Unit 36: Supprting Individuals during Last Days f Life Unit reference number: F/616/7374 Level: 3 Unit type: Optinal Credit value: 4 Guided learning hurs: 32 Unit summary Prmting respnsive care in the final stage f life is a significant rle fr all care wrkers. The rle requires the ability t recgnise the final phase f life and t adapt care rutines and appraches as death becmes imminent. This can be a highly sensitive and emtinal perid f time fr family, friends and caring staff. Fr the individual, significant physical changes can lead t fear, cnfusin, pain and discmfrt. All f these symptms require careful management t enable the individual t cntinue t cmmunicate their needs and chices, and t meet their death with dignity and peace. This unit will enable yu t gain mre f an understanding abut changes in the final phase f life and hw t supprt the individual and thers. As a senir care wrker, yu will demnstrate hw t prepare fr this, leading staff t prmte the highest standards f care and sensitivity. 1
Learning utcmes and assessment criteria T pass this unit, the learner needs t demnstrate that they can meet all the learning utcmes fr the unit. The assessment criteria utline the requirements the learner is expected t meet t achieve the unit. Learning utcmes 1 Understand the impact f the last days f life n the individual and thers 2 Understand hw t respnd t cmmn symptms in the last days f life 3 Understand hw t supprt individuals and thers during the last days f life 4 Be able t respnd t the changing needs f an individual during the last days f life Assessment criteria 1.1 Explain the psychlgical aspects f the dying phase fr the individual and thers 1.2 Discuss the impact f the last days f life n the relatinships between individuals and thers 2.1 Explain the cmmn signs f appraching death 2.2 Explain hw t minimise the distress f symptms related t the last days f life 2.3 Describe agreed cmfrt measures in the final hurs f life 2.4 Discuss the circumstances when life-prlnging treatment can be stpped r withheld 2.5 Describe the signs that death has ccurred 3.1 Evaluate different ways t enhance an individual s wellbeing during the last days f life 3.2 Explain the imprtance f wrking in partnership with thers t supprt the individual s wellbeing 3.3 Evaluate hw different tls fr end f life care can supprt the individual and thers 3.4 Explain hw t help thers t understand the prcess fllwing death accrding t agreed ways f wrking 4.1 Demnstrate hw t fllw the individual s advance care plan in the last days f life 4.2 Recrd the changing needs f the individual during the last days f life accrding t agreed ways f wrking 4.3 Demnstrate hw t supprt the individual when their cnditin changes accrding t agreed ways f wrking 2
Learning utcmes 5 Be able t wrk accrding t natinal guidelines, lcal plicies and prcedures, taking int accunt preferences and wishes after the death f the individual 6 Be able t manage wn feelings in relatin t an individual s dying r death Assessment criteria 5.1 Carry ut actins immediately fllwing a death that respect the individual s wishes and fllw agreed ways f wrking 5.2 Demnstrate hw t prvide care fr the individual after death accrding t natinal guidelines, lcal plicies and prcedures 5.3 Demnstrate hw t fllw an individual s wishes fr their after-death care 5.4 Evaluate agreed ways f wrking relating t the preventin and cntrl f infectin when caring fr and transferring a deceased persn 5.5 Demnstrate hw t supprt thers immediately fllwing the death f a clse relative r friend in line with agreed ways f wrking 6.1 Explain ways t manage wn feelings in relatin t an individual s death 6.2 Use supprt systems t manage wn feelings in relatin t an individual s death 3
Cntent What needs t be learned Learning utcme 1: Understand the impact f the last days f life n the individual and thers Individual The individual is the persn requiring care r supprt. Others Others, e.g. families r carers, friends, clleagues, ther prfessinals, members f the public, advcates. Psychlgical aspects Palliative care. Mdels f care. Educate and infrm patient and family while understanding their gals and develping a flexible and respnsive care plan. Theries f grief and lss. Anticipatry grief and murning. Death anxiety. Nature f patient/family respnse will depend n: stage in life cycle illness histry lss histry, including past experiences f dying/death cping style/persnality cultural values spirituality and/r religius affiliatin presence/absence f supprt netwrk additinal stressrs, e.g. financial, etc. Relatinship between individual and thers Last wishes. Need t express feelings. Fear f prcess f death and what happens afterwards. Fear f nt being able t cpe. A gd death. Finding meaning; purpse and hpe. Future hpes. 4
What needs t be learned Learning utcme 2: Understand hw t respnd t cmmn symptms in the last days f life Signs f appraching death Sleep mre difficult t wake. May have nly few lucid mments. Can appear cnfused when cnscius. Lss f gag reflux, secretins cllect at back f thrat. Hands and feet cld. Cyansis arund muth, fingertips. Changes in breathing Cheyne-Stkes. Incntinence. Restless, agitated. Minimise distress and discmfrt Teamwrk. Fllw agreed wishes and preferences f individual. Muthcare and fluids if tlerated. Regular repsitining. General persnal care and hygiene. Sft lighting. Never left alne. Encurage family and friends t be arund. Have persnal belngings clse. Apprpriate pain cntrl. Life-prlnging treatment Equality and human rights, Human Rights Act 1999. Presumptin in favur f prlnging life. Acting n advance requests fr, and refusals f, treatment. Signs that death has ccurred N breathing. N heartbeat. Lss f cntrl f bwel r bladder. N respnse t attempts t awaken, shaking r shuting. Eyelids slightly pen. Eyes fixed n certain spt. Jaw relaxed and muth slightly pen. 5
