation to advanced care planning.
Ethical issues: these can be when an individual refuses treatments as they are within their rights too( e.g d.n.a.r, having a percutaneous endoscopic gastrostomy, (peg) feed put in ,or esophagogastroduodenoscopy(egd) and g-tube so they are receiving enough nutrition and fluid to be able to sub stain their life). They may inform carers who they want to involved in their end of life care. Conflicts can arise between the family and the individuals who are treating the individual who is on end of life for example the district nurses.
Legal issues: it can be when the withdrawing of life sustain treatment for the individual. The appointment of lasting power of eternity to make decisions on an individual’s behalf and determine whether an individual has capacity this is examples of when legal issues can arise when an individual is on end of life care.
Explain the importance of recording significant conversations during end of life care.
The importance of recording significant conversations during end of life care is that all needs and wishes can be meet and assessed by the key individuals involved in the care of the dying individual. This also encourages communication for all people involved as well. This prevents any miss communication so this individual gets all needs and wishes meet. This also ensures that the care plan is up to date and current.
Explain factors that influence who should give significant news to an individual or key people.
This is a sensitive issue that requires empathy and skills. And should be done and approached in a sympathetic manor .the factors to consider when approaching individuals who are about to recivie significant news are: the individuals preferences (who they want to be there, if they want to be told), who they want to receive the news from, their capacity, (who their represented is if they don’t) the type of news that is being received. The individual who is delivering the news has to have knowledge and expertise to be able to answer any questions they may have and any they can’t answer give them information on who to contact to get the answers they require.
You also have to take in to account the relationship with the individual who is delivering the news and the individual who is receiving the news. Because people receiving the news can react in different ways and you need to know how to handle this.
Describe conflicts and legal or ethical issues that may arise in relation to death, dying or end of life care.
Ethical issues arise during end of life care and dying due to concerns about what kind of treatment and care is available for someone who has a limited life expectancy. There is often issues between doctors, nurses and family members about what care is appropriate for the individual who is dying. A lot of issues can be avoided by making sure people know who has to make the difficult decisions when it comes to end of life care.( This legally has to be done through a solicitor if it is contested it will have to go through court)
When you understand the legal and ethical frame work that decisions are made this can transform problematic questions in to straight forward answers.
Analyse ways to address such conflicts.
How to manage these conflicts will depend upon the role you are in you have to follow agree ways of working, what the nature of the conflict is and the extent of the conflict.
We can use different methods of communication verbal or written. When using written it is always more formal and you can keep a copy as proof of communication. We can use communication strategies to ensure different options and approaches can be considered. Provide more information about treatments this will give individuals a better understanding of why they are having the treatment they are.
You need to involve your manager as necessary.
We can always seek advice from other professionals such as gps, nurses, palliative care team, and counsellor.
Describe the role of support organisations and specialist services that may contribute to end of life care.
There are many support organisations and specialist service that support individuals during end of life care:
You have the palliative care teams and nurses that will visit you on a regular basics at home and when you are in a care home.
You have local hospices that you will have a choice for them to be your preferred place to spend your final days.
Funeral directors will assist you in making the final arrangements.
Palliative care teams and nurses and hospices can provide support and advice on pain control and support for families, friends and the individual who is on end of life care
There is also charities that will assist and support an individual and their loved ones through end of life. This is offered through Macmillan cancer support these help in every way they can from emotional support to finding financial support when and if required
Analyse the role of and value of an advocate in relation to end of life care.
The role of the advocate is to speak up for the individual they are advocating for to ensure they have a voice to ensure their end of life needs and wishes are carried out. They have to ensure all religious needs are meet. They have to be open in the convocation they have with the individual and key people involved in their care. Advocates need to ensure that the individual is informed about their choices in regards to end of life care they need to ensure that they have access to all services available to them to ensure they are comfortable at end of life they have to have trust between them ensuring that the individual is listened to at all times.
Explain how to establish when an advocate maybe beneficial.
They can sometimes be requested by the individual. As they might wish to express concerns or wishes that they don’t want to discuss with close family or relatives so not to upset them advocates support individuals to make their own choices and decisions about their end of life care preferences. They can also help to assist in preparing advanced directives when planning end of life care. The individual can also ensure that their needs and wished are not only being herd but they are also acted upon if they involve an advocate.
Explain why spiritual need may be especially important at the end of life.
This is an important time for the individual they may have unresolved family issues that they want to get sorted. Individuals may develop a desire for self-worth or meaning and may want rot talk through their feelings with someone else that’s not involved in their care they may have rituals and rites of passage they might want to do. This may be how the individual finds inner peace and is able to rest and relax. It may also be comforting to the individual to pray and comforting to the families to know that their loved one is at peace. This can be a way of remembering the individual’s life achievements. They will have their love ones around them all finding comfort in the same thing and they will find this reassuring that everyone is there.
Describe a range of sources of support to address spiritual needs.
Supporting an individual’s spiritual needs at the end of their life is something we should all be doing. It is important to know when and how to obtain the support that is required for the individual the first people you should turn to is the management as they will be able to inform you where to find the information that is required for the individuals particular faith( this should be documented in a individuals care plan in the section about end of life care ) there is also family and friends as these people will know the individual will end of life may not be something the individual wishes to talks about until the time comes. Other sources of support can be priests, rabbi, psychologists and volunteers from support groups as well.
Identify when support would best be offered by other members of the team.
When providing end of life support we work in partnership with a multi-disciplinary team of health care professionals. The best person to offer support will depend on the individuals needs and wished and the condition of the individual, how fast they have detreated. You will have to refer them to a specialist. It is also up to the individual who is on end of life care.
Explain why it is important to know about an individual’s wishes for their after death care.
It is important to know what an individual’s wishes are when they have died so we can follow there wishes and preferences. We have to comply with the individuals advance directives (if there is any in place) to respect the individual who was in our care. And to show respect for their families and friends at this hard time this can be in the form of giving them time to say good bye in their own way. We will need to follow and spiritual needs and wishes and preferences due to every religion having their own rituals after someone has died from protocols for washing the individuals who have died to what way they have to leave the building and how soon the funeral has to take place. We need to know how to follow these rituals according to the deceased needs and wishes to be able to be involved in saying goodbye.
Describe ways to support key people immediately following an individual’s death.
We need to make sure that support is available for key individuals immediately after the individual has died. Key people must be given time to spend with the individual to say their goodbyes and to carry out any spiritual and religious needs that the deceased individual wanted. We must be available for the deceased loved ones to be able to talk to us and answer any questions that they may have this must be done with empathy, respect and understanding. If they require any information and guidance on what to do next this must be offered as well as offering assistance and support on what support groups and bereavement counselling is available where required.
Identify ways to manage own feelings in relation to an individual’s dying or death.
We all experience grief in our own way this all depends on what type of relationship you had with the individual who has died. It can also depend on your belief, culture, religion and our own influence in the process. It will benefit you if you talk to your colleagues who have gone through it with you and also your manager who should always listen to you when you have been through the whole process of the individual dying and their death. If you still find yourself unable to cope your manager can put you in contact with a work councillor if they have one or give you a contact number of one, support groups, helplines where you can talk to someone 24 hours a day about how you feel.
Htts://grief.com>the five stages of grief