Question

caring in the the last days and hours

Answer 1

The last few days of a person’s life also called tlas the terminal phase, or the dying phase.

Everyone’s experience of dying is different and it can be difficult to know when a person is reaching the last few days of their life.

A person’s care needs in the last few days of life will be as individual as they are.

There are some aspects of care you should consider for all patients:-

Good communication with patient:-

Even when a person has been living with a terminal illness or the dying phase, it can be a shock for them and their loved ones when they reach the last hours/days of their life. It is important to speak to the person and those important to them about what’s happening.

Approach the conversation sensitively but try to avoid using euphemisms such as ‘going to a better place’. Using the word ‘dying’ where appropriate can avoid confusion.

The best person to speak to the person and their loved ones is a health professional who is confident and experienced and has a good rapport with the person. If you don’t feel comfortable doing this, you can ask a colleague to help.

Person-centred care and making decisions:-

✓Keep the dying person at the centre of every decision to ensure their needs and preferences are met as much as possible.

Find out if they have any advance wishes about treatment documented in their care plan.

Find out how much the person with terminal illness wishes to be involved in making decisions about their care. Ask if they would like someone else to be present at any important conversations with social and health care professionals. Some people will lack capacity to consent to decisions about their care. A person’s ability to be involved in making their decisions may change as the patient condition deteriorates.

It is important to ask the person, or their representative, what is important to them in their last days/terminal illness of life. This may includes:-

*personal goals.

*preferred place to die.

*people to see.

*resolution of conflict or other unfinished business.

*any treatments they do or don’t want to manage their symptoms.

Hydration and nutrition:-

People often become less interested in food and drink in their last few days.

Support someone to eat and drink if they want to and are able to. Provide mouth care in continuity as keep their mouth and lips moist and comfortable. If you have any concerns about their ability to swallow safely, speak to their GP(General practitioners), district nurse, or the specialist nurse. They might suggest other ways to keep the person hydrated.

Managing symptoms in last days of life:-

Pain, nausea and vomiting, breathlessness, agitation and noisy chest secretions are common in the last days of life.

We have more information on recognising and managing symptoms like;

*pain

*nausea and vomiting

*breathlessness

*agitation

*noisy chest secretions.

Speak to the person’s GP( General practitioners), specialist nurse, or district nurse if you have any concerns that their symptoms aren’t being managed well enough to keep them comfortable.

Medications :-

The person’s GP(General practitioners) or specialist nurse might review the person’s medications and stop any that the patient can no longer physically manage to take or are not essential at the end of life.

The GP(General practitioners) or specialist nurse will keep the person on the medicines that will manage their symptoms to make them most comfortable. If they are unable to swallow medicines, they can receive certain medicines through a syringe pump.

Anticipatory prescribing:-

It is done when a GP(General practitioners), specialist doctor or specialist nurse prescribes injectable medicines that might be required if the patient deteriorates and can no longer swallow medications. These medicines can be supplied and kept at the person’s home or in their nursing or care home in case they’re needed. They are often called as ‘Just in Case’ medicines or end of life medicines.

Looking after yourself:-

Caring for someone who’s dying can be emotionally demanding.

It is important to be aware of your own feelings. You may have built a bond with the person you have been caring for. Sometimes a person’s death can remind you of experiences from your personal life, and make you consider your own mortality.

✓You should ask for help from another health and social care professional such as the person’s GP(General practitioners), district nurse or specialist nurse if:

*you don’t feel comfortable having important conversations about dying with the person and their family

*you have any concerns that the person’s symptoms aren’t being managed

*you think anticipatory medicines are required