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The importance of great end of life care

Author: Sara Smith
25 July 2017

Sara Smith, Clinical Nurse Specialist in palliative care at Walsall Manor Hospital in the West Midlands, explains the value of providing the best possible end of life care with this story.

*Robert was a 70 year old gentleman who lived with his wife. He had two children and five grandchildren, and was very much a family man. He loved nothing more than to spend time with his family and enjoyed regular holidays abroad. He was physically fit and still ran several businesses, one of which was a scaffolding business and involved heavy manual labour.

One day he sought advice from his GP for back pain which he believed to be work-related, and he was treated with painkillers. He had no significant problems in his past medical history other than mild hypertension, and had given up smoking 20 years previously.  

Robert referred himself to the emergency department in February this year when his back pain worsened following a fall at home. He still thought it was due to work, however he also reported some more concerning symptoms such as night sweats and tiredness, along with  having lumps on his chest which he believed to be cysts. He otherwise felt well.

After various tests Robert was diagnosed with a malignant, incurable tumour in his right lung. He was understandably shocked by the diagnosis, however he maintained his strength and was very focused on getting as well as he could, returning home to organise his finances and officially hand over his business to his son, who had worked with him since leaving school.

He was referred to the hospital specialist palliative care team for pain control, and psychological support for his wife who was also struggling with news. This was where we first met.

Robert was anxious about our input at first as he believed it meant that he was dying. We reassured him this was not the case as he was still being considered for oncological treatment. Our team role and services were explained, and he was referred to the community palliative care for ongoing symptom management.

Robert and I met a couple of times during his admission and he talked a lot about his future, his wishes and his concerns. He did however decline the offer to complete an advanced care plan at this time. He planned to revisit this once he was settled at home.

Four weeks later Robert’s wife called the emergency services when his condition deteriorated. His wife reported a gradual decline over the last two weeks and told me that Robert knew he was dying, and had expressed wishes to die at home.

After discussion with his wife, daughter and granddaughter, myself and the specialist nurse practitioner for end of life care coordinated his quick discharge from the hospital.

He was prescribed medication and a directive was completed for the community nurses to administer what was needed to ensure his comfort.

Robert was transferred home in just over two hours.  The community nurse was there to meet him and make sure he was settled, as well as support his family and leave vital contact details if needed overnight. He died in the early hours of the morning in his own bed and with his family around him, as he wished.

Clinical team work at its finest

Among the many people who helped this happen so fast and efficiently were the hospital specialist palliative care team, the community nurses, and the hospital’s emergency team for supporting Robert’s wishes during an extremely busy day and finding him a bed to lie on rather than a stretcher for him to be comfortable in his last hours.

Also Robert and his wife, who shared with me some of their most personal and difficult thoughts and preferences which enabled us to fulfil his wishes.

I feel that the most important thing to remember is that ultimately we all share the same aim regardless of our role. This is to provide excellent patient care, and to care for people at some of the most harrowing times of their life. The importance of communication, not just to patients but to their families and each other as professionals should never be under estimated.

By supporting each other and utilising the services around us we can meet patients’ needs effectively, providing us with a sense of pride and job satisfaction.

*All identifiable information has been changed for confidentiality reasons.

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