Article: Development of an eHealth information resource for family carers supportive a person receiving palliative care in Ireland

Many people receiving palliative care wish to die at home, however carers often report feeling underprepared to undertake this role. This paper describes the process of developing a consensus and evidence-based website to provide core information to help support carers/family members.     Content was developed by a Virtual Reference Group (VRG) comprising of patients, carers and professionals, along with subject exerts and a web developer. Nineteen systematic reviews  identified nine areas of core information required by carers.  These included a description of palliative care, prognosis and treatment of the condition, medication and pain management, personal care, specialist equipment, local support services, what to do in an emergency, nutrition, and support for the carer. 

Scott, D. 2019.  Development of an eHealth information resource for family carers supportive a person receiving palliative care in Ireland.   BMC Palliative Care:

Available on line

Article: The use of digital legacies with people affected by motor neurone disease

The aim of this study was to investigate the views and experiences of people living with motor neurone disease (MND) creating a video based digital legacy to pass on to a family member.   The study consisted of 4 people living with the disease, and 3 young people who had been bereaved and had access to the legacy. The study found the creation of the legacy provided a sense of purpose for people with MND and for the bereaved family member a sense of comfort, once they had reached an appropriate place within their grief journey.

Clabburn, O. et al. 2019.  The use of digital legacies with people affected by motor neurone disease for continuing bonds: an interpretive phenomenological analysis study.

Available online

Article: Patient safety incidents in advance care planning for serious illness: a mixed-method analysis.

Advance care planning (ACP) is essential for patient centred care in the last phase of life.  This study characterises and explores patient safety incidents arising from the ACP process reported in the National Reporting and Learning System.  Searching over a 10 year period - 2005 - 2015 the study found 70 reports in which an ACP caused a patient safety incident across 3 areas: ACP's not completed despite being appropriate (23%); ACP completed but not accessible or miscommunicated between professionals (40%); and ACP completed and accessible but not followed(37%).  Reasons for this included lack of staff knowledge, lack of confidence, and trust in prior documentation to create or enact the ACP.  The authors conclude that staff related causes  should be explored in local contexts along side system development for ACP documentation.

Dinnen, T. et al. 2019. Patient safety incidents in advance care planning for serious illness: a mixed-method analysis.  BMJ: Supportive and Palliative Care. epub ahead of print. August 2019

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Article: In what ways might group clinical supervision affect the development of resilience of hospice nurses

This research comprising of a survey and focus group interviews looked at how clinical supervision might improve resilience in hospice nurses.  Clinical supervision was found to help work confidence, regulating emotions, offering a coping strategy, managing expectations and developing self-awareness.   This was dependent however upon individual preference and experience, the local organisational context and wider social and political factors.  The study provides a number of recommendations for practice.

Francis, Amy & Bulman, C. 2019. In what ways might group clinical supervision affect the development of resilience of hospice nurses.  International Journal of Palliative Nursing, 25 (8) p387 - 396.

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Article: Opioid use in palliative care: new developments and guidelines

This UK article describes the analgesic options available in palliative care.  It reviews recent evidence and guidelines and explores patients' and prescribers common concerns about opioid use.

Bemand-Querishi, L. et al. 2019. Opioid use in palliative care: new developments and guidelines.  Prescriber, April 2019. P 25 - 31.

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Article: Anticipatory syringe drivers: a step too far

An editorial piece discussing the findings of the recent Gosport War Memorial Hospital inquiry and the practice of anticipatory prescribing of syringe drivers in palliative care.

Bowers, B. et al. Anticipatory syringe drivers: a step too far.  BMJ Supportive & Palliative Care. 2019 online.

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Article: Managing constipation in palliative care

Constipation, particularly opioid-induced constipation in patients who are receiving palliative care is extremely common.  There are many pharmacological treatments but their effectiveness is variable and the evidence inconclusive.  This article brings together the latest evidence on the treatment of constipation in adults receiving palliative care.

Young, J. 2019.  An evidence review on managing constipation in palliative care.  Nursing Times, (115) 5, 28-33.

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Article: Infection control - hand hygiene

This article, explains the importance of hand hygiene, when it should be done and the cleaning agents to use.  It also outlines the procedures for decontaminating the hands using alcohol-based hand rub.

Wigglesworth, N. 2019.  Infection control 2: hand hygiene using alcohol-based hand rub.  Nursing Times, 115 (5) p 24 - 27.

