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]

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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

 

Article: Managing medicines for patients dying at home: a review of family caregivers' experiences

Increased life expectancy, technical advances in treatment and symptom control and the extension of palliative care in the community has resulted in family care givers often being responsible for providing the greater part of patient care including management of complex medication regimes. This literature review looked at 15 articles on this topic.  The findings showed that family caregivers often struggle to manage medications for someone dying at home yet there is an expectation they will take on this role. Five key themes were identified around administration, organisational skills, empowerment, relationships and support.

Wilson, E. et al. 2018. Managing medicines for patients dying at home: a review of family caregivers' experiences.  Journal of Pain and Symptom Management, September 11 epub - online

Available to download  or contact the library for a copy

Article: End of life decision making for people in a minimally conscious state: a review of the application of the Mental Capacity Act 2005

This UK article provides a thorough overview of the key sections of the Mental Capacity Act applied in end of life minimally conscious state (MCS) cases.  Currently any decision involving the withdrawal of clinically assisted nutrition and hydration must be referred to the Court of Protection.  It discusses two UK cases and how the courts have interpreted best interests when considering withdrawing or withholding nutrition and hydration and other life sustaining treatments.

Curtis, M. et al.  2018.  End of life decision making for people in a minimally conscious state. Indian Journal of Palliative Care, 24 (3) p 334-344

Available to download or request a copy from the library

Article: Creating a legacy - a tool to support end of life patients

Legacy activities help individuals and their families initiate a life-review process that results in a product that can be enjoyed before and after the person dies. Staff in a Portuguese palliative care unit explore the concept and creation of a legacy and the techniques and benefits, both physical and spiritual for both patients and carers.  They note the process "allows the patient to live better in the present and promotes a legacy that is lived, instead of only creating a legacy that is left behind for others".

Vidal, C. et al. 2018.  Creating a legacy - a tool to support end of life patients.  European Journal of Palliative Care.  25 (3) p 116-119.

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Article: Role of clinical psychologists in hospices

NICE guidance in 2004 recommended a tiered approach to psychological care within cancer care with the provision of Clinical Psychologists to support other professionals deliver psychological care to patients.  However little is known currently about this  role within UK hospices and a survey was undertaken to address this gap.  The survey included quantitative and qualitative items about professionals' experience, how their input is organised, their roles and activities and their views on the aspects of working in this setting. Eighteen clinical psychologists responded and there was considerable variance in how their roles were organised with a range of therapeutic approaches  used. 

Russell, C. & Fountain A.  2018. Role of clinical psychology in UK hospices.  BMJ Supportive & Palliative Care,  e-pub.

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Article: How to explore the end of life preferences for homeless people in the UK

There is a scarcity of research into the end of life preferences of homeless people in the UK. This article examines the barriers to this population accessing palliative care and outlines ways in which their preferences can be determined.

Webb, A. et al.  2018.  How to explore the end of life preferences for homeless people in the UK.  European Journal of Palliative Care, 25 (1) p 59-62.

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Article: Is cancer fundraising fuelling quackery

Doctors face difficult conversations with patients with metastatic cancer for whom NHS treatments have failed.  A growing problem is how to advise patients who opt to pursue expensive, experimental treatment in the private sector.  This article reports on the crown funding sites helping people with advanced cancer spend thousands of pounds on such treatments and looks at ways to ensure patients and their donors are not being exploited.

Newman, M. 2018.  Is cancer fundraising fuelling quackery.  BMJ. 362.  September 12 online.

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Article: End of life Doulas - what we can offer at the most difficult time of life

The end of life Doula movement is relatively new.  Following on from birth doula's that were established about a decade ago to provide support and guidance to mothers, and mothers-to-be, end of life doula's provide practical and emotional support for people who are dying and the families they leave behind.  This article written by Anna Webb, an end of life doula discusses her work.

Webb, A. 2018.  End of life Doulas - what we can offer at the most difficult time of life.  European Journal of Palliative Medicine, 25 (2) p 64-67.

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Medicinal cannabinoids in palliative care

This Australian article discusses the use of medicinal cannabis for refractory symptoms in palliative care.  It provides an overview of the guiding principles of palliative symptom management, the symptom areas where cannabinoids have been evaluated and other practical considerations to be aware of.

Agar, M. 2018.  Medicinal cannabinoids in palliative care.  British Journal of Clinical Pharmacology, June 2018.

Available to download or request a copy from the library

Article: Psychological ideas in palliative care: distress, adjustment and coping

There is a growing recognition in the palliative care community of the emotional and psychological needs of patients - and their carers - as they reach the end of life.  But not every patient needs, wants or has access to formal contact with a psychologist.  Written by a clinical psychologist at Marie Curie Hospices, the article summaries the concepts of distress, adjustment and coping.   She lists a number of questions that are useful to ask to promote helpful discussions to gauge what support someone might need.

Strachan, J. 2018.  Psychological ideas in palliative care: distress, adjustment and coping.  European Journal of Palliative Care, 25 (1) p 26 - 30.

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Article: The role of volunteers supporting people with life-limiting illness at home

Many hospices and palliative care organisations rely on volunteers to provide a range of roles in different settings.  This article describes the findings of an evaluation of end of life support delivered by volunteers on behalf of a local UK charity, along with expert input from a group of end of life care organisations.

Boland, J. & Fearnley, R. 2018.  The role of volunteers supporting people with life-limiting illness at home.   European Journal of Palliative Care, 25 (1) p 33-36.

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Can patients and carers' experiences shape services?

Hospice admission for patients with dementia has been shown to increase caregiver satisfaction yet admission can also be harmful for the patient. This article, from Royal Trinity Hospice, London reports on the experience of a patient with dementia admitted for symptom control, along with respite for his carers.  Shortly into this admission he became increasingly agitated and was discharged home early.  This article reports on the changes the hospice made to create a  "dementia friendly" environment to reduce the disorientation and distress dementia patients were experiencing during their hospice stay.

Parry, L. 2018.  Can patient and carers experiences shape services.  BMJ Supportive & Palliative Care.  epub.

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Clinical Practice Guidelines: Diagnosis, assessment and management of constipation in advanced cancer

Constipation is a commonly experienced problem and a significant source of  discomfort and distress.  The 2018 European Society of Medical Oncology (ESMO) updates guidelines for the diagnosis, assessment and management of constipation in advanced cancer.  A recommendation for the use of peripherally acting mu-opioid receptor antagonists (PAMORAS) is made.

Larkin, N. I. et al. 2018.  ESMO Clinical Practice Guidelines: Diagnosis, assessment and management of constipation in advanced cancer.  Annals of Oncology 29 (4) 111-125.

Available to download or request a copy from the library

Article: The dementia patient's pathway through the Specialist Palliative Care Services: part 1

The role of a specialist palliative care service for non malignant diseases is a relatively new one.  This