HSC 3048 Support individuals at the end of life by Gaël Romanet
Support individuals at the end of life
Level 2 Diploma in Health and Social Care
Unit HSC 3048
Tutor Name: Akua Quao
Thursday 12th September 2013
Release Date: 05/09/2013 03:33
Author's Note I designed 100% of the achievement of this unit; graphics and page layout, including textures and design. Support individuals at the end of life, is a resume of 3 weeks work, accounting for more than 250 working hours. My knowledge of level design and creating textures from my job in France for 9 years helped me to the achievement in this work. Page 1 of 120
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HSC 3048 Support individuals at the end of life by Gaël Romanet
Assignment task – HSC 3048 Support individuals at the end of life
Unit purpose and aim This unit is aimed at those working in a wide range of settings. It provides the learner with the knowledge and skills required to support end of life care.
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Task 1 understand the requirements of legislation and agreed ways of working to protect the rights of individuals at the end of life
Exemplification: Legislation and agreed ways of working will include policies and procedures where these apply, and may relate to: - equality, diversity and discrimination - data protection, recording, reporting, confidentiality and sharing information - the making of wills and living wills - dealing with personal property of deceased people - removal of medical equipment from deceased people - visitors -
safeguarding of vulnerable adults
Outline legal requirements and agreed ways of working designed to protect the rights of individuals in end of life care
Explain how legislation designed to protect the rights of individuals in end of life care applies to own job role
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Task 2 understand factors affecting end of life care
Outline key points of theories about the emotional and psychological processes that individuals and key people may experience with the approach of death
Exemplification: An individual is the person requiring end of life care Key people may include: - Family members - Friends - Others who are important to the well-being of the individual
Explain how the beliefs, religion and culture of individuals and key people influence end of life care
Explain why key people may have a distinctive role in an individual’s end of life care
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Explain why support for an individual’s health and well-being may not always relate to their terminal condition
Task 3 understand advance care planning in relation to end of life care
Exemplification: Systems for advance care planning may include: - Gold Standard Framework - Preferred Priorities for Care
Describe the benefits to an individual of having as much control as possible over their end of life care
Explain the purpose of advance care planning in relation to end of life care
Describe own role in supporting and recording decisions about advance care planning
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Outline ethical and legal issues that may arise in relation to advance care planning
Task 4 be able to provide support to individuals and key people during end of life care
Support the individual and key people to explore their thoughts and feelings about death and dying
Provide support for the individual and key people that respects their beliefs, religion and culture
Demonstrate ways to help the individual feel respected and valued throughout the end of life period
Provide information to the individual and/or key people about the individual’s illness and the support available
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Give examples of how an individual’s well-being can be enhanced by: -
environmental factors
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non-medical interventions
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use of equipment and aids
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alternative therapies
Contribute to partnership working with key people to support the individual’s well-being
Task 5 understand how to address sensitive issues in relation to end of life care
Explain the importance of recording significant conversations during end of life care
Explain factors that influence who should give significant news to an individual or key people
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Describe conflicts and legal or ethical issues that may arise in relation to death, dying or end of life care
Analyse ways to address such conflicts
Task 6 understand the role of organisations and support services available to individuals and key people in relation to end of life care
Describe the role of support organisations and specialist services that may contribute to end of life care
Exemplification: Support organisations and specialist services may include: - nursing and care homes - specialist palliative care services - domiciliary, respite and day services - funeral directors
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Analyse the role and value of an advocate in relation to end of life care
Explain how to establish when an advocate may be beneficial
Explain why support for spiritual needs may be especially important at the end of life
Describe a range of sources of support to address spiritual needs
Task 7 be able to access support for the individual or key people from the wider team
Identify when support would best be offered by other members of the team
Exemplification: Other members of the team may include: - line manager Page 9 of 120
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- religious representatives - specialist nurse - occupational or other therapist - social worker - key people
Liaise with other members of the team to provide identified support for the individual or key people
Task 8 be able to support individuals through the process of dying
Carry out own role in an individual’s care
Contribute to addressing any distress experienced by the individual promptly and in agreed ways
Adapt support to reflect the individual’s changing needs or responses
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Assess when an individual and key people need to be alone
Task 9 be able to take action following the death of individuals
Explain why it is important to know about an individual’s wishes for their after-death care
Carry out actions immediately following a death that respect the individual’s wishes and follow agreed ways of working
Exemplification: Actions may include: - Attending to the body of the deceased - Reporting the death through agreed channels - Informing key people
Agreed ways of working will include policies and procedures where these exist
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Describe ways to support key people immediately following an individual’s death
Task 10 be able to manage own feelings in relation to the dying or death of individuals
Identify ways to manage own feelings in relation to an individual’s dying or death
Utilise support systems to deal with own feelings in relation to an individual’s dying or death
Assignment task – HSC 3048 Answers
Task 1 understand the requirements of legislation and agreed ways of working to protect the rights of individuals at the end of life
Exemplification: Legislation and agreed ways of working will include policies and procedures where these apply, and may relate to: - equality, diversity and discrimination Page 12 of 120
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- data protection, recording, reporting, confidentiality and sharing information - the making of wills and living wills - dealing with personal property of deceased people - removal of medical equipment from deceased people - visitors -
safeguarding of vulnerable adults
Outline legal requirements and agreed ways of working designed to protect the rights of individuals in end of life care (19 pages to answer the question)
What are rights? Rights are freedoms. They allow a person to have a quality of life and to live life as they choose. We also think of rights as things that are protected and cannot be taken away from us. They are not a privilege but are an entitlement of every person. Rights are often outlined in, and guaranteed by, law and should not be taken away from individuals except in very specific circumstances - for example taking away a person's right to freedom if they are found guilty of a crime by court of law and sentenced to imprisonment.
Even imprisonment for a crime does not strip person of all the rights. Legal requirements and agreed ways of working designed to protect the rights of individuals in end of life care includes laws such are:
The Equality Act 2010 legally protects people from discrimination in the workplace and in wider society. Page 13 of 120
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The Equality Act 2010 - External Link has extended the protection from the 6 equality strands to 9 protected characteristics, which are: -
Age Disability Gender reassignment Marriage and civil partnership Pregnancy and maternity Race Religion and belief Sex Sexual orientation
Under the Act people are not allowed to discriminate, harass or victimise another person because they have any of the protected characteristics.
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ESFRS (East Sussex Fire & Rescue Service) will also give due regard to reducing the inequalities of outcome which result from socio-economic disadvantage. The Equality Act 2010 includes a new public sector Equality Duty which states that public bodies must have due regard to the need to: -
Eliminate unlawful discrimination, harassment and victimisation Advance equality of opportunity Foster good relations between different groups
Before The Equality Act 2010 came into force there were several pieces of legislation to cover discrimination, including: -
Sex Discrimination Act 1975 Race Relations Act 1976 Disability Discrimination Act 1995
The Equality Act 2010 (Specific Duties) Regulations 2011 came into force on 10 September 2011. Note about the Equality Act 2010 (Specific Duties) Regulations 2011: The specific duties require public bodies to publish relevant, proportionate information showing compliance with the Equality Duty, and to set equality objectives.
The Data Protection Act 1998 The Data Protection Act 1998 covers both ‘manual’ records (relevant filing systems) and those processed electronically, relating to living individuals. Relevant filing systems are defined as any set of information relating to individuals structured either by reference to individuals or by reference to criteria relating to individuals so that personal information can be readily accessible. Personal data covers both facts and opinions about the individual. It includes information regarding the intentions of data’s controller towards the individual, although in some limited circumstances, exemptions will apply. The Act itself is complex and establishes a number of offences that may result from both non compliance with its terms and or the principles embodied in it. The Information Commissioner also has power to impose a monetary penalty for a failure to comply with the data protection principles. Page 15 of 120
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To resume, The Data Protection Act controls how your personal information is used by organisations, businesses or the government. Everyone who is responsible for using data has to follow strict rules called ‘data protection principles’. They must make sure the information is: -
used fairly and lawfully used for limited, specifically stated purposes used in a way that is adequate, relevant and not excessive accurate kept for no longer than is absolutely necessary handled according to people’s data protection rights kept safe and secure not transferred outside the UK without adequate protection
There is stronger legal protection for more sensitive information, such as: -
ethnic background political opinions religious beliefs health sexual health criminal records
A living will (otherwise known as advance decision) records what YOU want to be done if you become so ill or severely injured that you cannot speak for yourself. If you do not want to be subjected to medical treatments and interventions which might prolong your life but result in a quality of life you would find unacceptable, you can make a living will. There are many valid versions but all are formal documents which must be considered in depth and in detail. All need to be witnessed and dated and most encourage the nomination of a proxy to speak on your behalf if there is any doubt in your doctor's mind as to your wishes. A solicitor is required in Scotland but not in England.
Dealing with personal property of deceased people, mean dealing with a deceased person's money and property. After someone dies, someone (called the deceased person's 'executor' or 'administrator') must deal with their money and property (the deceased person's 'estate'). They need to pay the deceased person's taxes and debts, and distribute his or her money and property to the people entitled to it. Page 16 of 120
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Executor or administrator If the deceased person left a valid will, the person who deals with the estate is called the deceased person's 'executor'. If the deceased person left an invalid will or no will at all, the person who deals with the deceased person's estate is called an 'administrator'. An administrator must usually be appointed by the court before they can deal with the deceased person's estate. Accessing a deceased person's money, property and other assets If the deceased person left a lot of money or property in his or her estate, the executor or the administrator may have to apply for a grant of representation to gain access to the money. An application for a grant is made to the Probate Registry. If the deceased person left a valid will, the Probate Registry will grant probate of the will. If the deceased person left an invalid will or no will at all, the Probate Registry will issue a grant of letters of administration. What is probate? 'Probate' is a term commonly used when talking about applying for the right to deal with a deceased person's affairs (called 'administering the estate'). In practice, different terms are used, depending on whether or not the deceased person left a will and where they lived. Small estates and dealing with immediate debts If the deceased person left a small amount of money (usually £10,000 or less) in his or her estate, it may not be necessary to obtain a grant of probate or letters of administration to withdraw money from the deceased's account with a bank or financial institution. This can be useful if money is needed from the deceased’s estate to pay for immediate expenses such as the funeral, mortgage or house insurance. Each bank or financial institution has its own rules on what proof it requires and how much money it will release to the person acting in the estate of the deceased. If the deceased person had several bank accounts, each holding only a small amount of money, but in total exceeding £10,000, then it may still be possible to access the money in those accounts without a grant of probate or letters of administration. Again, each individual bank or financial institution will decide whether or not to release the money to the person acting in the estate of the deceased. If a bank or financial institution does not require a grant, it may ask the person acting in the estate of the deceased to sign an indemnity. The purpose of this is to protect the bank or financial institution if it later turns out that the money has been paid to the wrong person.
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Money in joint accounts The deceased person may have held money with another person in a joint bank or building society account. Normally this means that the surviving joint owner automatically owns the money. The money does not form part of the deceased person's estate for the purpose of administration and therefore does not need to be dealt with by the executor or administrator. However, a deceased person's share in joint property is treated as part of their estate for inheritance tax purposes, both on death and on gifts made during their lifetime. Accessing a deceased person's property 'Property' includes houses, real estate generally, shares, antiques, jewellery, works of art, and intangible property such as patents and copyrights. If the deceased held property in their sole name, and they left a valid will dealing with the property, then the property will usually pass in accordance with the will. If the deceased left no valid will, or a will that did not deal with the property, it is dealt with under the law of intestacy. If the deceased held property with another person or persons, the deceased's executor or administrator needs to find out how the property was owned. Where the property is a house, there should be written documentary evidence of the type of ownership. Jointly owned property If the deceased person owned property with another person or persons as 'beneficial joint tenants', the deceased person's share automatically passes to the surviving joint owner(s). Property owned as joint tenants does not form part of a deceased person's estate on death. But the value of the deceased person's share of jointly owned property is included when calculating the value of the estate for Inheritance Tax purposes. In other cases, where the deceased person owned property with another person or persons, the deceased person's share of the property forms part of their estate and is dealt with by the executor under the terms of the will or by the administrator under the law of intestacy. Pension schemes Different rules apply to different pension schemes. The executor/administrator will need to contact each scheme the deceased belonged to and ask if: -
death benefits are payable there is a pension for a spouse, civil partner or children any of the investment has become part of the deceased's estate under a selfemployed pension scheme
Remember that an ex-spouse or former civil partner may have rights to some of the pension, depending on the terms of the divorce or dissolution settlement. Page 18 of 120
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Life insurance policies It's advisable to contact the insurance company as soon as possible. They'll tell you what to do and what documents they need before they can pay out. It's also advisable to check carefully the amount that should be due, and to whom, under the policy before signing for any money. Also, remember to make sure policies are still in force, and how much they are worth, before committing to funeral costs. Always get a receipt from the insurance company when cashing in a policy. Where to keep money belonging to the estate Whatever the size of the estate, it's a good idea to open a separate 'estate account' with a bank or building society, so that all transactions relating to the administration of the estate can be recorded. Beneficiaries are entitled to go to the court and seek an order that the executor/administrator provide them with a full inventory of the estate and a copy of the estate accounts. Preventing identity theft Sometimes fraudsters try to take the deceased person's identity to steal money from their estate.