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Article: Use of personal protective equipment in nursing practice

Personal protective equipment (PPE) such as gloves, aprons, and eye protection play an important role in the prevention and control of infection for all healthcare staff.  This article defines PPE and it's components, outlining when these items should be used and the procedures for putting on and removing them.  It includes a self assessment quiz at the end and could be used as part of the 35 CPD hours required for revalidation.

Brown, L. et al. 2019.  Use of personal protective equipment in nursing practice.  Nursing Standard, 34 (5) p 59 - 66.

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Article: Noisy upper respiratory tract secretions: pharmacological management

A short overview of the practical management of noisy upper respiratory tract secretions.

Boland, J. & Boland, E. 2019.  Noisy upper respiratory tract secretions: pharmacological management.  BMJ Supportive & Palliative Care, online.

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New Book: Palliative and end of life care in nursing

The book is written for nursing students and non-specialist staff to provide the essential knowledge in the care and management of people nearing the end of life.  Chapters include: communication in palliative care; exploring loss, bereavement and grief; and rehabilitation in palliative and end of life care.  Each chapter includes activities to help readers think and learn about the topic.  A useful book for those involved in teaching or mentoring new staff.   Chapters can be scanned and sent over.

Nicol, J. & Nyatanga, B. 2017.  Palliative and end of life care in nursing.  2nd edition.  Sage Publishing

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Article: Use of low dose sedative medication at end of life

This study investigated current practices when using sedative medication at the end of life in London palliative care organisations. It consisted of focus groups of clinicians and examining documented sedative use in patient records.  Participants all reported the use of sedative medication for managing agitation or distress, selecting drugs and dosages as appropriate.  None used structured observational tools to assess effect, strongly preferring clinical observation and judgement.  The authors concluded practice in these London settings broadly aligns with the EAPC framework for using sedation at end of life but lacks any objective monitoring of depth of sedation.  A follow up study explores the use and feasibility of monitoring sedation in practice.

Vivat, B. 2019.  Palliative care specialists in hospice and hospital/community teams predominantly use low doses of sedative medication at the end of life for patients comfort rather than sedation: Findings from focus groups and patient records for I-CAN-CARE.  Palliative Medicine, online.

Available to download

Article: Young people and their understanding of loss and bereavement

A significant proportion of secondary school pupils in the UK have experienced the death of someone close to them.  The aim of this study was to explore how pupils aged between 12 and 18 understand major loss, death and dying, whom they talk to and the support they chose to access at these times.   The findings showed that young people primarily seek support from family and friends, but the role of peers is less well recognised by parents and teachers.  The school as a source of support was mainly recognised by teachers.

Scott, R. et al. 2019. Young people and their understanding of loss and bereavement.  Bereavement Care, 38 (1) p 6 - 11.

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Report: Talking about death can be life changing

Research by Macmillan Cancer Support and YouGov show 3 in 5 people (62%) in the UK haven't spoken with the family or friends about their wishes in relation to their death.  Almost 1 in 4 (23%) did not know all of their family or friends' wishes. 

Macmillan has information and resources for people to help them plan for death, including a questionnaire to find out how ready they are to talk about it, a guide for starting the conversation and a planning checklist.

Report: Never too busy to learn: how the modern team can learn together in the busy work place

This publication explores how learning environments can be created in busy clinical settings and workplaces and have bought together a range of case studies and examples of how NHS Trusts are doing this.   Examples include huddles, ward rounds, schwartz rounds, simulation, and social media such as WhatsApp and Twitter journal clubs.

Royal College of Physicians & NHS Health Education England, 2019.  Never too busy too learn: how the modern team can learn together in the busy work place. 

Available online

Report: Care after caring: supporting family carers facing and following bereavement

This report aims to share good practice and ideas to improve outcomes for bereaved carers. It sets out what we know already about carers facing and managing bereavement and some of the recommendations to improve support. The report ends with 12 examples of local good practice support.

Hospice UK, and the National Bereavement Alliance. 2019.  Care after caring: supporting family carers facing and following bereavement. 

Available online

Article: Leadership needs to come from all levels to make a great workplace

An article describing how two Senior Managers at large NHS Trusts in London have empowered their staff to improve performance.

Pearce, L. 2019.  Leadership needs to come at all levels to make a great workforce. Nursing Standard, 34 (6) p 55-58.

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Article: How to get the most out of reflective discussions

A two page easy to read article on the benefits that reflection can bring to staff working in stressful work areas.  Particularly useful for staff undertaking NMC revalidation.

How to get the most out of reflective discussions.  Nursing Standard, 2019. 34 (5) p 37-39.

