Article: Malignant hypercalcaemia: definition, symptoms and treatment

Hypercalcaemia - an abnormally high level of calcium in the blood - is common in advanced cancer. It can often be successfully treated, whether with bisphosphonates or the monoclonal antibody denosumab, and the side-effects of treatment can often be managed. However, many patients face the challenges posed by other burdensome symptoms of malignant disease and a poor prognosis. This article provides an extensive overview of malignant hypercalcaemia, including its causes, symptoms, treatment and implications for nursing practice.

Beland, P. 2018. Malignant hypercalcaemia: definition, symptoms and treatment. Nursing Times, 114 (11) p 40-44.

Article: Listening to the family's voice: evaluation of a tool to improve symptom control and communication

Hospitals will remain the most common place of death for the foreseeable future and there is a need to improve the experience of dying in hospital. This article evaluates the use of a Family's Voice (FV) diary to aid communication between clinical staff and relatives.  Nine sites took part in the study, consisting of 7 acute trusts, an NHS hospice and a group of nursing homes. 112 diaries were completed.  Ten themes were identified following analysis of the diaries, and provided a good insight into what families observed and felt was important.  Some symptoms were managed better than others but overall families were positive about the care provided.  For hospices, where quality of care is already noted to be higher than in hospitals, the authors note further work is needed to explore whether the FV diary could be of use. 

McEvoy, M., Scott, E., Blenkinsopp, J., Hamilton, S. 2018. Listening to the family's voice: evaluation of a tool to improve symptom control and communication. International Journal of Palliative Nursing, 24(11) p 548.

Article: Anticipatory prescribing of injectable medications for adults at the end of life in the community

The anticipatory prescribing of injectable medications to provide end of life symptom relief is an established community practice in a number of countries. However, the evidence base to support this practice is unclear. An extensive literature search was carried out.   The results showed healthcare professionals believe anticipatory prescribing provides reassurance, effective symptom control and helps to prevent crisis hospital admissions. The attitudes of patients towards this remains unknown.  It was found to be a low cost intervention but there was inadequate evidence to draw conclusions about its impact on symptom control, comfort or crisis hospital admissions.  The authors conclude the views and experiences of patients and their family carers towards anticipatory prescribing need urgent investigation along with further research to investigate the impact on patients' symptoms, comfort, safety and hospital admissions.

Bowers, B. et al. 2018. Anticipatory prescribing of injectable medications for adults at the end of life in the community: a systematic literature review and narrative synthesis. Palliative Medicine, published online December 2018

Article: Timing of referral for hospice-based palliative care varies nationwide

This article reviews a retrospective study carried out looking at the timing of referral for palliative care to UK hospices.  64 hospices took part, representing a third of UK hospices, a mix of charity-managed and NHS managed sites, and varied in geographical location and size. The study found hospice care is introduced on average 48 days before death. Younger people and those with cancer were more likely to receive hospice care early in their illness trajectory. For people with dementia, the average time spent under hospice care was just nine days.  This study adds to the body of evidence describing inequalities in care for people who are dying. Research into models of care is needed to understand the potential solutions.

Timing of referral for hospice-based palliative care varies nationwide, November 2018, Nursing Times, 114 (11) p 52.

The full report can be accessed at the National Institute for Health Research (NIHR) -

Article: When is wound cleansing necessary and what solution should be used?

Routinely cleansing wounds at every dressing change can do more harm than good if the gauze swabs disrupt fragile tissue growth and damage new capillaries.  This article explains the circumstances in which it is appropriate to cleanse a wound.   It also discusses the re-emergence of antiseptic solutions - which are becoming more popular, particularly for infected or heavily contaminated wounds - and offers guidance on when to consider using them to cleanse wounds.

Brown, A. 2018. When is wound cleansing necessary and what solution should be used? Nursing Times, 114 (9) p 40-43.

Article: Respiratory rate: why measurement and recording are crucial

Respiratory rate is a vital sign but it is frequently omitted, inaccurately measured and not recorded. This article, the first in a six-part series on respiratory rate, explores the importance of respiratory monitoring in acute care. The article also explains why nurses need education, skills and knowledge to assess this neglected vital sign.

