Unit 52 End of Life
1. Discuss the current legislation and agreed ways of working related to the support of
individuals’ who need end of life care. You should include your own policy and procedures.
You should discuss your own role and relate it to the legislation. Consider how you are
meeting the requirements for Gold Standards or how you intend to achieve this.
Current legislation includes the health and Social Care Act 2012, Equality Act 2010, Mental
Capacity Act 2005, Mental Health Act 1983, Care Act 2014, Sexual Offences Act 2003,
Safeguarding Vulnerable Groups Act 2006, Human Rights Act 1998, Data Protection Act
1998, Freedom of Information Act 2000, Health and Safety at Work Act 1974, Manual
Handling Operations Regulation 1992 (amended 2002), COSHH 2002, RIDDOR, Food Safety
Act 1990. Equality is in place to promote equality and to eliminate anti- discriminatory
policies for instance, individuals receiving end of life care. The legislation enforces the right
of the individual to receive the best care possible and free from abuse and neglect on any
level. Personal dignity and emotional well-being, respect and advanced care planning ensure
that the individual receives person-centred care for the individual, their families and others.
The Gold Standards Framework, with it’s systematic evidence-based approach, provides
training to all people who provide end of life care “to ensure better lives for people and
recognised standards of care “ (www.goldstandardsframework.org.uk) .Using training
programs, tools and measures of progress and support, Gold Standards Framework helps to
improve the quality of care and outcomes for end of life care. In my place of work we have
no end of life care as we are not in that speciality. However, I have previously worked in
palliative care and can easily reflect and recognise the quality care that is provided. I worked
with cancer patients in a hospice and what surprised me most was what a ‘happy’ place it
was. This was certainly due to the quality care they provided, and I was naïve enough to
expect a very unhappy atmosphere, but it wasn’t. Of course, there was much sadness but
generally everyone was happy and content with the quality care they received.
2. Discuss theories of emotional and psychological process individuals’ may experience with
the approach of end of life. You should discuss their family and friends as part of your
answer. One of the biggest emotional theories facing individuals in end of life may be fear;
fear of the unknown or of pain. Some individuals may be aware of their own passing and
may say things like “I won’t make it till Christmas”. I have experienced this when working in
palliative care as they referred to it as ‘going on a journey’, and often an individual may call
you over and say “would you hold my hand? I am going on my journey now’, or “ sit with
me, I’m ready now”. Sometimes the individual may hallucinate leading up to the passing or
may experience super sensitive stimulation and may not want to be touched (www.leaving-
well.org/emotional-changes.php) .
3. Describe the impact of an individuals’ beliefs, culture and religion on end of life care. Use
examples from your practice. It is important that we are aware of the individuals’ culture
and cultural needs and religious beliefs. Some individuals may want to know everything
about their illness and treatment; others may not want to know anything. Different cultures
have different beliefs about serious illness and death and it is important to recognise this.
They may have religious practices and may or may not need support with these. they may
wish to undergo or withhold medical needs due to their cultural or religious beliefs, as some
things may be forbidden. There may also be specific practices that they wish at the time of
, their death or afterwards. Some cultures share the belief of reincarnation and may celebrate
death as a new beginning. It is important to discuss cultural and religious beliefs with the
individual in order to promote person-centred care around end of life.
4. Discuss the different roles key people play in an individuals’ end of life care. Use examples
from your practice. You should include family, friends, GP, DN and any others in involved in
care. Key people in end of life care play a very important role. The nursing staff will provide
round-the-clock care and treatment if in a hospital or hospice or care home, ensuring that
the individual is comfortable and pain free as much as is possible, and the GP’s and Doctors
maintain support throughout. There are organisations that become key elements too,
offering support and advice and providing a partnership with the individual, families and
friends with after care support. The most important people are family, providing the love,
care and support for the individual and often putting their own feelings aside to provide end
of life care support. Also, the Distric Nurses play a key part, in caring and treating the
individual, and building a positive relationship with the individuals and their families. When I
was working in palliative care we had a family room where individuals could sit with their
families, away from the clinical atmosphere of a hospice, and families would spend most of
their time in there with no limits on time. The nurses and care staff were so involved and
supportive that many family members would often visit, even after their loved one had
passed, and would call in just to chat and to thank everyone for their care and support. I was
surprised at the level of care, especially when sometimes individuals were sitting drinking
beer which the care staff had allowed as it was their wishes and included into their plan of
care.
5. Discuss an individuals’ well-being in terms of end of life care, why is it important to
recognise that not all aspects of care needs are directly related to their terminal condition.
How do you ensure that members of staff understand this and fulfil their role? The aim is to
prevent or relieve suffering as much as you can and to respect the individuals’ wishes. This is
called Comfort Care. This comfort care involves the physical, mental and emotional needs,
spiritual support as well as practical tasks. Care comes in a variety of ways and should be
centred on the individual’s well-being. The individual may be experiencing pain and
discomfort, fatigue, breathing or digestive problems, skin irritations, depression and
confusion etc. and it is important that these needs and wishes are recognised and supported
(https://www.nia.nih.gov/health/providing-comfort-end -of-life/) . It takes skilful
communication with individuals and their families to implement realistic goals and
understanding the individuals’ and families’ concerns, and this is achieved through Advanced
Care Planning, to help individuals to live well and die well in the place and manner that they
choose (www.goldstandardsframework.org.uk/advance-care-planning/) . the individual may
appoint someone as their advocate or surrogate to act on their wishes on their behalf. This
should all be communicated to everyone involved in the individuals’ care and all care staff.
Where needed, all staff should receive training in ACP in order to maintain consistency and
to achieve the best outcomes for the individual.
6. Describe how you ensure an individual has as much control over their care as possible. Why
is this important? The individual must be at the centre of their own care planning and must
be involved in every aspect of their care provision. Their choices should be respected and
supported throughout their care management. Communication should be readily available
to them and support for the decisions that they make. It is important that the individual is