| End of Life |
| If you have come to this section you may be witnessing the end of life of your loved one |
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What is end of life care? Hopefully you will of by now realised that the person you have looked after is going to die of cancer.
This next phase of caring is probably the most emotional period you are ever likely to face. You or the person you are looking after could even be in denial, thinking that matters will improve and they will get better.
Although the Doctors will of predicted this stage of cancer, they can never be sure when death will occur.
The dying process is complex dependent on many factors. |
Pain relief will be given and other medication such as sedation, but this will be discussed with you and the loved one if they able to. It can be a lonely place with other family members or friends feeling hopeless to help you.
We don't know the right or wrong way of dealing with it,many of our members experiences prove how individual we deal with it. It can be a relief that their suffering is over, complete loss and feelings of emotional collapse.
Support will be given to you by nursing staff or hospice staff but if you are at home do call friends or neighbors to be with you. If they should die at home, please don't try to move them as sometimes air can be expelled from their lungs which can be a little frightening. Call your GP or an Ambulance when you are ready.
If they choose to die at home, please check support services are available and when? Its the patients choice, but events can change very quickly.
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Covering Central Lancashire Only
Lancashire Teaching
Hospital-Ribblesdale Ward
- Has full time Palliative Care Consultants
and specialist nursing staff(oncology)
 Does not provide out of hours palliative
care** (Currently being discussed with implementations expected in 2010)
- Ribblesdale Unit (Cancer ward) is not an
admissions ward!
- Has access to other medical and clinical
teams and specialists 24 hrs a day
St Catherine's Hospice
- Has a full time Palliative care team, but
not out of hours*( changes are planned in 2011)
- Admission only be referral, see your GP or
Hospital Consultant
- Has limited inpatient beds
- Does not have access to specialists on
site
At Home
- Access to District nursing(limited resources) this will form part of the advanced care plan(make sure you have one and fully understand it)
- Access to out of hours GP's services ( May have limited up to-date patient information) **Keep your own records of drugs,recent treatment etc.
- Palliative services such as Marie Curie may be able to help, a referral from your GP or district nurse is required, but locality of nurses is important
- Difficulty calling for assistance if the situation deteriorates quickly(GP out of Hours services)Have contact numbers ready
- If you feel the situation is deteriorating quickly and you cannot get normal help, dial 999 and ask for the Ambulance Service and give information **
Talk to you Palliative Care Team, its really important
 It is really important that you identify the palliative care team. If you are at home, ensure both your GP knows about you and also the district nursing team! Out of hours care is improving but don't fully rely on it. You may wish to consider Marie Curie Nursing** or your local hospice when needed.
Both these services can be accessed through your GP or Lead nurse who is looking after the patient
If you are in hospital,this can be difficult, busy clinical wards are not ideal places for someone to die in.
Privacy and dignity can be difficult to organize, ask the nursing staff, they will try their best, but be prepared for difficulties.
Its a sad fact but the majority of cancer patients still die in hospital.
Your palliative care team will try to organize the right sort of care, but this is not a 24 hr service. Sometimes events can happen very quickly and may be out of your control.
The person you are looking after may not be fully aware of what is happening to them.
Ensure you have been given adequate information about administering pain relief at home, remember Morphine is a controlled class A drug!
 **General Introduction
Many people who are seriously ill and for whom active treatment is no longer an option wish to remain at home for as long as possible in comfortable and familiar surroundings.
Marie Curie Cancer Care makes this possible, by giving high quality nursing care to those who are ill and offering ongoing day to day support for the carers.
Marie Curie funds the service through charitable donations in partnership with the NHS and is free of charge to patients and carers.
Marie Curie Nursing service
The Marie Curie nursing service offers practical nursing care in the home during the day or overnight to patients.
This allows respite for the carers who can rest in the knowledge that their relative is being cared for by highly trained nursing staff.
Both Marie Curie Nurses and trained Senior Health care assistants provide the nursing care needed by the patient.
They work closely with the District Nurse and other professionals to ensure that the highest level of care is planned and given.
Even though help from Marie Curie nurses is given it does not prevent family/carers being involved in the care of their relatives
whilst they are in the home and they will work closely with all involved to ensure they are true partners in care.