Kelly, C. 2018. Respiratory rate 1: why accurate measurement and recording are crucial. Nursing Times, 114 (4) p 23-24.

Article: Diagnosing and managing infection in acute and chronic wounds

This article discusses the latest guidance from the International Wound Infection Institute on managing wounds.  It explains the difference between local and systemic wound infection and provides an overview of the available antimicrobial wound products available.

Brown, A. 2018. Diagnosing and managing infection in acute and chronic wounds. Nursing Times, 114 (7) p 36-41.

Article: New guidance on how to define and measure pressure ulcers

The occurrence of pressure ulcers is an indicator of care quality. As part of the Stop the Pressure programme, new guidance on pressure ulcer definition and measurement in England has been issued by NHS Improvement after a consensus-seeking exercise involving a large range of stakeholders. The guidance will be rolled out nationally from April 2019. This article discusses the guidance, why it was needed and how it was developed.

Fletcher, J., Hall, J. 2018. New guidance on how to define and measure pressure ulcers. Nursing Times, 114 (10) p 41-44.

Article: From a good death to a better bereavement? The impact of the end of life experience on bereavement adjustment

To date, the majority of research into a good death has focused on the experience of the person who is dying.  Taking the perspective of bereaved individuals, this qualitative study explores which elements of the end of life experience constitute a good death and how these elements influence the process of bereavement adjustment. Following interviews with ten bereaved adults four themes were identified which together define a good death; a lack of physical distress, emotional resolution, 'naming death as death' and death 'at the right time'. The value of open communication prior to death is highlighted.  For those in palliative care settings, potentially modifiable elements of the end of life experience which may support better bereavement are suggested.

Wakenshaw, C. & Sillence, E. 2018. From a good death to a better bereavement? The impact of the end of life experience on bereavement adjustment, a thematic analysis. Bereavement Care, 37(3) p 109 - 117

Article: Legal issues in end-of-life care - the adult patient

As nurses make every effort to give the best possible care to dying patients and their loved ones, some legal and ethical questions may arise. This first article in a three-part series explains what the law says about how to accommodate the wishes and preferences of adult patients at the end of life, even when they are beyond the point of active participation in decision-making.

Taylor, H. 2018.  Legal Issues in end-of-life care 1: the adults patient. Nursing Times, 114 (11) p 25-28.

Article: What role do Death Doulas play in end of life care?

Following on from Birth Doula's that were established about a decade ago to provide support and guidance to mothers, and mothers-to-be, there is now a new role, that of a death doula emerging in the end of life care space.   The authors, from an Australian University carried out a literature search to explore the role and potential implications for palliative care.  It established that Death Doulas are working with people at the end of life in varied roles that are still little understood and can be described as similar to that of "an eldest daughter" and similar to some specialist palliative care nurses.

Rawlings, D. et al. 2018.  What role do Death Doulas play in end of life care? A systematic review.  Health and Social Care in the Community, September 26 [online]

Download article here

Article: Informed consent - 1: legal basis and implications for practice

Nurses have a legal duty to ensure they obtain informed consent from their patients before carrying out any intervention or treatment. This is one of the requirements of the Nursing and Midwifery Council's Code. This article - the first in a series of two - discusses why informed consent is fundamental to the provision of person-centred care and explores the legal principles behind it.

Taylor, H. 2018. Informed Consent -1: legal basis and implications for practice.  Nursing Times, 114 (6) p 25 - 28.

Article: Informed consent - 2: assessing validity, capacity and necessity

This second article goes on to explore what makes consent valid, how it can be obtained, and in what circumstances treatment may proceed lawfully without the patient's consent - which has been clarified by the Mental Capacity Act 2005.

Taylor, H. 2018. Informed consent - 2: assessing validity, capacity and necessity. Nursing Times, 114 (7) p 50-52.