What needs t be learned Learning utcme 3: Understand hw t supprt individuals and thers during the last days f life Enhance wellbeing Calm and relaxing envirnment. Cmpetency in skills. Awareness f individuals needs and preferences. Effective cmmunicatin. Gd relatinships with family and friends. Wrking in partnership Shared decisin making. Shared expertise. Persnalised planning. Efficiency f service delivery. Effective cmmunicatin. Tls fr end f life care Assessment tls, mnitring pain intensity: Abbey Scale PAINAD. Hlistic Cmmn Assessment Framewrk. Gld Standards Framewrk. Preferred Pririties fr Care. Clinical prtcls. Agreed ways f wrking. Care planning and pathways. Understand prcess fllwing death Frmal identificatin. Certified death by GP. Pssible discussin regarding rgan dnatin. Laying ut f bdy. Cntact with funeral directrs. Registering death. Bereavement cunselling and supprt. Arranging funeral. 6
What needs t be learned Learning utcme 4: Be able t respnd t the changing needs f an individual during the last days f life Advance care plan Supprts individuals wishes. Prmtes respect and dignity. Values decisins made. Allws carers and family t be sure they are acting in individual s best interest. Changing needs f individual Hlistic appraches. Care planning: review f medicatin discussin with individual cessatin f nutritin maintenance f fluids cntinence measures risk management. Meeting the needs f the individual Effective pain cntrl. Change f psitin. Oral and skin care. Reassurance. Calm envirnment. Cntact with family and friends. Nt left alne. Sft lighting. Relaxing envirnment. Avid excessive nise. Sensitive care. 7
What needs t be learned Learning utcme 5: Be able t wrk accrding t natinal guidelines, lcal plicies and prcedures, taking int accunt preferences and wishes after the death f the individual Natinal guidelines, lcal plicies and prcedures Cmmn cre principles and cmpetences fr scial care and health wrkers wrking with adults at the end f life (Skills fr Care and Skills fr Health, 2014). NICE Standards fr Quality End f Life Care (2014). Natinal Cuncil fr Palliative Care The end f life care strategy: New ambitins (2013). Gld Framewrk Standards (2017). Plicies in setting. Health and safety plicy. Infectin cntrl plicy. Use f persnal prtective equipment (PPE). Clinical dispsal f waste. Awareness f infectin risks. Supprting thers Need t express feelings. Fear f prcess f death and what happens afterwards. Fear f nt being able t cpe. A gd death. Finding meaning, purpse and hpe, future hpes. Cunselling. Bereavement supprt. Supprt frm mentr and team. Learning utcme 6: Be able t manage wn feelings in relatin t an individual s dying r death Managing wn feelings Grief. Lss. Grieving prcess. Supprt systems Cunselling. Bereavement supprt. Supprt frm mentr and team. 8
Infrmatin fr tutrs Suggested resurces Bks Kübler-Rss E - On death and dying: What the dying have t teach dctrs, nurses, clergy and their wn families (Simn and Schuster, 2014) ISBN 9781476775548 Kübler-Rss E and Kesler D - On Grief and Grieving: Finding the Meaning f Grief Thrugh the Five Stages f Lss (Simn and Schuster, 2014) ISBN 9780743263443 Websites www.gv.uk/dh Department f Health includes an verview f prgress n cmmitments made in One Chance t Get it Right: the system-wide respnse t the Independent Review f the Liverpl Care Pathway. www.ncpc.rg.uk/ The Natinal Cuncil fr Palliative Care infrmatin fr all thse invlved in palliative, end f life and hspice care in England, Wales and Nrthern Ireland. www.nhs.c.uk scie-scialcarenline.rg.uk www.skillsfrcare.rg.uk NHS England NHS England's Actins fr End f Life Care 2014. The UK s largest database f infrmatin and research n all aspects f scial care and scial wrk. Standards and legislatin relating t death and dying. 9
Assessment This guidance shuld be read in cnjunctin with the assciated qualificatin specificatin fr this unit. This unit is internally assessed. T pass this unit, the evidence that the learner presents fr assessment must demnstrate that they have met the required standard specified in the learning utcmes and assessment criteria, and the requirements f the assessment strategy. T ensure that the assessment tasks and activities enable learners t prduce valid, sufficient, authentic and apprpriate evidence that meets the assessment criteria, centres shuld fllw the guidance given in Sectin 8 Assessment f the assciated qualificatin specificatin and meet the requirements frm the assessment strategy given belw. Wherever pssible, centres shuld adpt an hlistic apprach t assessing the units in the qualificatin. This gives the assessment prcess greater rigur and minimises repetitin, time and the burden f assessment n all parties invlved in the prcess. Unit assessment requirements This unit must be assessed in accrdance with the assessment strategy (principles) in Annexe A f the assciated qualificatin specificatin. Assessment decisins fr learning utcmes 4, 5 and 6 (cmpetence) must be made based n evidence generated during the learner s nrmal wrk activity. Any knwledge evidence integral t these learning utcmes may be generated utside f the wrk envirnment, but the final assessment decisin must be within the real wrk envirnment. Simulatin cannt be used as an assessment methd fr learning utcmes 4, 5 and 6. Assessment f learning utcmes 1, 2 and 3 (knwledge) may take place in r utside f a real wrk envirnment. 10