Removal of medical equipment from deceased people If a patient dies and the death is reportable to the coroner, you should leave all equipment in place until you have discussed the case with the coroner’s officer. This factsheet gives you further information about what to do. Equipment that is needed for other patients If the patient has been connected to equipment that is needed urgently for other patients - for example, a respirator - you should take a photograph or make a sketch diagram before it is disconnected from the patient. The sketch or photograph may preserve forensic evidence that could be crucial to the coroner’s investigations. The equipment should not be disconnected or used again if it is possibly faulty or could be the subject of an investigation into a possible complaint or adverse event. Other equipment Equipment such as intravenous lines, drains, catheters etc should be left undisturbed. This is to preserve any forensic evidence, and to give the coroner’s pathologist the best opportunity for independent inspection and assessment of the case. The equipment may be relevant not only in cases of possible crime, but also in cases where the clinical management may be called into question. Page 19 of 120
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Examples of items that should be left undisturbed include: -
Endotracheal tubes Intravascular lines Drains Cannulae Catheters Feeding tubes Defibrillator pads Cardiac pacing devices Sutures
Faulty equipment If you think that any piece of equipment might be at fault, it must be left untouched and, if possible, sealed and stored in a locked room or cupboard. It can be then be examined on behalf of the coroner and/or the Health and Safety Executive. Sudden or violent death In cases of sudden or violent death - for example, in the Accident and Emergency Department or where patients are brought in dead - the clothing should be left undisturbed. Any item (eg, a knife, needle or syringe) should not be touched. It should be left for forensic examination and will be dealt with by the scene-of-crime police officer or the forensic pathologist. If it is necessary to remove clothing or equipment, you should make a careful note of this. If there is anything you are unsure about, contact the coroner’s office and they will be able to provide you with further information. Each case is different and the facts of the case will assist in making the appropriate decisions. Cremations It is essential that pacemakers and/or radioactive implants are removed before the body is taken away for cremation in order to avoid the risk of causing an explosion in the crematorium.
Legislation and agreed ways of working that include policies and procedures where these apply, and may relate to visitors, mean legislation relating to general health and safety. The legislation who relates to general health and safety is the Health and Safety at Work Act 1974. Health and Safety at Work Act 1974 The Health and Safety at Work Act 1974, also referred to as HSWA, HSW Act or HASAWA, is the primary piece of legislation covering occupational health and safety in Great Britain. Page 20 of 120
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The Health and Safety Executive with local authorities (and other enforcing authorities) is responsible for enforcing the Act and a number of other Acts and Statutory Instruments relevant to the working environment. It is significant to know that the health and safety legislation, policies and procedures are in place to ensure the safety of everyone within the workplace, including visitors. The responsibilities for health and safety in the workplace are shared between the employer and employee. Your workplace will be covered by The Health and Safety at Work Act 1974. This Act has been updated and further regulations and guidelines added to it to extend the areas that it covers.
Legislation and agreed ways of working that include policies and procedures where these apply, and may relate to safeguarding of vulnerable adults, mean legislation relating to the Care Standards Act 2000. The Care Standards Act 2000 has two fundamental aims. To protect vulnerable people from abuse and neglect, and to promote the highest standards of quality in the care that people receive.
Key legislation related to rights of individuals in the end of life A number of Acts have been passed into legislation related to rights, which you need to know about when working with individuals in the end of life care.
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The Human Rights Act sets out a number of basic human rights that are protected by law in countries that have signed up the Convention of Human Rights. The Human Rights Act 1998 In 1951, the European Convention of Human Rights (ECHR) was established. It includes the following which were turned into UK law through the Human Rights Act 1998: -
The right to education
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The right to life
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The right to respect for private and family life, home and correspondence
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Freedom of thought, conscience and religion
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Freedom of assembly and of association
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The right to marry and found a family
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Prohibition of discrimination in the enjoyment of conventional rights
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The right to peaceful enjoyment of possessions
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The right to a fair trial
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The right not to be discriminated against on any ground
About the Human Rights Act 1998 The Human Rights Act means that residents of the United Kingdom are able to seek help from the courts if they believe that their human rights have been infringed. It is likely that anyone working within health and social care will be working within the provision of the Human Rights Act. With the introduction of the Human Rights Act, the government had to show commitment to protecting the most vulnerable adults. In the past some people had not always been able to access their rights; this will now be regarded as a violation of an individual's human rights.
Dignity in Care In 2006 a Dignity in Care Campaign was launched. Page 22 of 120
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Its aim is to ensure that dignity and respect are put at the centre of care services. The campaign has developed a Dignity Challenge, which is a list of ten things that high quality services who are respectful of people’s dignity should follow: -
There should be zero tolerance for all forms of abuse
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Individuals should be supported with the same level of respect that you would want for yourself or a relative
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Every individuals should be treated as an unique person and receive a personalised service
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Individuals should be supported and enabled to have maximum independence, choice and control
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Individuals should be listened to and supported to express their needs
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An individual’s right to privacy should be respected
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An individual or their key people (relatives, supporters, family members, friends and others who are important to the well being of the individual) should be able to complain without fear of comeback
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Family members and key people should be engaged with as partners in care
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Individuals should be assisted to maintain positive self esteem and confidence
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Carers and key people should work to reduce individual’s loneliness and isolation
There is lots of information about the Dignity Challenge and ways carers and key people can help to meet the ten key points. Information and resources about supporting dignity in care can be found on the web site of the Dignity in Care at www.dignityincare.org.uk
The Mental Capacity Act 2005 outlines people’s rights to make decisions, particularly in the case of people who may lack capacity to do that for themselves. Mental Capacity Act 2005 The Mental Capacity Act sets out, in legislation: -
Who can make decisions and how decision making capacity in decided and assessed
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How decisions can be made by, and for, people who are deemed to lack mental capacity to make them for themselves
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The Act takes the position that, unless a person is proven to lack capacity, they are to be judged as competent to make decisions, even if those decisions might appear unwise to others. Where someone lacks capacity Best Interest decisions can be made on behalf of, and about, them. On occasions making a decision on behalf of a person who lacks capacity is helped: By someone previously appointed by the person who now lacks capacity as Lasting Power of Attorney: -
A person with Lasting Power of Attorney will be able to make decisions about financial matters and health and social care
Through an advance decision: -
This is where the person previously made a decision about future treatment should he or she become unable to make those decisions for him/herself at a later date
The Mental Capacity Act provides a statutory framework aimed at empowering and protecting people who are vulnerable and unable to make their own decisions. It makes clear the circumstances in which other people can take decisions for an individual and allows people to plan ahead for a time when they may not be able to decide for themselves.
Best Interests decisions If someone is unable to make a decision for themselves then it must be made for them. All decisions must be made in the best interests of the person who lacks capacity. This is done through what is called a Best Interests Assessment.
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The Mental Capacity Act does not define best interests but does provide a check list: -
Must involve the individual who lacks capacity
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Have regard for the past and present wishes, feelings and beliefs
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Consult with Key people (family members, friends, supporters, key worker, health professionals, care home staff, others who are important to the well being of the individual, and involved in the care of the individual)
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No discrimination against the individual
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Consider whether the outcome could be achieved in a less restrictive way
What do I need to do when involved in making a Best Interests decision? Unit Manager Care Home takes overall responsibility for supporting a Best Interests decision making assessment. However, all care home staff may have a role to play in the decision making process. The following points outline the basic principles that must be applied in all Best Interests Assessments. Best Interests Assessments: -
If someone has to make a decision for somebody else, they must decide what is in their best interests, but no one can assume what is in someone’s best interests just because of how old they are, how they look or how they behave
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To work out what is in a person’s best interests you must listen to what the person says, ask people who know them and make sure they are involved in the discussion. Their life history and story and any advanced directives are important to include
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You need to talk to the person’s partner, children, siblings and friends; even professionals who know them. In fact, anyone who knows them well; you need to ask key people (family members, friends, others who are important to the well being of the individual) about past and present wishes, feelings, beliefs, hopes and values of the person concerned
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You need to consider what factors the person would have considered if they were intellectually able to make the decision
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You need to be aware that there may well be differences of opinion which may need to be taken into account
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Once all the information has been gathered and different options appraised a best interest decision can be taken that needs to be the most appropriate and least restrictive
Independent Mental Capacity Advocates Every local authority has appointed Independent Mental Capacity Advocates who are there to represent people who may lack capacity and who have no one else to speak on their behalf. Independent Mental Capacity Advocates are skilled in working alongside practitioners and in assisting people to make independent decisions where possible. They are also experts on the Mental Capacity Act. To access an Independent Mental Capacity Advocates you should contact your Local Authority who will be able to put you in touch.
Summary of Best Interests decisions -
People should always be assumed to have capacity to make a decision unless assessment proves otherwise
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Assessment of capacity are always time and decision specific
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Decisions can include big specialist decisions through to everyday decisions about daily life
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There is a clear process for assessing capacity. In the process of assessing capacity, you have to do everything you can to explain things clearly and in a way that a person can understand
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Independent Mental Capacity Advocates can provide help and support if you need it. They are also there to represent people who may lack capacity and have no one else to speak on their behalf
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Where a person lacks capacity a Best Interests Assessment and decision must be undertaken. This must involve a range of people involved in the care of the person who lacks capacity
The Deprivation of Liberty Safeguards in England form part of the Mental Capacity Act 2005. They outline the law with regards to rights and freedom of action of people who may lack capacity to make decisions about their own care. Page 26 of 120
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Deprivation of liberty safeguards in England The Mental Health Act 2007 introduced the deprivation of liberty safeguards into the Mental Capacity Act 2005. They apply to people who do not have the capacity to consent to care or treatment for themselves and who have a condition such as dementia or a severe learning disability and who are assessed to require care. The safeguards aim to: -
Provide legal protection for vulnerable people who may have their freedom of liberty taken away
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Where a hospital or care home identify a person lacks capacity and they are at risk of being deprived of their liberty or freedom then they must apply to the “supervisory body” to get permission to do this. The permission to restrict someone should always be asked for in advance except in an emergency. All permission is granted on a case by case basis looking at the individual’s circumstances
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Where restriction of freedom is a risk the care home should always consider if they can identify less restrictive alternatives
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However, whilst always striving to provide the least restrictive care possible, care providers and staff may feel it is necessary to restrict certain freedoms in certain circumstances in order to provide care that is in the person’s best interests. For example the main door to a care staff can ensure there is freedom to move around within the care home and always free access to outside, safe garden areas
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Anyone who is concerned that a person’s freedom is being restricted can raise this with the supervisory body who will then complete an assessment
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As part of the Deprivation of Liberty Safeguards process, a person and their key people including family members, friends and others who are important to the well being of the individual, have the right to be represented by an independent Mental Capacity Advocate.
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An independent Mental Capacity Advocate should always be appointed immediately if the person has no key people (family members, friends, others who are important to the well being of the individual) to support them during a Deprivation of liberty safeguards process
What is deprivation of liberty? There is no single definition of, or list of things that are judged to be, deprivation of liberty. Assessment need to be made on a case by case basis as judgements are made in relation to individual best interests and the delivery of a particular plan of care. Page 27 of 120
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Examples of, when the courts have decided people were deprived of their liberty.
They include: When a person was restrained in order to admit them to a care home because they were refusing to be admitted When a person was forced to take medication against their will When a person was not allowed to see relatives and friends because the care home had restricted who could have access to them
What is Dementia? After two years working with individuals living with dementia, on 48 hours/week, I can say with my own words, dementia is the less of everything you know. Dementia are the signs and symptoms caused as a result of specific diseases such as Alzheimer’s or a stroke that involve the damaging of brain cells; as the brain cells die the person with a dementia will lose their ability to do things they are used to doing as different parts of the brain are damaged. Dementia affects both older and younger people and the decline in the person will get worse as more brain cells are damaged or die. Strictly speaking dementia is the name of the syndrome (or collection of symptoms) that is caused by irreversible brain disease. Commonly dementia is used as the collection name for the number of different diseases that all affect the brain. Dementia is not a part of normal ageing. You can’t have dementia from other people.
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How Dementia affect the brain?
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Summary of legal requirements and agreed ways of working designed to protect the rights of individuals in end of life care The Equality Act 2010 legally protects people from discrimination in the workplace and in wider society.
The Equality Act 2010 (Specific Duties) Regulations 2011 came into force on 10 September 2011.
The Data Protection Act 1998 covers both ‘manual’ records (relevant filing systems) and those processed electronically, relating to living individuals.
