The Role of the District Nurse in End of Life Care

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The Role of the District Nurse in End of Life
Care
Carol Alstrom Chief Nurse and Director of
Infection Prevention and Control 19th November
2009
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History of District Nursing

• William Rathbone and Mrs Robinson
• Queen Victoria Jubilee Institute for Nurses
• Queens Nurses trained till 1968
• Mandatory District Nurse education
• Specialist practitioner qualification

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Role of the District Nurse

• To hold continuing responsibility for the
  assessment and provision of care to a group of
  patients within a chosen locality
• Planning, implementation and evaluation of care
• Be leaders and managers of a team of nurses,
  ensuring effective team working across the
  boundaries of health and social care

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The role of the District Nurse in end of life care

• Supporting patients in their choice to die at
  home
• Dependent on a network of support from healthcare
  professionals, family and friends
• Excellent communication with all members of the
  team
• Maintaining an up to date knowledge base to
  provide high quality palliative care at home

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Caring for a dying person at home is a privilege
experienced by every district nurse and to some
of us, supporting the dying person and their
family in the final days of life is a unique and
always remembered experience. The district nurse
can within a matter of hours or days become a
vital support for the family and quickly become a
healthcare professional to be relied on. At the
end there is sadness for all, including the
district nurse, who will often find herself
supporting the bereaved family
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Gold Standards Framework

• Its about living well until you die
• GSF is a systematic common sense approach to
  formalising best practice, so that quality end of
  life care becomes the standard for every patient.

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5 Goals of GSF

• To provide for patients with any final illness
• Consistent high quality care
• Alignment with the patients preferences
• Pre-planning and anticipation of needs
• Improved staff confidence and teamwork
• More home based, less hospital based care

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3 Simple Steps

• Identify
• Patients who may be in the last year of life and
  identify their stage
• Identify these patients early
• Include on GSF register to have early focused
  discussion allowing better care, more patient
  control and choice
• Identify approximately where they are on their
  end of life trajectory helps to estimate likely
  stage and possible current and future needs, to
  be able to better plan and provide best care

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3 Simple Steps

• Assess
• Current and future clinical needs and personal
  needs
• Assess the likely needs clinical and personal,
  current and future
• Holistic assessment of patients needs
• Advanced care planning
• Consider carers needs early practical,
  supportive and financial

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3 Simple Steps

• 3. Identify
• Develop an action plan of care
• Take the lead on EOLC within the DN team
• Plan to avoid crises and unnecessary admissions
• Anticipate the patients likely needs
• Pre-plan to enable a dignified good death in the
  patients place of choice
• Fulfilling the patients wishes is a priority
• Multi-disciplinary meetings
• Key worker role
• Team working with others
• Reflection as a team on how care might be improved

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Challenges for District Nursing

• Lack of 24 hour ongoing care
• If terminal phase not pre-empted then required
  support may not be there e.g. just in case boxes
• Care cant be restricted by documentation and
  pathways the patients needs must come first,
  flexibility and patient centred care is the key

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Supporting the role of the District Nurse

• Education
• Advice
• Clinical supervision
• Resources equipment, staffing
• 24 hour / 7 day a week service provision
• Networks and clear guidance

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Feedback from Nurses

• We have had an increase in the number of
  terminally ill patients. You get involved. I find
  it very satisfying, but also very stressful.
  Caring for dying patients is emotionally draining
  and theres not much support
• I do find palliative care very satisfying.
  Although we had support from the Macmillan
  nurses, it was still very difficult

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Caring for the dying person in their own home can
be both a pleasure and a challenge, but always
the District Nurse must remember she is a guest
in the home. She can only advise and recommend
and when allowed take the lead, provide vital
support and guidance and ensure that it is always
about living well until you die
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Thank you for listening Photographs provided
free of charge by Steve Gascoigne Available
Light Photography 32 Well Street, Ryde, Isle of
Wight, PO33 2SG Tel [phone] contact_at_availabl
eloght.cc www.availablelight.cc