Article: Top ten tips for palliative care clinicians caring for heart failure patients

Heart failure is an increasingly prevalent condition with a very high symptom burden with prognosis often unpredictable.  This US article brings together heart failure and palliative care experts to provide advice on the best management of these patients.

Warraich, H. et al. 2018. Top ten tips for palliative care clinicians caring for heart failure patients.  Journal of Palliative Medicine, 21 (11) p 1646 - 1650.

Article: Top ten tips palliative care clinicians should know about Parkinson's Disease and related disorders

People with Parkinson's disease (PD) experience significant symptom burden that includes many non motor symptoms, such as depression, fatigue, pain and dementia.  This US article brings together a team of PD and palliative care experts to assemble practical advice for the care of people with Parkinson's disease to provide optimal palliative care.

Katz, M. et al. 2018. Top ten tips palliative care clinicians should know about Parkinson's Disease and related disorders.  Journal of Palliative Medicine, 21 (10) p1507 - 1517

Article: UK end-of-life care services in dementia, initiatives and sustainability: results of a national online survey

People living and dying with non-cancer diagnoses, including dementia, have poorer access to specialist palliative care than people with cancer and experience worse outcomes in terms of pain, symptom control and experience of care. An online survey following up 16 palliative care services identified as providing examples of good practice back in 2008 was carried out.  15 services responded to the new survey.  They engaged in a wide range of activities predominately providing direct care and workforce development or educational activities.  Results showed that sustainability of the service is reliant on clinicians with a leadership role and recent initiatives largely built on the expertise of the nursing profession.  This new model of care has been termed Hospice-enabled Dementia Care.

Amador, S. et al. 2018.  UK end-of-life care services in dementia, initiatives and sustainability: results of a national online survey.  BMJ Supportive and Palliative Care, 8 (4) p 424 - 427.

Article: Crash course in EPaCCS (Electronic Palliative Care Co-ordination Systems:) 8 years of successes and failures in patient data sharing to learn from

Electronic Palliative Care  Co-ordination Systems (EPaCCS) are England's pre-eminent initiative enabling advance care planning, improved communication and co-ordination at end of life.  Striking outcomes have been recorded around EPaCCS such as 77.8% of patients dying in their preferred place.  EPaCCS have, however been extremely challenging to develop and implement with many projects remaining "under development" or folding. Rigorous research is also non-existent.  This paper discusses current EPaCCS and the way forward, outlining 5 key challengers and 6 key drivers.  It then proposes a number of initiatives working on information standards, re-thinking of national funding and new levels of individual and community involvement.

Petrova, M. 2018.  Crash course in EPaCCS (Electronic Palliative Care Co-ordination Systems:) 8 years of successes and failures in patient data sharing to learn from.  BMJ Supportive and Palliative Care, 8 (4) p 447 - 455.

Article: Quality improvement priorities for safer out of hours palliative care

Patients receiving palliative care are often at increased risk of unsafe care with the out-of-hours setting presenting particular challenges.   This article aimed to explore the nature and causes of unsafe care from primary care services.  An analysis of patient safety incident reports from the National Reporting and Learning System was carried out.  A total of 1072 patient safety reports involving patients receiving sub-optimal palliative care via the out of hours primary care services were identified.  Almost two-thirds of reports described harm with outcomes such as increased pain, with emotional and psychological distress featuring highly.  Commonly identified contributory factors were a failure to follow protocol, lack of skills/confidence of staff and patients requiring medication via a syringe driver.

Williams, H. et al. 2018.  Quality improvement priorities for safer out of hours palliative care: lessons from a mixed-methods analysis of a national incident-reporting database.  Palliative Medicine, published online December 2018

Article: Using human-centred design in end of life care

The Helix Centre, a healthcare innovation lab within St Mary's Hospital in London, comprising of designers, technologists and clinicians.   Working on a number of end of life projects, their aim is to research and design innovative solutions that improve the quality of life for those living with life-limiting conditions or at end of life.  The article discusses their work in the emergency care setting, advanced care planning and hospice care. 

Williams, I. 2018.  Using human-centred design in end of life care. European Journal of Palliative Care. 2018 25 (3) p 138 - 141