A living will (otherwise known as advance decision) records what YOU want to be done if you become so ill or severely injured that you cannot speak for yourself.
Dealing with personal property of deceased people, mean dealing with a deceased person's money and property. After someone dies, someone (called the deceased person's 'executor' or 'administrator') must deal with their money and property (the deceased person's 'estate'). They need to pay the deceased person's taxes and debts, and distribute his or her money and property to the people entitled to it.
Removal of medical equipment from deceased people If a patient dies and the death is reportable to the coroner, you should leave all equipment in place until you have discussed the case with the coroner’s officer. This factsheet gives you further information about what to do.
Legislation and agreed ways of working that include policies and procedures where these apply, and may relate to visitors, mean legislation relating to general health and safety is the Health and Safety at Work Act 1974.
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Legislation and agreed ways of working that include policies and procedures where these apply, and may relate to safeguarding of vulnerable adults, mean legislation relating to the Care Standards Act 2000.
The Human Rights Act 1998 sets out a number of basic human rights that are protected by law in countries that have signed up the Convention of Human Rights.
Dignity in Care In 2006 a Dignity in Care Campaign was launched. Its aim is to ensure that dignity and respect are put at the centre of care services.
The Mental Capacity Act 2005 outlines people’s rights to make decisions, particularly in the case of people who may lack capacity to do that for themselves.
The Deprivation of Liberty Safeguards in England form part of the Mental Capacity Act 2005. They outline the law with regards to rights and freedom of action of people who may lack capacity to make decisions about their own care.
The Health and Social Care Act 2008 established the Care Quality Commission. All health and social care providers in England will be required to register with this new regulator in order to provide services. There are specific essential quality standards for care homes and domiciliary care which all providers must meet, and these will be checked during an inspection process.
The National Occupational Standards: As well as quality standards there are national occupational standards which set out in detail criteria for best practice in the various care tasks health and social care providers will undertake. These standards should be met as a minimum in order to give the best possible care to the individuals in end of life care. These standards will be reflected in any qualifications health and social care providers undertake in the care sector.
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Explain how legislation designed to protect the rights of individuals in end of life care applies to own job role (7 pages to answer the question)
The way the legislation are designed to protect the rights of individuals in end of life care applies to my own job role, as a care assistant working with individuals living with dementia, mean to understand my main duties and responsibilities, and to report any form of potential abuse by referring to the Care Homes policy on safeguarding. My job description outlines the duties I am expected to carry out. This also gives guidance about what I can and cannot do in my job role. In other words, there will be situations I should not deal with because they need to be referred to someone senior to me.
Standards and Codes of Practice The General Social Care Council (GSCC) has developed Codes of Practice for care workers. These codes describe the standards of conduct and practice in which I should work. As a care assistant working with individuals living with dementia, I need to be familiar with and understand my responsibilities outlined in this Code. There are six statements which describe what I must do in my daily work: -
I must protect the rights and promote the interests of residents and care workers
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I must strive to establish and maintain the truth and confidence of residents and care workers
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I must promote, if possible, the independence of residents while protecting them as far as possible from danger or harm
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I must respect the rights of residents while seeking to ensure that their behaviour does not harm themselves or others (The right of freedom don’t stop when dementia comes)
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I must uphold public trust and confidence in social care services
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I must be accountable for the quality of my work and take responsibility for maintaining and improving my knowledge and skills (doing nvq2 for example) Page 32 of 120
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My professional and caring relationship with residents living with dementia My relationship with the residents I support will be different from the type of relationships I have with my family and friends. I must have a professional but caring relationship. It is important that I make good relationships with the residents I support and treat each in such a way that I am showing them respect, and in a way that I would like to be treated if I was a resident cared by myself. I will need to find out the resident's preferred method of communication. There are some barriers of communication due to living with dementia with visual or hearing difficulties, but I should do everything I can to make communication effective. I have to be aware of my limits in my relationship with the residents living with dementia. My job role is to help and support, not to influence or pressurise in any way. The level of familiarity should always be decided by the resident, for example, I should address each resident in the way the resident choose, and not assume I can call a resident by the first name. For all residents living with dementia, I am an important part of their lives. They need me to provide the cares they need, washing, bathing, feeding, and assisting to go to toilet and bed. They expect from me to be totally reliable and dependable. If I say I am going to do something, then I should do it. Residents living with dementia will feel "safe" if they know I mean what I say.
Laws that protect the rights of individuals in end of life care, applies to my own job role, as a care assistant working with individuals living with dementia, are the following: -
Health and Social Care Act 2008
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National Occupational Standards
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Human Rights Act
The Human Rights Act sets out clearly the rights to which all individuals are entitled. If we are stopped from exercising these rights, we can take this matter to court. The main theme running through the Act is protection of the individuals from abuse in any form. This is very relevant for me in my job role as a care assistant working with individuals living with dementia.
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In order to treat everyone with respects, I need to be aware of how my own values and beliefs can affect the way I work with residents living with dementia. I try to be aware of my own attitudes and to be careful that I do not impose my own personal values and beliefs on the residents I support.
What is abuse? Abuse can cover a wide range of things that may be deliberate or due to negligence or ignorance. It can be physical, verbal, psychological, emotional, neglect or a failure to do something. It can include making or persuading a vulnerable person to enter into a financial arrangement or sexual relationship to which they do not have the capacity to consent. Abuse can happen on a one-off basis or be repeated over time. It can be carried out by paid care staff, key people including family members, friends, supporters; other residents, and others who are important to the well being of the person.
Who is a vulnerable person? A vulnerable person is someone who is: -
Unable to take care of, or protect, him or herself against harm or exploitation
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Who receives care services because of problems with mental health or other disability, age or, and illness
Vulnerable person can include people who are very frail, people living with dementia or other mental health problems, people with learning disabilities.
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Definitions of these types of abuse are outlined below: Physical abuse Includes hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions (such as removal from public areas or removal of mobility equipment). Psychological abuse Includes emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or, and supportive networks. Neglect and acts of omission Include ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating. Discriminatory abuse Includes racism, sexism, or acts that someone justifies because of a person’s disability, and other forms of harassment, slurs or similar treatment. Encouraging others to commit abuse Permitting or falling to report abuse Sexual abuse Includes rape and sexual assault or sexual acts to which the vulnerable person has not consented, or could not consent or was pressured into consenting. Financial or material Includes theft, fraud, exploitation, pressure in connection with wills, property, inheritance, financial transactions, the misuse or misappropriation of property, possessions or benefits.
What is the protection of vulnerable person or safeguarding? This is the requirement of care providers to ensure that individuals within their care are not subject to abuse of any kind. Everyone who works in a care home has a responsibility to ensure individuals being cared for are not being abused.
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Care homes policy on safeguarding The Care Homes policy on safeguarding states that: All the residents have the right to live a life free from abuse. Residents have rights such as independence, privacy, choice, safety and the right to be involved in decision making about their care. If these rights are ignored, then that can also be abuse and neglect. Abusers can be any person on our premises including; staff members, key people, family members, friends, others who are important to the well being of the residents, relatives, volunteers, service providers (such as hair dressers, chiropodists). Abuse can constitute the criminal offence of assault. There is also an offence under the Mental Capacity Act 2005 of ill treatment or wilful neglect of a person who lacks mental capacity; such are, residents living with dementia or other mental health problems, or with learning disabilities. The Care Homes policy on safeguarding states the actions that must be taken to prevent and detect abuse and to deal with if it occurs or is suspected. It is important that to read the full policy on safeguarding. The full policy on safeguarding can be found, asking the Care Home Manager who will be able to provide a copy. All health and social services departments have guidelines for identifying and dealing with abuse. Each care home has a copy of the relevant local guidelines that is kept alongside the Care Homes policy on safeguarding.
What are the signs of abuse? The most common cause of signs of abuse are unexplained and undocumented bruises or other marks on the face, arms, legs or body of a resident. Misuse of a resident’s property, or and money including taking, or and using resident’s money or and property. This may appear as money or property going missing without explanation. Claims that a bruise is self-inflicted or injuries that arise are due to frequent accidents. Unconvincing explanations for incidents should also arouse suspicion. Also to look out for signs of sexual abuse such as pain in the genital area or blood stains on underwear.
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Residents being unattended to when in distress, pain or a physically uncomfortable position, such following incontinence, no working of profile bed to change frequency of individual's position in end of life care. Residents who are left for long periods without any human contact; this is a sign of neglect of their physical or, and emotional needs. Residents should be checked for signs of abuse as part of their initial assessment on arriving at the home ensuring that the check is sensitive and is respectful of the person. It is important to watch how residents react to individual members of staff, as an abused person will display nervousness when the abuser is nearby. Staff should be alert to the possibility of abuse by visitors to the home. A resident who is afraid of a visitor may ask a staff member to be present during visits. Staff should be alert to any signs of residents abusing each other.
What do I do if I suspect abuse is happening? Care Homes have a clear procedure for reporting and investigating potential abuse. It is important to know what to do when believing someone may be being abused by referring to the Care Homes policy on safeguarding.
The Human Rights Act 1998, legitimate descendant of Jesus Christ's Sermon on the Mount Jesus Christ's Sermon on the Mount is the very first and significant contributor to Human Rights. Jesus Christ's Sermon on the Mount, Matthew 5:1-12 Seeing the crowds, Jesus went up on the mountain, and when he sat down his disciples came to him. And he opened his mouth and taught them, saying: Blessed are the poor in spirit, for theirs is the kingdom of heaven. Blessed are those who mourn, for they shall be comforted. Page 37 of 120
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Blessed are the meek, for they shall inherit the earth. Blessed are those who hunger and thirst for righteousness, for they shall be satisfied. Blessed are the merciful, for they shall obtain mercy. Blessed are the pure in heart, for they shall see God. Blessed are the peacemakers, for they shall be called sons of God. Blessed are those who are persecuted for righteousness’ sake for theirs is the kingdom of heaven. Blessed are you when men revile you and persecute you and utter all kinds of evil against you falsely on my account. Rejoice and be glad, for your reward is great in heaven, for so men persecuted the prophets who were before you.
This section of teaching, recorded in Matthew, chapters 5 to 7, is the longest piece of teaching from Jesus in the gospels.
The Meaning of the Sermon on the Mount is intended to identify the ways in which the followers of Jesus should behave in living a life of acceptance of God’s gracious invitation to enter the kingdom of heaven. The Meaning of the Sermon on the Mount is intended to remind to the human race two things; first, they are a creation of love by God; second, they are never alone in the love of Jesus, son of God. "Thou shalt love thy neighbor as thyself" is the most important commandment, because the Human first Right is to be loved. Page 38 of 120
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Task 2 understand factors affecting end of life care
Outline key points of theories about the emotional and psychological processes that individuals and key people may experience with the approach of death (4 pages to answer the question)
Exemplification: An individual is the person requiring end of life care Key people may include: - Family members - Friends - Others who are important to the well-being of the individual
Individuals in the end of life care and key people may react differently, because they are differently involved in the approach of death, so the key points of theories about the emotional and psychological processes will be different. An individual requiring end of life care may experience with the approach of death, very strong emotions such as fear to the unknown, and psychological questions such as will I be in pain? When thinking about dying, a majority of us fear pain the most. In most situations pain can be managed. Pain relieving medication, such as morphine, may be administered by injection, via a patch, or most often, in a form that can be dissolved under the tongue. Not all pain requires medication though – sometimes pain can be alleviated through treatments such as physiotherapy or occupational therapy.
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Occasionally, if an individual requiring end of life care is in severe pain, the only way to relieve the pain might be to administer pain relieving medication up to a level where that person loses consciousness. This is called sedation. Sedation can only be applied when an individual is suffering intolerably and if there is no other way to relieve their symptoms. Family members, friends, others who are important to the well being of the individual requiring end of life care, known as key people, may feel uncomfortable talking to and interacting with an individual requiring end of life care who is dying. This is due to that, key people have no way to understand the individual end of life care perspective, and what the individual are experiencing emotionally and psychologically. Studying the Elisabeth Kübler-Ross theory and other approaches to the dying process can help the key people to become more comfortable by increasing their understanding and adding insight into the perspective of the dying individual. This can begin to help increase communication and interaction during a dying individual's last days. For an individual requiring end of life care, being diagnosed with a terminal illness can be a very frightening experience. Sometimes doctors give information to the individual in end of life care that the individual find difficult to take in. If an individual in end of life feels the need to have different doctors to repeat the information, to explain the condition, treatment options or life expectancy in more depth, or if the individual in end of life have any questions, then the individual in end of life should ask. Having answers to the asking questions from individuals at the end of life, is psychologically important, such as, to know the name of the disease an individual in the end of life suffer. If individuals in the end of life care find it difficult to talk to the specialist doctor, they could speak to others involved in their care, such as nurses, social workers or another doctor, such as their general practitioner. The individual in end of life may want to ask to the key people, such as family members, a close friend or others who are important for the well being of the individual in end of life, to be with him/her during the conversations to give emotional support, or to help the individual in end of life to ask the questions him/her fear to ask. We are all different, some individuals want to know everything about their condition and life expectancy and others don’t. It is important to let the doctors to know how much information the individual in end of life would like to have, so that they know what suits best for the individuals at the end of life.
