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The Role of the District Nurse in End of Life Care


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 – PowerPoint PPT presentation

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Title: The Role of the District Nurse in End of Life Care

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

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

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

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
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.

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

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

3 Simple Steps
  • Assess
  • Current and future clinical needs and personal
  • 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

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

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

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

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

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
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 07734 444800 contact_at_availabl