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Nursing home perfecting end-of-life care

Author: Petrina Vousden
27 July 2017

Staff at the St Oliver Plunkett Hospital in County Louth are perfecting the way they deliver end-of-life care

Staff at the centre including nurses, care attendants and physiotherapists have taken part in the Journey of Change programme developed by the Irish Hospice Foundation to enhance end-of-life care in residential care centres.

Kay O’Keeffe, director of nursing at the centre said: “We were always very focused on end-of-life care and knew we were good at it but taking part in the Journey of Change Programme really clinched it.

“The facilitator Thelma Pentony was fantastic. She really empowered us to come up with our own vision. Some members of the group reported that the experience helped them cope with their own personal bereavements outside of work.”

The centre currently has 54 residents in single or double rooms.

After taking part in the workshops the centre now has an end-of-life room to ensure that all residents at end-of-life have the option of having a room of their own.

“The provision of this room seemed an impossible task at the outset but it has been achieved. It’s so dignified, Kay said.

Kay said: “The educational experience of Journey of Change helped to validate what we were doing and more importantly made us think about how we were doing things and gave us more confidence in having conversations around end-of-life.

"The facilitator used an exercise called start ,stop, continue and change to get the group to reflect on their practice This really got us thinking.  We also used this to canvass the views of all in-house staff when drawing up the vision for end-of-life care.

“The facilitator, Thelma was very skilled in getting the group to reflect on our personal attitudes towards death and dying and empowered the group  come up with solutions to problems.

“We drew up an action plan with short,medium and longterm goals and this really focussed the group. We were also fortunate that one member of the group had just completed the Certificate in Palliative Care .

As a result of the experience she said staff are more confident in dealing with end of life issues and in dealing with families and supporting bereaved families.

Kay said: “Care plans are more person focused and reflective of residents’ wishes. The course has helped to put the resident at the centre and ensure that they die with dignity and with their wishes respected."

 “Communication between staff and relatives has improved and staff are more relaxed and confident when discussing end of life issues with families for example admission to acute hospital or administration of rehydration fluids.”

Meetings called Compassionate End of Life (CEOL) Review Process now take place after a resident’s death.

Kay said: “The meetings gives staff an opportunity to come together to reflect on the care provided and acknowledge what went well and identify anything they would like to do differently.

“Staff also benefit from the review and report that it was a final mark of respect for the resident who passed away and they were now remembering them as a person not a patient. It’s a lovely idea to remember the person.

“It also validates the wonderful work of all the Team. They start the review with a short reflection, lighted candle and a photograph of the deceased. This idea came from one of the carers in the CEOL Group.”

Interventions to improve quality of life at end of life such as reflexology and aromatherapy, hand massage, use of essential oils, window blinds,noise reduction,mood lighting,quilt for bed, flowers, CD player and CDs have all been introduced.

Families are encouraged to ventilate any worries or fears around end of life. The nursing home facilitates other residents to pay their final respects with a remembrance mass.

And end-of life symbol is placed outside a deceased residents room. Special end of life handover bags are used to give relatives the possessions of a resident.

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