23 Last days of life

Case update

Michelle is becoming increasingly sleepy and less responsive. The staff on duty at night time report that she is restless and appears frightened when Simon has gone home. After discussing this with Simon, he arranges for a friend to stay with the children at home and he spends the next few nights with her to help her settle. It has been decided at a team review to offer Michelle and Simon a bed on the specialist palliative care ward. Simon is taken to look at the ward by the Macmillan nurse and feels it is the right place for Michelle. It has a separate room where he can sleep and the children can play. He is hoping that once she is more settled, she may be able to go home. Michelle is very frightened at what is happening and finding it difficult to make any decisions.

Activity

Terminal agitation

Consider how Michelle’s fear may be addressed. What might be causing this fear?

List all the nursing care interventions that can support a person who is distressed in the last days of life. You might want to refer back to chapter 16 where we looked at spiritual and emotional distress and terminal agitation in the last days of life. Also reflect back to a patient you might have looked after on a previous placement who was distressed. Make a list of the care interventions that helped in this situation and then consider if they would be appropriate in Michelle’s care.

NMC Domain 1: 1.1; 1.2

NMC Domain 2: 2.1; 2.3; 2.4; 2.5

NMC Domain 3: 3.1; 3.2; 3.3; 3.6; 3.7

Points to consider

The management of terminal agitation is an important part of managing last days of life. The way a person dies can have a big impact not only on relatives but also other patients and the care team.

Activity

Psychological and spiritual support

Consider the support Simon will need. Who might be the best person to provide this?

Refer back to Chapter 7 where you were introduced to a range of roles within cancer services. Use this list to pick out who might be able to offer Simon support. Find out if the specialist palliative care ward/unit at your local hospital has any leaflets or information sheets that can be given to relatives. Reading through this information is a good way of being able to answer questions and offer support at the appropriate time. Consider how the information about Michelle being a ‘lapsed catholic’ might help in the ways distress might be managed.