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Emotional and psychological processes for individual in end of life care and for the key people such as, family members, friends, others who are important to the well being of the individual in end of life care, are different because the key people are not directly involved with impending death, but they may be very affected by losing a loved one. Nobody knows what happen after life. Nobody except Jesus has come back after death. Since the world is world, the questions related to the afterlife are in every parts of the world met by every culture.
What is the Elisabeth Kübler-Ross theory? In 1969 Elisabeth Kübler-Ross wrote On Death and Dying. Research and interviews began in 1965 and encountered problems because there is no real way to study the psychological aspects of dying and patients were often willing to talk but it was hard to convince the doctors.
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Stage Theory: From this research, Elisabeth Kübler-Ross theory saw a pattern emerging that she expressed in the way of stages. These stages begin when the patient is first aware of a terminal illness. While Elisabeth Kübler-Ross believed this to be universal, there is quite a bit of room for individual variation. Not everyone goes through each stage and the order may be different for each person.
Stages of Dying: Stage 1, Denial and Isolation: Used by almost all patients in some form. It is a usually temporary shock response to bad news. Isolation arises from people, even family members, avoiding the dying person. People can slip back into this stage when there are new developments or the person feels they can no longer cope. Stage 2, Anger: Different ways of expression Anger at God: “Why me?” Feeling that others are more deserving Envy of others: Other people don't seem to care they are enjoying life while the dying person experiences pain. Others aren't dying. Projected on environment: Anger towards doctors, nurses, and family members Stage 3 Bargaining: A brief stage, hard to study because it is often between patient and God. If God didn't respond to anger, maybe being good will work. Attempts to postpone: “If only I could live to see...” Stage 4 Depression: Mourning for losses Reactive depression (past losses): loss of job, hobbies, mobility. Preparatory depression (losses yet to come): dependence on family, etc Stage 5 Acceptance: This is not a happy stage, it is usually void of feelings. It takes a while to reach this stage and a person who fights until the end will not reach it. It consists of basically giving up and realizing that death is inevitable. Hope is an important aspect of all stages. A person's hope can help them through difficult times. Page 42 of 120
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Explain how the beliefs, religion and culture of individuals and key people influence end of life care (9 pages to answer the question)
Attitudes toward end of life care are highly influenced by beliefs, religion and cultural perspectives that are rarely acknowledged. Cultures are maps of meaning through which people understand the world and interpret the things around them. When individuals and health care workers have different cultural backgrounds, they frequently follow different “maps,” which can hinder effective communication. Culture is a strong determinant of individual's views of the very nature and meaning of illness and death, of how end of life decisions can or should be controlled, how bad news should be communicated and how decisions; including end of life decisions should be made. United Kingdom, which has a multicultural population, has made up of laws and important documents, such as The Mental Capacity Act 2005 who outlines people’s rights to make decisions, particularly in the case of people who may lack capacity to do that for themselves; the Act takes the position that, unless a person is proven to lack capacity, they are to be judged as competent to make decisions, even if those decisions might appear unwise to others. Where individual lacks capacity Best Interest decisions can be made on behalf of, and about, them. An individual with Lasting Power of Attorney will be able to make decisions about financial matters and health and social care; for example this is where the individual previously made a decision about future treatment should he or she become unable to make those decisions for him/herself at a later date. The Mental Capacity Act 2005, Best Interest, and Lasting Power of Attorney, help to cultural pluralism and equality for a society which has a multicultural population. Unfortunately our health care system does not always reflect this diversity; this is particularly problematic in end of life care, a time that produces intense feelings, when individuals and family members draw heavily from cultural beliefs and traditions. In addition, our health care system tend to neglect the substantial differences in the way people of different cultures perceive, experience and explain illness and death.
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Often, when individuals and health-care workers come from different cultural backgrounds, they interact under the influence of unspoken assumptions, about health, illness and dying that are so different that they prevent effective communication. In reality no one has more culture or less culture than anyone else. We are all “cultural beings”, our view of the world being shaped by cultural blueprints we are often not conscious of. Furthermore, our health care system itself is strongly patterned by culture, with multiple sub-cultures, shaped by the values and practices of teams, departments and professional disciplines, embedded within it. Understanding how our own multifaceted cultural perspectives affect our attitude toward end of life care is critical to understanding the cultural perspectives of others.
Cultural Considerations: No one has more culture or less culture than anyone else.
What we consider to be “common sense” is determined by culture.
Culture is passed from generation to generation without being articulated.
It is inaccurate to believe that if we do not participate in our cultural traditions we are not affected by them.
We are not fully conscious of the influence of culture in our lives.
Our cultural background has a significant influence on our clinical practice.
The first step in effective cross-cultural work in health care is to understand our own cultural values and beliefs.
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Cultural Context: The terms “Western” and “non-Western” are used here in a philosophical, rather than cultural context. As described by Edward Twitchell Hall, generally speaking Western culture is low context and non-Western culture is high context. Edward Twitchell Hall, Jr. (May 16, 1914 – July 20, 2009) was an American anthropologist and cross-cultural researcher. He is remembered for developing the concept of Proxemics, a description of how people behave and react in different types of culturally defined personal space.
Cultural context has many features; the most salient for consideration at the end of life, particularly in relation to decision-making is that low-context cultures emphasize independence, the individual and a future-time orientation. Communication takes place almost exclusively through language. High-context cultures emphasize interdependence, interconnections with others and a present time orientation. In high-context communication, less information is conveyed by verbal expression and most of the message is embedded in the social context or internalized in the communication process itself. For example, individuals in a high-context culture may show their support to a dying person solely through their actions rather than ever directly discussing their loss.
What is effective communication? Example of effective communication in my work place: Effective communication affects all aspects of my work because communication is vital to ensure a good team work with other care assistants to answer the needs and provide the cares for the residents. Better understanding communication open better team work open better cares!
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In my work place, effective communication include day staffs and night staffs (hand over at the beginning of each shift), residents and resident's family, meetings with my manager, staff meeting and other training. It is very important to ensure effective communication is clear, concise, accurate, non judgmental and informative. This reduces the possibility of mistakes who can be made and help to ensure appropriate care service delivery. Communication is a two way process depending with who you are communicating and the age of your communicator.
Non-verbal communication can include eye contact, touch, physical gestures, body language and behaviour.
Verbal communication includes vocabulary, linguistic tone and pitch.
Communication can be achieved by technological aids.
Also, people react differently: -
Kinematics (Touch)
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Auditory (How it sounds, what will be said MATTER!)
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Visual (Pictures)
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Olfactory (Smell memories)
To enter in the private sphere of an individual (resident) take lot of time.
As a friend, a care assistant will do everything to make feel the resident like home. Page 46 of 120
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Effective Communication Cycle
What is communication? Communication is composed of three elements:
Only 7% of personal communication is composed of spoken words. 38% of personal communication is the tone of the voice, and 55% of personal communication is about body language. It is very important to observe an individual’s reactions, when communicating with, because the body language is more than the half (55% body language) of personal communication. That means that you are going to miss a large part of communication if you don't pay attention to individual's facial and body reactions. By observing and understanding the body language of an individual, you can know about the well being of the individual.
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To observe body language is a perfect way to know how the individual at the end of life is feeling inside the nursing care home. Is the individual seemed to be stressed when close to staffs? Is the individual's voice sound stressed or scared? More than a third of elements of personal communication (38%) are about the tone of the voice. The way the individual's voice sound can help to detect any form of abuse who could occur inside the nursing care home.
What is Diversity? Diversity means difference. The fact or quality of being diverse; people's differences can be many and varied. People are different in the way they look, dress, behave, believe and worship; where they work; how they live; age, gender, Sexual orientation, Marital status, Politics, Religion, Disability, Socio-economic differences, Family structure, Health, Values, Race, Culture, National origin, Ethnic group - yet also have many similarities. In a diverse society people need to tolerate and value differences in people so that we can continue to be individuals. Diversity allows people to contribute to society. The more people are economically active, the more successful is the economy and this then benefits everyone. Diversity is about valuing difference. It does not mean that everyone should be treated in the same way as different people have differing needs. Everyone should be treated with equal respect. A successfully diverse workforce is one that contains people at all levels who have a range of different characteristics and who have been recruited on the basis of their abilities and competence to do the job.
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Diversity: It takes all sorts to make a world
Cultural Context High Context
Low Context
information drawn from context group interdependence hierarchy traditional ways
information explicitly communicated individual Independence Equality question belief
What is Equality? Equality means the state of being equal, in status, rights, and opportunities. Equality is ensuring individuals or groups of individuals are treated fairly and equally and no less favourably, specific to their needs, including areas of race, gender, disability, religion or belief, sexual orientation and age. Promoting equality should remove discrimination in all of the aforementioned areas. Bullying, harassment or victimisation, are also considered as equality and diversity issues. Page 49 of 120
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Equality: That means treat everyone same
Explanatory Model of Illness Definition: Culture Determines:
In Practice:
Clarification:
What illness is? Why it occurs? and what measures can prevent or control it. Perception of health problems. Labelling of health problems. Meaning of health problems. Trajectory of health problems. Communicating about health problems. How we evaluate health care. Patient-health care interactions between people of different backgrounds often represent differences in explanatory models of illness. These interactions often involve major, unidentified, discrepancies in the perception of the problem, values and goals. What do you think has caused your problem? How does it work? How severe is it? What kind of treatment do you believe is best? What worries you most about the illness? Page 50 of 120
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Explanatory models of illness reflect the cultural understanding of what illness is, how it occurs, why it exists and what measures can be taken to prevent or control it. Many non-Western people hold different views of clinical reality than the Western biomedical view. In Western medicine, the primary explanatory model of illness focuses on abnormalities in the structure and function of body organs and systems, for example, pneumonia is due to pneumococcal. Most non-Western cultures tend to perceive illness in a much broader and far less tangible manner; for example, they may perceive health and disease as separate entities, with each one varying in intensity, even in the absence of symptoms. Advance care planning at the end of life and end of life decisions can be particularly problematic if the fundamental causes of illness unto death are neither identified nor agreed upon. The following example illustrates some of the potential differences these three differences in perspective can generate in relation to end of life care and planning. A patient comes into an intensive care unit in an incompetent state. In its meetings with the patient's family, the health care team focuses on biomedical explanations of illness, the patient's wishes about treatment before the incompetent state substituted judgment, and encourages an open and direct conversation about the patient's wishes. The team hopes thereby to arrive at the best plan for this individual's medical care. However, for this family of non-Western origin, the focus on individual rights and choices, direct and blunt verbal communication, the introduction of the element of choice and the focus on a purely biomedical explanatory model of illness may be so confusing that it leads to a complete breakdown in communication. Although, increasingly, end of life care identifies and values interrelationships with others, autonomy and, in turn, the individual, remain at the heart of most values and choices in relation to dying patients. These factors lead to substantial differences in cognitive processes, perception, social structures, values and beliefs about which individuals often are not conscious. Unless the health care worker dealing with end of life identifies and adapts to these factors, the efforts to improve end of life care will be greatly limited in a pluralistic society.
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Statement: Ethics, Culture and End of Life Care In a society that values respect for diversity, equality, inclusion, and no discrimination, key people have a responsibility to respect, as much as possible, individual differences and values at the end of life.
Autonomy is not a universal concept, therefore using it as a guiding principle at all times, may be greatly unfair to some individuals and key people including family members, friends and others who are important to the well being of the individual in end of life care.
Because end of life is a major life event, it is crucial to have a moral responsibility to respect beliefs, religion and cultural differences in how it is understood, experienced and reacted to.
Explain why key people may have a distinctive role in an individual’s end of life care (6 pages to answer the question) Key people such as, family members, friends, others who are important to the well being of the individual at the end of life, may have a distinctive and important role for the individual’s end of life care because key people are in direct relation with the individual who is in end of life care, by knowing very well the individual before. The key people may have a distinctive role in the individual’s end of life care by providing personal support, such as letting know to the medical staff the preferences of the individual at the end of life care. Also, key people know the individual's preferences, likes and dislikes, better than the medical staff. How to let know to the medical staff your preferences, likes and dislikes when you can't talk due to the end of life condition you are living in. For example, water with lemon can make a big difference in the day of an individual at the end of life, if the individual prefer water with lemon than plain water. It is why in this situation, key people have a distinct role in an individual's end of life care. Page 52 of 120
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Key people know what the individual prefer or not. Relaxing music can help to relax for an individual at the end of life. An individual at the end of life can refuse treatments, such as Cardio Pulmonary Resuscitation (CPR), mechanical or artificial ventilation, artificial nutrition and hydration, and antibiotics. The treatments that an individual at the end of life can't refuse are food and water, and pain relief. Medical staff are dealing everyday with the most common end of life treatments, this is why it is important for an individual at the end of life to speak about it with the medical staff about which ones the individual at the end of life are most likely to receive because this depends on particular condition, such as the individual's general health condition, and of course, the agreement of the individual in end of life care. Treating individuals at the end of life, request from medical staff and key people, lots of humanity, without any discrimination, and with all the inclusion possible, to provide respectful care and a support with dignity.