District Nurses are the central point for co-ordination of the patient’s care and are also the key referrers to the Marie Curie Nursing Service.
Please contact your GP or District Nurse if you would like to request a Marie Curie Nurse.
To find out more about the Marie Curie Nursing Service, visit our website www.mariecurie.org.uk/nursing or contact the support services on 0800 716 146. (reproduced with kind permission from Marie Curie)
Please note: This is not a complete list of what may happen next, and it may vary according to where the death occurs
DNR Orders
Do not resuscitate instructions. When a person who is dying from cancer in hospital, at home (if paramedics have been called) or in a hospice,
the one matter which may give rise to a dilemma for carers is when/if the patients heart stops during the final phases of dying.
Knowing the person you love is going to die does not always prepare you for taking decisions not to prolong life by restarting the heart.
Resusitating a person is very dramatic and can seem very brutal, its purpose is to do whatever action is required by Health care staff to maintain life itself.
Its a hard choice to make but if you ask the care team not to take such action, this must be clearly indicated and noted on the patients medical care plan
in advance and will be subject to the patients consent if they are fully cognicant**
** advanced care planning requires assessment under the mental capacity act which health staff will have to satisfy the patients awareness to the outcome of these instructions.
You as the main carer must be aware that the final decision may not be yours to take, seek advice if your unsure but it may be something to discuss with your loved one earlier rather than later.
The Morgue
This is a department set aside from the wards where the deceased person will be taken from the ward when relatives or carers have indicated to the
nursing staff that this is in order. The body will be identified by the morgue staff and kept in chilled units to preserve the body pending either an autopsy
or for collection from funeral directors. You can view the body at most times by contacting the ward they died or received care first.
It is normal practise for a nurse to accompany the person wishing to see the deceased person. The body will be prepared for you in a quiet room, but please remember
changes to the body will have occurred since death and it may further upset you again.
Informing relatives
At a time when the worst has happened to you as a carer, loosing a loved one may throw you into an emotional collapse.
The thought of contacting other family members about the persons death can seem overwhelming and extremely difficult.
If at all possible ask a close friend or trusted family member to inform who ever needs to be informed, remember that breaking bad news can be
upsetting at the best of times. If religious considerations are required please ask nursing staff to help or direct you for additional information.
After Death
Once death has been confirmed by a doctor, nursing staff will, with the permission of the family, clean and dress the deceased and remove
items of jewelry or other personal possessions before the body is removed from the ward. This is carried out with great dignity by
nursing staff and great care is taken to ensure privacy is maintained.
You may stay with your loved one as long as you wish, but at some stage
the nursing staff will have to remove them from the ward. If your loved one dies at home ring your GP as soon as you are able to,
if its out of hours call the out of hours service or if that fails call an ambulance but also ask a friend to visit you as soon as possible.
Try not to move your loved one if possible, other noises may be heard from them even after death, this may be just air being expelled from their
lungs but it can be alarming to hear.
Nursing staff
It is possible that nursing staff may have formed some sort of relationship with the person who has had the cancer and to you as a carer.
Even though Nursing and medical staff will be aware of the potential death of the patient, it still affects them even if during this stage
they do not show it, or seem to be concerned with other matters rather than the death or even the carers feelings.
They should act professionally at all times but do not assume they are not affected, most of them are, and they are not as immune
from the tragedy as you may think.
This is only a general guide and is not intended to cover everything that happens at the end of life.
For carers it can prove overwhelming and emotionally draining, accepting our loved ones passing is bad enough,
but considering the demands after death can prove even harder.
If you leave the Hospital or Hospice alone, try to ask for friends
or family to stay with you a while at least until arrangements have been made.
Emotional feelings
No one can describe the feelings after loosing someone close to you unless you have experienced this before. Many of our team have, it affects us all differently
but the emotions can run very high at this time, anger at Health Care staff, anger at relatives, releasing pent up anger over treatment. Maybe given poor advice
about a longer outcome by the Doctor or Consultant, and one common theme, releif everyone deals differently and over time many experience flashbacks
and could you have done more. Getting support at this time is important, not just for the practical matters but to know someone is their to talk to.
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End of Life Care