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Article: Clinical supervision in nursing practice

This article provides an overview of clinical supervision, outlining its features and functions.  It includes 3 case studies relating to group clinical supervision, discussing how this was implemented in each case and the various methods of group working that were used.

Driscoll, J. et al. 2019.  Enhance the quality of clinical supervision in nursing practice.  Nursing Standard, 34 (5) p 43-47.

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Article: Remembrance: a self-care toolkit for healthcare staff

This US article describes the development of Bereavement Rounds - also known as "Remembrance,"  a multidisciplinary approach to acknowledge and process the death of patients in an inpatient palliative care service, paying particular attention to how staff can be affected by patients and their families.  A template is included providing details of the format, factors to be considered and the roles different staff play in the weekly 30 minute meetings.

Morris, S. 2019. Remembrance: a self-care toolkit for clinicians.  Journal of Palliative Medicine.  22 (3) p 316 - 318.

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Article: Parental life-limiting illness: what do we tell children

This UK study aims to increase our understanding of children's experiences when a parent has a life-limiting illness.  Interviews were carried out with 7 bereaved children exploring the experience of the support they received along with interviews with 16 healthcare professionals to gain their perspective of the support offered to the children.  The findings showed the children need open, clear and age appropriate conversations with their parents.  Parents often found this difficult and looked at healthcare professionals for support and guidance, however healthcare professionals didn't always feel able to offer support. The role of healthcare professionals, training and role in this process is discussed further

Fearnley, F. & Boland, J. W. 2019. Parental life-limiting illness: what do we tell children.  Healthcare, 7 (47) online

Available to download

Article: Patients' views on care and their association with outcomes in palliative care

In palliative care, it is often the views of bereaved relatives that are used to assess the quality of care.  This short article reports on a new questionnaire - Views on Care (VOC) consisting of 4 questions used with patients to examine their views on the care they receive.   Participants were adults receiving specialist palliative care in 8 hospitals, hospice inpatient units and community settings in England.  The findings showed across all settings that palliative care was providing benefit but the questionnaire also revealed areas such as communication and trust in healthcare professionals making a difference. The authors acknowledge the study was small and follow up finding limited but consider the VOC a brief and easy to use tool in palliative care.

Pinto, C. et al. 2019. Patients' views on care and their association with outcomes in palliative care  Palliative Medicine, 33 (4) p 467 - 469.

Available to download

Article: Quality indicators for palliative care day services

This paper describes the development of the first set of quality indicators specifically for quality improvement in palliative care day services.  A panel of experts identified 30 indicators.  Additional information to that presented in this paper can be found at https://www.qub.ac.uk/sites/QualPalUK/

McCorry, N. 2019. Quality indicators for Palliative Day Services.  Palliative Medicine.  33 (2) p 197-205.

Available to download here

RCN Guidance: Catheter care

This publication is a resource and framework for any healthcare staff  required to undertake urinary catheterisation as part of their role.  The guidance can be used in many ways including: a practical guide taking the national occupational standards to a user-friendly clinical level; forming a catheter care benchmark to compare competencies and practice; and a point of reference to support academic work.

RCN, 2019.  Catheter Care: RCN Guidance for Healthcare Professionals.

Available to download

eHospice: 10 minute teaching sessions

Sonia Bedford, Deputy Ward Manager at the Prince of Wales Hospice in Pontefract, West Yorkshire, explains how 10 minute lessons are empowering their clinical staff.

Read more here

Article: What can nurses do to manage incontinence challenges in end-of-life care?

When a person approaches the end of life, common symptoms of altered bladder and bowel habits may occur.  This article discusses how this can be managed  effectively through communication, a team approach, an effective assessment process and management of urinary and facial incontinence.

Kelly, Anne-Marie. 2019. What can nurses do to manage incontinence challenges in end-of-life care?  International Journal of Palliative Nursing, 25 (4) p 160 - 164.

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Article: I'd recommend..... How to incorporate your recommendation into shared decision making for patients with serious illness

This article describes an expert approach to formulating a recommendation using a shared-decision framework.  It consists of 3 steps: 1) evaluate the prognosis and treatment options; 2) understand the priorities that are important to your patient given the prognosis; and 3) base your recommendation on the patient's priorities most compatible with the likely prognosis and available treatment options.

Jacobsen, J. 2018.  I'd recommend..... How to incorporate your recommendation into shared decision making for patients with serious illness.  Journal of Pain and Symptom Management, 55 (4) p 1224 - 1229.

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