What is Dignity? When we speak about dignity, we think first of the Human Dignity. With my own words, the Human Dignity means caring for others, in the same manner that you would like to be cared if you would like to care for yourself.
What is discrimination? The definition of discrimination is the act of prejudice against a person because they have a certain set of characteristics. Discrimination is to treat a person less favourably than another person is, or would be, treated in the same or similar circumstances. Discrimination is treating someone differently because of some ascribed difference. Usually negative. Discrimination is to treat people unequally, some favoured more than others - is often an expression of prejudice.
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Discrimination can take many forms but in many countries around the world there are laws prohibiting any form of discrimination. Discrimination can be on the grounds of sex and sexual orientation, race, disability, mental health, age, ethnic background, religion, gender and gender reassignment, learning ability, life style and outlook. This is not acceptable. Discrimination can be based on the assumptions people make about other, such as; people with mental health issues are dangerous.
Quote about discrimination by Zora Neale Hurston ”Sometimes, I feel discriminated against, but it does not make me angry. It merely astonishes me. How can any deny themselves the pleasure of my company? It’s beyond me”
What is inclusion? Inclusion means the action or state of including or of being included within a group or structure.
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Inclusion is ensuring that all people with health needs can become valued and responsible citizens and take part in mainstream activities alongside people who do not need to use health services. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (World Health Organisation, 1948) No sector of society should be excluded from access to health benefits. Group which have been excluded include substance abusers, alcohol abusers, travellers and people with mental health needs.
Quote about inclusion by Warwick Davis ”The world worries about disability more than disabled people do”
Treatments an individual can refuse Cardio Pulmonary Resuscitation (CPR) If the heart of an individual stops, medical staff might try to restart it using CPR. This involves the medical staff repeatedly pressing against the individual's chest in a pumping action, in order to stimulate the heart’s natural rhythm of the individual. Page 55 of 120
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At the same time, air will be pumped into the individual's lungs to replicate breathing.
Mechanical or artificial ventilation A ventilator machine can help the individual if he/she is unable to breathe on his/her own. Ventilators are also known as respirators or life support machines. It involves pumping air into the individual's lungs through a tube, which is inserted into the nose or mouth of the individual. In some circumstances, a surgeon might need to create a small hole in the individual's throat and insert the tube directly into it, but this is uncommon.
Artificial nutrition and hydration If the individual is unable to eat or to drink in the normal way, the medical staff might provide the individual with a liquid solution that contains the hydration or nutrition for the individual's need. The liquid can be given to the individual through a number of routes, depending on the individual's particular condition; such as the individual's veins, via an intravenous drip. Alternatively, the individual could receive the liquid through a tube that goes through the individual's nose and into the individual's stomach (a nasogastric tube). These tubes can only be used for a few weeks though; if the individual really need an artificial nutrition or hydration for a longer amount of time, a PEG (Percutaneous Endoscopic Gastrostomy) feeding tube might be required. This involves an operation as surgeons will need to put the PEG directly into the individual's stomach.
Antibiotics At the end of life, when the body is already weak, infections that an individual would otherwise be able to fight off can be fatal. Medicines that treat these infections, such as antibiotics, could therefore be considered life sustaining medicines in this context. Antibiotics can be given through the individual's veins (via an intravenous drip), or in a pill, depending on the type of infection and the individual's general condition. Page 56 of 120
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Treatments an individual can’t refuse Food and water The medical staff do not allow an individual to refuse food and water. Food and water are not a form of medical treatment and therefore an individual can't refuse food and water in advance of losing capacity. On the other hand, artificial nutrition and hydration are considered to be a form of medical treatment and an individual can refuse this to the medical staff.
Pain relief The medical staff do not allow individuals to refuse basic care, which includes comfort, personal hygiene and pain relief. The medical staff who care for the individuals will do everything to keep them comfortable and pain free at the end of their life.
Explain why support for an individual’s health and well-being may not always relate to their terminal condition (3 pages to answer the question)
Choice, Access and Control Choice such as: Where I die? Who is with me when I die? When my treatment is stopped?
Access to; information on my choices for end of life care, palliative care that fit for own needs, support for key people
Control for: How I die? Symptoms and pain relief, Planning end of life Page 57 of 120
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Support for an individual’s health and wellbeing may not always relate to their terminal condition because an individual at the end of life needs also psychological need. The ways the key people might support and individual in end of life is very important for the psychological well being of the individual. End of life is a major life event, it is crucial that key people have a moral responsibility to respect beliefs, religion and cultural differences in how it is understood, experienced and reacted to. Each individual at the end of life is unique, the support the individual need and also the psychological support will be different. As individuals approach the end of their lives, they and their key people, including family member and close friends, commonly face tasks and decisions that include a broad array of choices ranging from simple to extremely complex. They may be practical, psychosocial, spiritual, legal, existential, or medical in nature. For example, dying individuals and their key people are faced with choices about what kind of caregiver help they want or need and whether to receive care at home or in an institutional treatment setting. Dying individuals may have to make choices about the desired degree of family involvement in care giving and decision-making. They frequently make legal decisions about wills, advanced directives, and durable powers of attorney. They may make choices about how to expend their limited time and energy. Page 58 of 120
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Some may want to reflect on the meaning of life, and some may decide to do a final life review or to deal with psychologically unfinished business. Some may want to participate in planning rituals before or after death. In some religious traditions, confession of sins, preparation to “meet one's maker” or asking forgiveness from those who may have been wronged can be part of end of life concerns. In other cultural traditions, planning or even discussing death is considered inappropriate, uncaring, and even dangerous, as it is viewed as inviting death. All end of life choices and medical decisions have complex psychosocial components, ramifications, and consequences that have a significant impact on suffering and the quality of living and dying. However, the medical end of life decisions are often the most challenging for terminally ill people and those who care about them. Each of these decisions should ideally be considered in terms of the relief of suffering and the values and beliefs of the dying individual and his or her key people. In addition, any system of medical care has its own primary values that may or may not coincide with the values of the individual. For example, in most Western medical systems the principles of individual autonomy (though not to the exclusion of key people) and informed consent are primary. In contrast, many cultures eschew the principle of autonomy and the principle of interactive, community decision-making is thought to be the ideal. Therefore, well intentioned presentations of treatment or care possibilities by health care providers may overlook a particular individual's wish not to discuss death. Treating individuals at the end of life, request from health care providers and key people, lots of humanity, without any discrimination, and with all the inclusion possible, to provide respectful care and a support with dignity. Its aim is to ensure that dignity and respect are put at the centre of care services for individuals at the end of life. Individuals at the end of life need to feel loved and not be seen as an individual doomed.
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Task 3 understand advance care planning in relation to end of life care
Exemplification: Systems for advance care planning may include: - Gold Standard Framework - Preferred Priorities for Care
Describe the benefits to an individual of having as much control as possible over their end of life care (2 pages to answer the question)
The benefits to an individual of having as much control as possible over their end of life care are: -
Help to reduce stress by the way the individual will know what happen because of planned actions.
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Help to ensure that, the individual owns wishes will be respected.
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Help the individual to go with dignity.
To resume, the benefits to an individual to have as much control as possible over own end of life care, mean to think about peace of mind, less fear, and a chance for the individual in the end of life care to accept the situation.
About Locus of Control One has an internal locus of control if he or she believes that a person can determine their fate through their own actions.
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One has an external locus of control if he or she believes that events occur independent of individual actions and that the future is determined by luck or fate.
Beliefs about locus of control are highly influenced by one's culture.
In general terms, Western peoples hold an internal locus of control and nonWestern peoples hold an external locus of control.
Clearly, planning for end of life involves adheres to an internal locus of control because it is a system based on human choices, an adherence that is highlighted by such concepts as living wills.
Explain the purpose of advance care planning in relation to end of life care (2 pages to answer the question)
Advance care planning improves end of life care and reduces stress, anxiety and depression in surviving relatives. Advance care planning has the potential to improve end of life care by enabling patients to discuss and document their future health wishes, and appoint a substitute decision maker (surrogate), thus increasing the likelihood of patient wishes being known and respected at the end of life. But no randomised controlled trials have investigated whether advance care planning improves end of life care. So researchers based in Australia set out to test the theory that coordinated advance care planning would improve end of life care, the perceptions of the quality of care, and levels of stress, anxiety, and depression in surviving relatives. Their study involved 309 competent patients aged 80 or more who were admitted to a large university hospital in Melbourne between August 2007 and March 2008. A total of 155 patients received usual care (control group) and 154 received usual care plus advance care planning from trained non-medical facilitators (intervention group).
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Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes. All patients were followed for six months or until death. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (86%) compared with the control group (30%). In the intervention group, family members of patients who died had significantly less stress, anxiety, and depression than those of control patients. Patient and family satisfaction was also much higher in the intervention group. This trial shows that advance care planning carried out properly by trained non-medical staff improves end of life care by enabling patients' wishes to be determined, documented, and respected at end of life, conclude the researchers. It also improves such care from the perspective of the patient and the family, and diminishes the likelihood of stress, anxiety, and depression in surviving relatives. Story Source: BMJ-British Medical Journal
Describe own role in supporting and recording decisions about advance care planning (1 page to answer the question)
Own role in supporting and recording decisions about advance care planning is to develop a better understanding and recording of their priorities, needs and preferences for the individuals at the end of life and those of their key people including family members, friends and others who are important to the well being of the individuals. This should support planning and provision of care and enable better planning ahead to best meet these needs. This philosophy of hoping for the best but preparing for the worst enables a more proactive approach, and ensures that it is more likely that the right thing happens at the right time. It allows for a detailed recording system that ensures that all parties that are involved in supporting the individual are aware of what they can do to comfort and understand the requests of the individual. It is there for the individual to add additional information to which can be used to review other documents like care plans and advanced directives. If advance care planning is started early enough then this may aid in later life if mental issues become a concern.
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Outline ethical and legal issues that may arise in relation to advance care planning (3 pages to answer the question)
The question can be asked by another question, such as: Can I refuse medical treatment? The answer is yes. Under common law, if you are an adult with mental capacity, you can refuse medical treatment even if you will die as a result. If the treatment has already begun, you can instruct your doctor to stop it. The law says that adults with mental capacity have an absolute legal right to refuse treatment, “notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.” This means that you do not have to justify your decision to refuse treatment, but you do have to show that you are capable of making the decision, and that you understand the consequences of it. In addition, The Mental Capacity Act 2005 has given Advance Decisions to refuse treatment statutory force. This allows you to refuse treatment in advance, should you lose mental capacity or the ability to communicate, through an Advance Decision. The Mental Capacity Act 2005 covers England and Wales only. To resume with the same words, you have the legal right to refuse medical treatment, even if you will die as a result, and you do not have to justify your decision to refuse treatment, but you do have to show that you are capable of making the decision, and that you understand the consequences of it.
What mean Advance Care Planning? Advance care planning involves thinking about decisions for the future of the individual. It might involve talking to key people who are important, such as family members, close friends, and general practitioners, for the individual at the end of life. Page 63 of 120
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Advance plans expressing preferences about care and treatment can guide families and/or healthcare professionals acting for individuals who are unable to make decisions for themselves. Under The Mental Capacity Act 2005 it is now possible to set on record an Advance Decisions to refuse specific treatments in particular circumstances. The National Council for Palliative Care has produced a summary guide to The Mental Capacity Act 2005, written with individual’s relatives and health care assistants in mind as well as other health and social care staff. The publication gives information about The Mental Capacity Act 2005 and its impact on end of life care and contains a number of checklists.
