Transcending Legacies'

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Transcending Legacies.

• Lesley Lindroth Lecturer,
• School of Health Science,
• Vivian Tower, Room 211,
• E.mail L.J.Lindroth _at_swansea.ac.uk
• Tele 01792-518574

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The mourning process phases

• Phase i the period of numbness close to time of
  loss.
• Phase ii the phase of yearning, denies the
  permanence of loss, anger plays an important part
  here.
• Phase iii the phase of disorganization and
  despair, difficult to function.
• Phase iv the phase of reorganized behaviour,
  beginning to pull life back together.
• (Parkes, 1970)

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Rationale behind Study

• The rationale for this study stems from
  reflections on personal experience, both as a
  nurse and as a family member caring for a loved
  one dying from a non-malignant condition in the
  acute setting.

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Themes emerging from the data collected

• Meeting families needs.

• Information giving.
• Gentle and sensitive truth telling.
• Information giving in relation to diagnosis and
  prognosis.
• Empowering families to be with their loved one at
  the end.

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Differences in care delivery between hospital and
hospice nurses.

• Differences in Care Delivery between Hospice and
  Hospital Nurses.

• Resources in provision of care,
• Differences in symptom relief,
• Empowerment strategies,
• Practical needs.

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Spirituality

• Spirituality accepted as a key principle in the
  philosophy of palliative care.

• Mixed responses in terms of how much spiritual
  care is given.
• Presence of pastoral team in hospices.
• Liverpool care Pathway incorporates this as a
  goal, aims to assess the religious/ spiritual
  needs with the patient/family.

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The death surround

• Steele (1990) says that
• the context and factors that surround the death
  of a loved one can have a deep impact on the
  bereavement process for survivors, and uses the
  term death surround to define the context of
  the death of a loved one which includes the type
  of death, where it occurred, the cause of death
  and the preparation for it.

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the trajectory of dying

• The World Health Organisation (1990) refers to
  the importance of a a support system for the
  family to help them during the illness and during
  their bereavement.

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Rogers (2001) identifies the scope and degree of
pain for patient suffering stroke Regional Study
of Care for the dying (1995)

• Some will experience post stroke headaches,
  central stroke pain neuropathic pain
  syndrome, when the pain is experienced in
  corresponding body part to the vascular lesion,
  this kind of pain is thought to be partially
  resistant to opioids.
• Rogers (2001) says that pain control by
  specialist palliative care experts maybe relevant
  here.

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The type of death

• The hospice nurses in my study expressed that
  situations vary at the end and it is not always
  peaceful and symptom free, symptom control was
  not always effective and if the relatives
  observed distressing symptoms, this caused
  difficulties with bereavement, which necessitated
  bereavement counselling
• (hospice nurse).

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Symptom relief re diagnosis

• Segal et al (2005) discuss the incorporation of
  palliative care into heart failure management.
  Symptoms of cardiac failure are described as
  distressing and poorly controlled.
• By bringing heart failure and specialist
  palliative care teams together we have ensured
  that team members have been empowered to manage
  heart failure patients differently (p.135).

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Collaborative Care

• Collaborative care is a philosophy that is
  applied in health policy and encourages team
  working, working between generic nurses and
  specialist palliative care nurses has been used
  as a solution to the differences in the delivery
  of symptom control.

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Collaborative working to deal with symptoms in my
study were discussed by both hospice and hospital
nurses.

• For symptom control we do call the palliative
  care team we use them more than we have in the
  past now in general nursing (hospital nurse).
• Hospice nurses were specific about being able to
  treat cancer symptoms, but could help hospital
  nurses with non cancer symptoms, however
  admissions to hospices of non cancer diagnosis
  could cause problems re symptom relief, not
  equipped to deal with.

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Pre and Post Bereavement carePreparation can
affect Bereavement.

• One of the key principles in needs of families
  and significant others, is to address the
  psychosocial, spiritual needs during the care and
  post bereavement

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Positive outcomes from the studies

• Included
• Invitation to bereavement
  meetings,
• Offer of personal bereavement
  counselling,
• Being able to help others in the
  group meetings,
• Understanding that your thoughts
  are not
• abnormal.
• Involvement in care.

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Being there at the end

• Duhamel and Dupuis (2003) say that
• families that cant make their farewells
  properly cant go through the grieving process
  after death well (p.115).

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Being there at the end hospice and hospital
nurses responses

• Often if a relative has been there for a long
  time and they pop out and the relative passes
  away without them being there, thats really hard
  for them (hospital nurse)
• His wife was there at the end, although we not
  palliate his symptoms that particularly well, we
  did feel we supported his family (hospice nurse)

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The Liverpool Care pathway (1998)

• The above care pathway was developed for use
  within hospitals but can be used in primary care.
  This care pathway empowers generalist nurses to
  care for dying patients in the last 48 hours of
  their lives.

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The framework highlights different aspects of
care which are slightly more detailed in the
definitions given of palliative care

• The goal of the care plan is explained and
  discussed with the patient/family.
• Family/others demonstrate they understand the
  plan care.
• Included is the discontinuation of inappropriate
  intervention as well as the
• Inclusion of comfort measures.
• Psychological awareness
• Information giving which empowers the family to
  be there at the end.

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Evaluation of the LCP (2003)

• Important pointers for this symposium
• Post bereavement care is also included in the
  documentation, which gives the nurses the
  information that nurses need

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The Care Pathway is meeting the requirements of
(NICE, 2004) which recommend

• information giving, spiritual support, and
  end-of-life bereavement care

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