Establishing a structured plan to provide high-quality end-of-life care in community settings
The purpose of this project was to explore how registered community nurses experienced providing holistic end-of-life care and how having a structured end-of-life care pathway plan would help develop their knowledge and skills, particularly in respect of communication and their ability and confidence in providing evidence-based compassionate care. For some practitioners there exists a lack of confidence surrounding end of life care, which can result in nurses' reluctance to become involved and avoid engaging in those ‘difficult conversations’. Following implementation, early reviews from practice suggest that incorporating the 19 steps of the plan into the delivery of community-based care at end of life has enhanced practice and patient experience.
It is estimated that 1% of the global population dies each year, and this value is predicted to increase by 17% in the future (Royal College of General Practitioners and Royal College of Nursing, 2012). Statistics show that about 35% of these deaths are home deaths, with 18% of individuals dying in their own homes and 17% dying in a care home. Reportedly, 60–70% are not dying in their preferred environment (Royal College of General Practitioners and Royal College of Nursing, 2012). It is suggested that 70% of patients would prefer to die at home, but only half achieve this (Dying Matters, 2018).
Nurses are believed to have the best opportunity to influence the dying process, because of their closeness to patients and their families. Of all healthcare professionals, nurses are said to spend the most time with the patient, and patients and their families look to the nurse for support and guidance (Mauk, 2013). This is especially true for community and home nursing services and when patients wish to die in their own homes. Thus, it is important that community nurses be adequately prepared and skilled to support such patients.
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