Advance Care Planning: Preferred Priorities for Care Preferred Priorities for Care (PPC) an Advance Care Plan Description: PPC is an example of Advance Care Planning documentation, used to identify an individual’s preferences and wishes at the end of life. The document which is held by the individual, can be taken with them if they receive care in different places. It has space for the individual’s thoughts about their care and the choices they would like to make, including saying where, if possible, they would want to be when they die. Information about choices and who might be involved in their care can also be recorded so any care staff can read about what matters to the individual, thereby ensuring continuity of care. If anything changes, this can be written into the plan so it stays up to date. It is never too early to start a PPC plan particularly for residents in care homes, which for many is their permanent and final place of residence. Residents can initiate a PPC at any time and this will help staff follow their wishes and act as an advocate if the resident loses capacity towards the end of their life. Key elements: -
A patient held document A tool to facilitate end of life care discussions A way for an individual to record their preferences for end of life care If an individual chooses they can share information in their PPC with family and professional carers
Can be used: -
To plan future care (With consent) to share information with appropriate professionals To provide evidence of patients wishes should they lose capacity Page 64 of 120
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DNAR: Do Not Attempt Resuscitation
Advance Care Planning: Gold Standard Framework
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Task 4 be able to provide support to individuals and key people during end of life care
Support the individual and key people to explore their thoughts and feelings about death and dying (4 pages to answer the question)
Interaction with a Dying Person The thought of dying often times evokes fear and apprehension in individuals and key people. Thinking of others dying can make our own mortality seem very real. Research has shown that individuals who are dying are even ostracized from society, even avoided by key people. In light of this, it is easy to see why many individuals who are dying report feeling isolated and alone. This is certainly not the type of death most of us would choose. Being surrounded by key people and loved ones is how the majority of us would choose to spend our last months or days.
Why is it so Difficult? There are several reasons many individuals and key people have a difficult time interacting with a dying person including not wanting to face the reality of their own death, not having the time to become involved, and not having the emotional reserves to deal with such an intense situation. Feelings of guilt over whether they could have done something to prevent or cure an illness, or over how their relationship with that person has been recently may also cause someone to avoid a dying person. When someone is having a difficult time interacting with a dying person, it often manifests as avoidance of them, difficulty speaking with them, difficulty maintaining eye contact, and keeping a physical distance from them. Page 66 of 120
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These are likely to be perceived by the person who is dying. Factors that may complicate an already difficult situation are whether the cause of death is viewed as socially acceptable or not (i.e. heart failure vs. AIDS), whether the death is perceived as “on-time” or not (i.e. an elderly person vs. a child), and where they die (i.e. a nursing home vs. their own home). Because everyone dies differently, the dying person may evoke more avoidance due to their level of pain or distressing symptoms and how they cope with them. Some dying people may not want to engage in full conversations but prefer brief, succinct communication.
Bridging the Gap On one side, you have the key people that are fearful or uncomfortable being around a dying loved one and on the other, the individual who is dying feeling abandoned, isolated, and alone. How do we bridge that gap to bring these people together? Open communication is the easiest and best way to bridge that gap. Let the dying person know you are feeling fearful or uncomfortable, or whatever emotion it is that you have. They’re going to figure it out anyway! It will let them know that you are taking steps to get past it and to give them what they need the most during this time. Ask the dying person what they need or expect from you. Some dying people will want to talk very openly about their illness and their impending death. Others will want to avoid talking about it and choose to focus more on fond memories or their loved ones lives. Both are okay but knowing what it is the dying person wants to talk about during your interactions will go a long way. Some will not want to talk at all but may want you at their side to hold their hand, read them a book, or just to feel your presence. Be honest about what you can offer. If they want you to visit daily and you can’t fit it into your schedule or don’t feel like you can handle that much emotional strain, let them know. Tell them what they can expect from you like, “John, I understand that you want me to visit you every day. I want to visit you as much as I can but every day may not be possible. I will be sure to visit you every Monday, Wednesday, and Saturday and if I can fit any extra days in, I will do it.” The important thing is to not make a promise that can’t keep. Also, be honest about what you feel comfortable talking about. Page 67 of 120
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Just because the dying person wants to be open about what is happening to them, you may not feel comfortable discussing every detail. Let them know if this is the case. Once everyone’s needs and expectations are in the open, the process of compromise can begin. Finding a place where everyone is comfortable and getting their needs met will help make interacting with the dying person a special experience that you can treasure.
What is open communication? Open communication is a type of communication characterised by free exchange of ideas and objections without limitations of positional status. For example, open communication in the work place, mean employees are on equal conditions with a transparent relation, and are able to express their ideas openly without fear of termination or direct/indirect consequences.
Open communication with a dying individual's thoughts and feelings The benefits of open communication are clear. Relationships that allow for communication about death often precede healthy adjustment. Researchers have found that the emotional impact of being labelled as dying is directly related to quality and openness of the communication between the individual who is dying and key people; such as family members, friend, and others who are important to the well being of the individual; where in, if open communication is not achieved, care givers operate on preconceptions rather than the dying individual's actual thoughts and feelings.
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Open Communication: Emotional, Thoughts and Feelings
Provide support for the individual and key people that respects their beliefs, religion and culture (2 pages to answer the question)
To provide support for the individual and key people that respects their beliefs, religion and culture, it is very important to be open minded because it is extremely helpful to understanding where the individual is coming from, with own beliefs, religion and culture. That helps to provide accurate support. The more you learn about other people, the more you learn to respect their values, culture, and beliefs. I have met in my work place so many really wonderful people from different places and different religions, with different values, culture, and beliefs.
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To provide support for the individual and key people that respects their beliefs, religion and culture, it is essential to find mutual ground, show an interest if the individual and key people wish to share beliefs or information, be non judgmental, encourage communication, let the individual and key people know that they are valued, avoid overwhelming them with personal information and your own beliefs, that will come with time and remember confidentiality is extremely important! I always treat the individuals and their key people, like I would like to be treated related to their and my Christian religion.
“When in Rome, do as the Romans do.”
Demonstrate ways to help the individual feel respected and valued throughout the end of life period (2 pages to answer the question)
Ways to help the individual to feel respected and valued throughout the end of life period are the following: -
Individuals have the rights to be respected and valued Individuals have the rights to be treated equally and not be discriminated against Individuals have the rights to be treated as a unique individual Individuals have the rights to be treated in a dignified way Individuals have the rights to have privacy Individuals have the rights to be protected from danger and harm (hazard and risk) Individuals have the rights to be cared for in a way they choose Individuals have the rights to have access to their information about themselves Individuals have the rights to communicate using their preferred methods of communication and language
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What is a hazard? What is risk? It is important to know the difference between a hazard and a risk.
What is a hazard? When we refer to hazards in relation to occupational safety and health the most commonly used definition is “a hazard is a potential source of harm or adverse health effect on a person or persons”
What is risk? When we refer to risk in relation to occupational safety and health the most commonly used definition is “a risk is the likelihood that a person may be harmed or suffers adverse health effects if exposed to a hazard” Example: Electricity is the hazard. Electrocution is the risk.
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Provide information to the individual and/or key people about the individual’s illness and the support available (3 pages to answer the question)
Offering emotional, psychological, social and spiritual support, care and help to deal with the financial effects, to the individual and/or key people about the individual’s illness can be provided by many different ways of information.
Information of End of life care An End of Life Care Plan enables you to express anything that is important to you and will give you peace of mind at the end of your life. 65% of people think they would be more likely to have a dignified death if they could discuss and record their wishes around care and treatment at the end of their lives. 40% of people have never discussed their wishes for care and treatment at the end of their lives with anyone. Before starting any investigation or treatment your doctor must ensure that you have been given enough time and information to make an informed decision, and that you have given your consent. This includes decisions about your pain relief. 89% of the British public consider choice over pain relief an important factor for having a dignified death. Any risk involved in medical treatments must be discussed with you in clear language. For minor investigations or treatments, it is usually enough for you to give oral or implied consent, which might for example be given by rolling up your sleeve to have an injection or to have your blood pressure taken. In higher risk situations, it is important that your doctor obtains your written consent, after they have given you all the information you need to make an informed decision. You can record your wish to be cared for at home, in a hospice, hospital or care home. Most people would prefer to die at home but only 1 in 5 of us do.
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If you want to be cared for and die at home, you can record this wish in an End of Life Care Plan. This will be particularly helpful in order to avoid an emergency hospital admission in your final hours. But not everyone wants to die at home - you can state where you would like to spend your last days in your End of Life Care Plan, and talk to your GP and others that care for you about your options. Traditionally, palliative care has been centred on cancer patients. 72% of people are shocked that palliative care is only routinely available to cancer patients, and not to those with other terminal illnesses. Although there will not always be places available in a hospice, health professionals should be able to provide you with high quality care in other settings, using tools such as the Liverpool Care Pathway. We would like to see more Government investment in palliative care so that everyone has access to these services at the end of life, regardless of where they live or the illness they have. If you have a progressive disease and are not reasonably expected to live for more than another six months, there are special rules to help you claim benefits more quickly and easily. You can get the highest rate of Disability Living Allowance (DLA) and Attendance Allowance immediately.
Information of making decisions about care and treatment You have the legal right to refuse medical treatment, even if you will die as a result. You do not have to justify your decision to refuse treatment, but you do have to show that you are capable of making the decision, and that you understand the consequences of it. You can refuse treatment in advance should you lose mental competency or the ability to communicate in the future. Since the Mental Capacity Act came into force in October 2007, health professionals have a legal duty to comply with your wish to refuse treatment as set out in your Advance Decision.
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If you make an Advance Decision you should give a copy to your GP to include in your medical record. 86% of people believe those suffering from a terminal illness should be able to exercise choice over their care at the time of death and 79% believe it is important not to have their lives prolonged against their wishes. The End of Life Care Strategy states that good PCTs (Priority Care Treatment) will set up localised end of life Care registers including people’s End of Life Care Plans and Advance Decisions. This process may take some time so it is strongly recommend that you give a copy of your Advance Decision to your GP and other health and social care professionals involved in your care.
Information for key people’ rights You are legally entitled to a carer’s assessment when you are a care assistant. Based on your assessment your social services team will decide if you are entitled to support. There are more than half a million carers of terminally ill people in the UK. Receiving more support such as, legal protection against employment discrimination, better access to respite care and access to Carer’s Benefit regardless of age, are legal rights.
Information about legal rights after death You may be able to claim Bereavement Payment or Bereavement Allowance if you have lost your partner and you fulfil certain conditions. The loss of a loved one is inevitably a very difficult and distressing time. As well as the grieving process, there are many practical considerations, such as registering the death and arranging the funeral, to be considered. Following the death of a loved one 89% of us believe that practical support dealing with legal and financial matters is important, and 77% believe that bereavement counselling and emotional support is important. To have easy access to services offering legal and financial advice and referral to counselling services, are important help. Page 74 of 120
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Give examples of how an individual’s well-being can be enhanced by: -
environmental factors
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non-medical interventions
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use of equipment and aids
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alternative therapies
(10 pages to answer the question)
What is constituted a nursing home environment for an individual's well being? A nursing home environment for an individual's well being is constituted of three elements; physical, people, and environmental.
The environmental factors play an important part in an individual's well being, and much more for an individual at the end of life care.
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For example, personalised the individual's room is very important for the well being of the individual. This can include simple things such as rearranging furniture in the room of the individual with the personal furniture of the individual, that help to make feel the individual like home, with the personal clock, the personal and favourite painting, objects such as personal books, personal parfum, a TV or/and a radio to listen a relaxing music, some personal pictures, religious pictures and objects in accordance with the individual's religion. This also include, if possible, moving an armchair or a bed in front of a window to enable the individual to gain a view and stimulate their senses. Simple environmental factors such as a vase of flowers, softer lighting or relaxing music to achieve a pleasant atmosphere, helps in all ways, to maintain the well being of the individual as good as possible. For an individual at the end of life, it is very important to know the date and time, and to feel the outside elements, such as wind; for example moving the bed closer the window and to open the window allow the individual at the end of life to feel the wind, that help to stay in contact with the outside world. A positive moral for an individual at the end of life is crucial, and give the boost needed for the individual to eat, to drink, and to fight for life. A person centred approach help to meet the needs of the well being for an individual. Person centred approaches, Support plan life, Support team life, and Communication chart, are essential Tools, to care and support an individual who request such tools.
What is a person centred approach? The person-centred approach is based on the theory and philosophy of Dr Carl Rogers.
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The person-centred approach is a non-directive approach to being with another; that believes in the others potential and ability to make the right choices for an individual, regardless of the therapist's own values, beliefs and ideas.
What is Communication chart? Example of two Communication charts in relation with Carol and Jennifer story: Carol and Jennifer story: www.gaelromanet.com/PCACAJS.docx
Communication chart 1: How I and WE communicate Carol’s chart
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Communication chart 2: Review of what’s working and what’s not working with a communication Jennifer's chart
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What does mean « person centred »? My own definition with my own words: Person centred means thinking about what is best for an individual, how to make feel happy and comfortable the individual ensuring the best possible well being in accord of respect, of dignity and to offer a REAL choice without forgetting the individual is always first to choose and can change the mind and take risks. It's about understanding the needs of well being (spiritual, emotional, cultural, religious, social and political.) What make feel good the individual to live the life day after day.
Information about « person centred » The values or person centred working recognise that the individual is the expert on their own needs and how these should be met. It recognises the value of working in partnership with an individual. Practitioners have to offer advice and information but the final decision usually lie with the individual. Only in exceptional circumstances where the individuals are deemed not to have the capacity to make specific decision with the final say rest with a practitioner.
Example of Person centred in relation with Carol story
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What does mean « person centred thinking tools »? My own definition with my own words in one phrase: Person centred thinking tools is a picture of the individual’s needs with words.
Examples of how an individual’s well-being can be enhanced by non-medical interventions are the following: -
Eat a healthy breakfast Drink at least 8 glasses of water Take a good quality multiple vitamin and mineral Connect with other people Express your emotions appropriately Eat fruits and vegetables Spend at least 30 minutes outdoors Do something physically active Take some quiet time for yourself Keep regular sleep hours Establish a relationship with a doctor you can trust
This list resumes ten essential elements of good health. If an individual take all of the actions listed above, the individual will be much healthier.
What is an active support? Active support means, Support that encourages individuals to do as much for themselves as possible to maintain their independence and physical ability and encourages people with disabilities to maximise their own potential and independence.
What is an active participation? An active participation is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is regarded as an active partner in their own care or support, rather than a passive recipient.
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What is a non-medical intervention? Example of non-medical intervention with depression: In recent years a new range of non-medical intervention for depression has been developed, and many of these have proved particularly effective for: -
People at risk of developing depression People with mild depression People recovering from depression
Non-medical approaches may also provide additional benefits that complement the treatments offered to people with more severe and enduring depression.
These are things that everyone can do in order to improve their mental health and well being such are: Self help books: In Wales and in some other parts of the UK these are available through a “books on prescription” scheme operated through a partnership between the NHS and the local library service. Doctors can write a “prescription” for a book from an approved list, which can be picked up from the local library even if you are not a member of the library. Page 81 of 120
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Brief Focused Counselling: Some primary care practices are able to offer access to brief (up to 6 weeks) focused counselling sessions aimed at helping you through the stressful life situations (such as debt, divorce, redundancy and housing problems) that are often the trigger for depression. Exercise on Prescription: Engaging in regular physical activity has been shown to have an antidepressant effect. Throughout Wales and in some other areas of the UK there are now “Exercise on Prescription” schemes through which your GP can refer you to a personal fitness coach based at your local leisure centre. Your fitness coach will work with you over a 6 week period to design a personalised fitness plan based on your level of fitness and your personal preferences. Advice on Diet: There is a growing body of evidence that a lack of chemicals such as tryptophan, folic acid, fish oils and selenium can make depression worse. This is probably made worse by eating too much “junk food”. Against this, people who eat a balanced and varied diet that is high in fibre and low in fat tend to have better well being and are less prone to depression. Most Primary Care practices can refer you to a dietician, who will be able to advise you on changing your eating habits and adopting a healthier diet. Remember that these non-medical interventions are not a “cure” for depression. Rather, they are ways of helping you build up the skills you need to manage and overcome mildmoderate depression for yourself. As such, they are not things done to you, but rather things that you have to actively engage with in order to benefit.
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What is well being? Well being is a positive outcome that is meaningful for people and for many sectors of society, because it tells us that people perceive that their lives are going well. Good living conditions including housing and employment are fundamental to well being. Tracking these conditions is important for public policy. However, many indicators that measure living conditions fail to measure what people think and feel about their lives, such as the quality of their relationships, their positive emotions and resilience, the realization of their potential, or their overall satisfaction with life and their well being. Well being generally includes global judgments of life satisfaction and feelings ranging from depression to joy. Individual identity and self-esteem are linked with the notion of well being because when you know where you are from, you know where you go and when you feel good inside, I mean when you have a good opinion about yourself, then you also feel good in your life. Well being is about spiritual, emotional, cultural, religious, social and political things. It's all about what make feel good the individual to live the life day after day as good as possible.
Examples of how an individual’s well being can be enhanced by use of equipment and aids, means how to open access for an individual who can't walk for example. In this situation the use of a wheelchair is a radical change in the life of the individual who can't walk. The wheelchair allows the individual to personal autonomy. An individual who is wheelchair user can drive a car with the use of equipment and aids, can work, can have a life as normal as possible. Another example of how the use of equipment and aids can enhance an individual's well being can be found with an individual who can't talk. Communication can be achieved by technological aids.
What is Alternative Therapies? The term “alternative therapy” is used to describe healing treatments that are not part of conventional medical training.
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Here are some examples of alternative therapies:
Acupuncture: Fine needles are introduced to specific points to stimulate, disperse, and regulate the flow of vital energy, and restore a healthy energy balance. In addition to pain relief, acupuncture is also used to improve wellbeing and treat acute, chronic, and degenerative conditions in children and adults.
Chiropractic: The chiropractic views the spine as the backbone of human health. Misalignments of the vertebrae caused by poor posture or trauma cause pressure on the spinal nerve roots, leading to diminished function and illness. Through manipulation or adjustment of the spine, treatment seeks to analyze and correct these misalignments.
Dance/Movement Therapies: Dance and/or movement therapy uses expressive movement as a therapeutic tool for both personal expression and psychological or emotional healing. Practitioners work with people with physical disabilities, addition issues, eating disorders, and other concerns.
Homoeopathy: A medical system that uses infinitesimal doses of natural substances, called remedies, to stimulate a person's immune and defence system. Common conditions homeopathy addresses are infant and childhood diseases, infections, fatigue, allergies, and chronic illnesses such as arthritis.
Hypnotherapy: By passing the conscious mind and accessing the subconscious, where suppressed memories, repressed emotions, and forgotten events may remain recorded. Hypnosis may facilitate behavioural, emotional, or attitudinal change such as weight loss, or smoking cessation. It is also used to treat phobias, stress, and as an adjunct in the treatment of illness.
Vitamin Therapy: Vitamin usage combined with other treatments to address a range of illnesses and to enhance the functioning of the body's systems and help to assists the immune system in combating diseases such as Chronic Fatigue Syndrome. Page 84 of 120
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Contribute to partnership working with key people to support the individual’s well-being (2 pages to answer the question)
What key people mean in this question? Key people are those people who are key to an individual’s health and social well being. They are those who are important to individuals and who can make a difference to their health and well being. Key people may include family, friends, carers and others with whom the individual has a supportive relationship.
Contributed to partnership working with key people to support the individual’s well being, mean for example to ask to the key people to buy new clothes because the individual's weight is different and the current clothes don't fit the individual. Concretely, it is to let know to the key people about the individual's needs - what need the individual have need to maintain his own well being. Needs may include those that are physical; emotional; mental; short term; medium term; long term. Individual's psychological needs are constituted of five elements: Comfort, attachment, inclusion, occupation and identity
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Contributed to partnership working with key people to support the individual’s well being, can also be part of taking risk to improve the well being of the individual. For example, young individuals living with dementia, request to go outside to visit new places they wish to see. To resume, contributed to partnership working with key people to support the individual’s well being mean to be aware to the individual's needs and to share with the key people in relation with the individual, what could improve the quality of life of the individual, to always make the well being of the individual a priority.
What is a risk? A risk takes account of the likelihood of a hazard occurring and may include the possibility of danger, damage and destruction to the environment and goods; the possibility of injury and harm to people.
What is a risk in part of a person centred approach? It's important to take risk in part of a person centred approach. If you were no longer allowed to take risk, that’s mean you can’t progress in anything. Risk is about learning! To take risk is all about challenge! If your right to take a risk was limited by others, that means you can’t decide by yourself and your right of liberty to take risk does not longer belong to you and so you literally lost control of your own destiny. To take risk should be an important part of a person centred approach for an individual because this is a part of choice in person centred work. Take risk make feel more responsible the individual to take control of his own destiny and it's make feel important for the individual of what he really want. Taking risk in part of person centred approach is about asking the person, reading their life and speaking to others about the individual background. What are their preferences, wishes and needs? It's all about dignity and how to treat the individuals with respect and to recognize that they have value. Taking risks in person centred approach means treating the person as an individual and assisting them to maintain their self respect and control of their own destiny. By offering a positive vision of success, the individual can be able to manage risk. Take risk is about take control of life! Page 86 of 120
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Task 5 understand how to address sensitive issues in relation to end of life care
Explain the importance of recording significant conversations during end of life care (3 pages to answer the question)
The importance of recording significant conversations during end of life care for an individual, ensure to be sure the individual's last wishes will be respected, such as the making of wills and living wills, and dealing with personal property. That allow the individual to feel confident about the personal wishes, knowing the wishes will be respected by the key people who act in the best interests of the individual. Also, any concerns about the recording and storing processes for information should be shared with a senior staff member. You have a duty to protect the confidentiality of the individuals you care for. If you find confidential documents you must return them immediately to the secure storage point. If you hear others gossiping about individuals in your care it is best to diplomatically point out that this is breaching confidentiality.
How can I ensure my healthcare wishes will be respected if I lose mental competency in the future? There are three main options for helping you make sure that your views about medical care will be respected in the future. Option one: Advance Decisions Option two: Lasting Powers of Attorney Option three: End of Life Care Plans Page 87 of 120
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Option one: Advance Decisions Make an Advance Decision (also known as a living will or an advance directive). An Advance Decision allows you to set out in advance, what medical treatment you would like to refuse, should you lose mental competency or the ability to communicate (for example if you were in a persistent vegetative state, or if you developed dementia). It is a very good idea to make an Advance Decision if you have strong ideas about the kind of treatment you would want in these situations, particularly in regard to life sustaining treatment. If you make an Advance Decision, it is recommended to talk to your doctors about it and give one copy to your GP (and any other specialists that you regularly see) and one copy to your next of kin. Some people also request their local hospital to file a copy of their Advance Decision so that the medical staff will be aware of the existence of their Advance Decision if they are admitted to hospital. It is a good idea to discuss your wishes and the contents of your Advance Decision with other family members as well. It's strongly recommended to make regularly update of your Advance Decision so that it reflects your wishes. Advance Decisions are legally binding, so doctors should respect your wishes as stated in your Advance Decision. An Advance Decision is fully compliant with the Mental Capacity Act, and easy to use. Some organisations such as the Alzheimer’s Society and the Huntingdon’s Disease Association provide Advance Decisions. A solicitor could also draw up an Advance Decision for you, but this is likely to be much more expensive than buying, or making a voluntary donation for an Advance Decision from a voluntary sector organisation.
Option two: Lasting Powers of Attorney The Lasting Power of Attorney was established by the Mental Capacity Act, and replaces the Enduring Power of Attorney. This authorises them to make decisions on your behalf should you lose mental competency or the ability to communicate. There are two kinds of Lasting Power of Attorney – financial, and health and welfare. Each kind of Lasting Power of Attorney costs £120 to set up and some people are eligible for a reduced charge to set up a Lasting Power of Attorney. Appointing someone as your Lasting Power of Attorney will give them complete control over your financial affairs and/or your health and welfare. Under the health and welfare Lasting Power of Attorney you can give someone the power to refuse life sustaining treatment on your behalf. Therefore, if you do decide to appoint a Lasting Power of Attorney you need to be confident that they will respect your wishes, and act in your best interests. Page 88 of 120
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Option three: End of Life Care Plans End of Life Care Plans allows you to record your wishes and preferences for the end of life. These may include specific wishes related to your healthcare. The Mental Capacity Act 2005 states that if you are no longer able to make your wishes clear, the people who make decisions about your healthcare must consider, so far as reasonably possible, your past and present wishes and feelings. They must in particular consider any relevant written statement you made in the past, such as an End of Life Care Plan. However, an End of Life Care Plan is not legally binding in the way that an Advance Decision is.
What if I make an Advance Decision and change my mind? It is recommended that you regularly read over and witness your Advance Decision, so that doctors know that refusals of treatment set out in it are up-to-date. If you change your mind about your treatment wishes you can make the change to your Advance Decision, sign and date the section you have changed, and ask someone to witness the change for you. You can also verbally revoke any decisions set out in your Advance Decision at any time should you change your mind. However, it is best to also make the changes to your Advance Decision in writing if you can.
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Explain factors that influence who should give significant news to an individual or key people (1 page to answer the question)
Factors that influence who should give significant news to an individual or key people are: -
Factors should be in relation with the individual or key people
-
A health professional who is involved with the individual health or key people health
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Expert on that significant news, who will give significant news to an individual or key people
Others factors that influence who should give significant news to an individual or key people are, the individual's choice, the individual's capacity, the expert opinions or the opinions of those who know the individual and key people well such as psychologist, individual's GP, and other expert who has the best information and who can answer questions to an individual or key people, like the attending surgeon.
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Describe conflicts and legal or ethical issues that may arise in relation to death, dying or end of life care (1 page to answer the question)
Conflicts and legal or ethical issues that may arise in relation to death, dying or end of life care are the following: Ethics involves critical reflection on morality. Ethical principles are not laws, but guiding principles about what is good and what is bad, that should help doctors and other health care professionals in their work and decision making. Issues arising over end of life care involving decisions that affect the nature and timing of an individual's death raise difficult ethical conflicts for all concerned and can be a source of discord between health professionals within a team, health professionals and key people, or between other different family members. Ethical dilemmas arise when there is a perceived conflicting duty to the individual at the end of life, such as a conflict between a duty to preserve life and a duty to act in the best interests for the individual at the end of life, or when an ethical principle such as respect for autonomy conflicts with a duty not to harm.
Analyse ways to address such conflicts (1 page to answer the question)
Ways to analyse conflicts and legal or ethical issues that may arise in relation to death, dying or end of life care mean to determine if the problem relates to a legal, moral or ethical issue or a combination of the three. Making a list of the critical issues involved in the dilemma, will help to consider the parties who will be affected by the decision, and also list all their rights as well as the dangers that could be posed to them. In addition, revisit the basic moral principles of justice, equality, being kind and charitable, respecting one another, being honest, not causing harm to another and the exercise of free will. That will help to identify who will benefit from what you choose to do and who will be hurt. It's also wise to evaluate and weigh the seriousness of these harms and/or the quality of the benefits of your choice. Think about both short-term and long-term effects as well, as this also will help to determine if the action is really worth it. Page 91 of 120
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Task 6 understand the role of organisations and support services available to individuals and key people in relation to end of life care
Describe the role of support organisations and specialist services that may contribute to end of life care (2 pages to answer the question)
Exemplification: Support organisations and specialist services may include: - nursing and care homes - specialist palliative care services - domiciliary, respite and day services - funeral directors
Describe the role of nursing and care homes that may contribute to end of life care. The role of nursing and care homes that may contribute to end of life care is to provide adapted end of life care to accompany the individual until the end. A skilled nursing home control end of life care and is specialized in end of life care. The role of the nurse and care assistant in a nursing and care homes that may contribute to end of life care is a significant and vital role in the care of individuals that are in the final stage of life. Individuals that are in the final stage of life need special and accurate cares. The end of life stage for an individual can be emotionally difficult, for the individual, for the key people, and for the medical staff.
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Describe the role of specialist palliative care services that may contribute to end of life care. The role of specialist palliative care services that may contribute to end of life care is to provide expert advice and support about the assessment and management of symptoms.
Describe the role of domiciliary, respite and day services that may contribute to end of life care. The role of domiciliary, respite and day services that may contribute to end of life care can be resumed such as the respite care service, by; they put their life on “pause” to provide the care that is required. It's a very important responsibility.
Describe the role of funeral directors that may contribute to end of life care. The role of funeral directors that may contribute to end of life care is varied. A funeral director has many responsibilities that entail preparing the body for burial, making arrangements for viewing and services and coordinating all aspects of the service. This includes making sure that the individual wishes and key people wishes are carried out including religious customs.
Analyse the role and value of an advocate in relation to end of life care (3 pages to answer the question)
The role and value of an advocate in relation to end of life care is to support and enable individuals to express their views and concerns, to access information and services, to defend and promote their rights and responsibilities, and to explore choices and options. The Mental Capacity Act 2005 provides protection and support for individuals who lack capacity to make their own decisions; this is done through three main organisations: -
The Court of Protection The Public Guardian The Independent Mental Capacity Advocate
Advocate in relation to end of life care; is the hand that hold the pen when you can't write. Page 93 of 120
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Definition of End of Life Care End of life care mean care that: Helps all those with advanced, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support.
Example of end of life pathway, step after step This pathway starts at step 1 although some patients may start this pathway at step 5, much of this will depend on the nature as well as diagnosis of the illness.
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For example a person may be given a diagnosis of dementia early into the onset of the illness and they will be afforded the time and opportunity to have discussions and make plans. Others however may become acutely unwell suddenly and their care plan may only be able to focus on the last few days of their life. Also, it is important to consider the support, care and information that are required by the person’s family and caregivers both during the illness and into bereavement. Similarly, spiritual care and support for both the person and their carers is integral to the end of life care pathway.
Explain how to establish when an advocate may be beneficial (1 page to answer the question)
An advocate may be beneficial for an individual at the end of life, as a support person or someone who can intercede on the behalf of another. While using an advocate, individuals at the end of life and their key people can focus more on recuperation or end of life care rather than handling the details surrounding care. Using the services offered by an advocate can reduce individual and key people stress, lessen the chance of treatment and billing errors and help foster a greater sense of cooperation between the individual, key people, medical professionals and health insurance providers. Page 95 of 120
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Explain why support for spiritual needs may be especially important at the end of life (1 page to answer the question)
Support for spiritual needs, such as religious beliefs are especially important for an individual at the end of life because during a particular difficult event of life, such as end of life that is a major event of life, the faith of an individual will help to access, with prayers, to give courage and to accept the situation. Spiritual well being is an integral part of mental, emotional and physical health; this doesn't change for an individual that is nearing at the end of his life. Spirituality and religion is not necessarily the same thing and it means different things to different people, in a general sense it's what gives meaning, purpose and value to our lives and what makes our thoughts and beliefs personal to us. For the individuals to have their spiritual needs met, means they have the opportunity to reflect, resolve issues and find inner peace. A spiritual person with a strong faith will always take life in a positive way, no matter what is on the individual's destiny.
Describe a range of sources of support to address spiritual needs (1 page to answer the question)
A range of sources of support to address spiritual needs can be found by having access to spiritual support from your local community faith leaders. For example, if you are a member of the Christian religion, you can access spiritual support by going in your own church and determine the spiritual needs that cover your faith best. To resume, a range of sources of support to address spiritual needs means to have access to related spiritual support in accords of respect of your own beliefs, religion and culture. Page 96 of 120
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Task 7 be able to access support for the individual or key people from the wider team
Identify when support would best be offered by other members of the team (6 pages to answer the question)
Exemplification: Other members of the team may include: - line manager - religious representatives - specialist nurse - occupational or other therapist - social worker - key people
Support would best be offered by other members of the team, such as: Line manager or Social worker: Support would best be offered by other members of the team such as, line manager or social worker, when an individual need to organise help with housework, shopping and cooking, or a personal care assistant to help with tasks such as washing and dressing. If an individual can afford it, he/she may be asked to pay towards the cost of this help, but in some circumstances it may be funded for the individual.
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Line manager or social workers can also give information about any benefits the individual may be able to claim, such as attendance allowance or disability living allowance. They may also be able to provide more advanced counselling and emotional support for the individual and the carers of the individual.
Religious representatives: Support would best be offered by other members of the team such as, religious representatives, when an individual's religious factors or cultural beliefs may impact on the decision making process of end of life care and so it is important to determine as far as possible whether they practiced any particular faith as well as being able to ascertain cultural beliefs. Consideration should be given to the fact that whilst someone may have been born into a particular faith they may no longer practice it, equally they may have changed faiths as an adult or have been devout to their religion all their lives and often key people, such as family members, friends or neighbours, and others who are important to the well being of the individual, can offer an insight into this. Culture can sometimes be narrowly viewed as only being connected to religion. Similarly, it is sometimes only taken into consideration when an individual’s culture is different to the prevailing culture of the society they currently live in but it is inherent in all of us and as such needs to be understood in order to be able to represent the person. However being able to research differing cultures, religions, and their belief systems may be difficult if the individuals at the end of life care is unable to express or explain this themselves but it is important to ask questions on behalf of the person about these factors and equally important not to assume. It may not be possible to find out much detail about an individual’s cultural or religious wishes with respect to end of life particularly from a person that is at the end stages of their life as they may be too unwell to communicate. Factors such as limited communication, understanding of the concept of death by the person and time constraints within the decision making process or the involvement may too impact on gathering this information however it should still be considered as part of the decision making process and by the person’s representative. Specialist nurse: Support would best be offered by other members of the team such as, specialist nurse, because a specialist nurse, district nurse or GP can tell to an individual how to access these healthcare professionals and about the specific types of help and support available in the area of the individual.
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Occupational or other therapist: Support would best be offered by other members of the team such as, occupational or other therapist, because they can visit the individual at home to assess whether specialist equipment that would help the individual to move around and to be able to do as much as possible the individual can do.
Where to get the equipment you need? Your specialist nurse or occupational or other therapist can organise equipment to help you manage at home. Your specialist nurse can arrange for you to have: -
a commode, urinal, bedpans or incontinence sheets a special mattress or shaped pillows a hoist or sling a special bed
Your occupational or other therapist can supply: -
an adjustable bed a wheelchair, walking frame or ramp small gadgets, such as two-handled mugs or special cutlery grab-rails for your bath
Your occupational or other therapist can also give you information about stair lifts. If you haven’t seen an occupational or other therapist, but need some equipment which they usually supply, asks your specialist nurse, GP or community palliative care team to arrange for one to visit your home. Many shops and organisations also sell or hire aids and equipment. The British Red Cross hires out equipment such as commodes and wheelchairs. You can also buy items such as incontinence pads and urinals from most large chemists.
About The British Red Cross The British Red Cross Offers a number of services for people with a disability, including medical equipment and a transport loan service. British Red Cross 44 Moorfields, London EC 2Y 9AL www.redcross.org.uk Page 99 of 120
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Key people: Support would best be offered by other members of the team such as, key people (family members, friends and others who are important to the well being of the individual) when the individual at the end of life want to die at home, in their own bed, surrounded by their close family and friends. If an individual at the end of life want to be at home, then help and support is available for the individual and key people.
Who can help if you want to die at home? Dying is a natural process; few people have experience of looking after someone who is dying. If you are a care assistant, the thought of looking after someone you care for or are close to at home can be frightening. However, it can also be one of the most rewarding experiences you can have, and a time of great closeness. It’s important that you and your carers have as much support as possible. Caring can be hard work, both physically and emotionally. It’s not always easy to ask for help, as we often feel we should try to cope alone. However, there are many healthcare professionals who can help you and your carers.
GP: While you are at home, your GP has overall responsibility for your care. They can help you in different ways, for example if: -
You’re worried about any changes in your symptoms, they can arrange to see you either in the surgery or at home – when they assess you, they’ll discuss options for treating and controlling your symptoms.
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You want to talk through what may happen as you become less well.
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You want to make a plan for dealing with emergencies (although this isn’t often needed) so that you get the care you want.
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You need nursing care – they can arrange for you to be seen by a district nurse who will help to organise this for you at home.
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You need specialist care from a palliative care team, they can arrange for you to be seen at home by a specialist palliative care nurse.
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District nurses: District nurses work closely with GPs and palliative care nurses. They make visits to patients and their care assistants at home and can provide help with: -
Giving drugs and injections, changing dressings, giving advice on pressure area care and toilet problems, such as incontinence and constipation – they will arrange visits as needed and will let you know about the services they provide.
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Showing your relatives how to move you and take care of your personal needs.
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Coordinating your care and contacting other health or social services to help look after you if they are needed.
District nurses often work with palliative care nurses to help support you and your carers so that you can remain at home. They may be able to arrange a nursing assistant (also called a healthcare assistant) to help with tasks such as washing and personal care.
Nurses who specialise in a specific disease: Nurses who specialise in caring for people with specific diseases or conditions, for example heart failure, renal disease or motor neurone disease, are known as clinical nurse specialists. They work in partnership with your district nurses, hospital or community team.
Principles for Dignity at the End of Life Choice: The first stage is to identify whether someone is in the last year of life, which would then allow the framework to be put in place. One of the resources attached to this stage is the “surprise question” which asks of those involved in the care of a person if they would be surprised if that person died within the following weeks, months or years. This is only one aspect of identifying whether end of life care needs to be considered the “Prognostic Indicator Guidance” and “needs based coding” also support those delivering the person’s care to fully explore this stage.
Access: At this stage the person’s needs are assessed including clinical, personal and future needs using advance care planning amongst other tools. Page 101 of 120
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Control: Finally the plan as to how to align the care with what the person’s wishes are is made and this looks in detail at how to do this including reducing any admission to hospital. The basis of the framework is to ensure inter-agency care and planning so that all patients regardless of their environment can receive a quality standard of care that places them at the heart of the process enabling them to both live and die as they would choose. Person’s care plan will contain information as to how the person will be cared for in their last months, weeks and days and offer a valuable insight into a person’s wishes. Where those wishes are not known, for example a person is admitted to a care home or hospital and is unable to express their feelings and beliefs about the subject this may mean that the principles for dignity at the end of life help to asks more questions on the person’s behalf rather than articulating their wishes.
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Liaise with other members of the team to provide identified support for the individual or key people (1 page to answer the question)
Other members of the team to provide identified support for the individual or key people are the following:
Specialist palliative care nurses: Specialist palliative care nurses are experienced in assessing and treating your symptoms and also provide counselling and emotional support for you and your carers. Most specialist palliative care nurses work closely with a wider hospital or community palliative care team, which includes doctors and other healthcare professionals. Specialist palliative care nurses are sometimes referred to as Macmillan nurses. However many Macmillan professionals are nurses who have specialist knowledge in a particular type of cancer. You may see them when you’re at clinic or in hospital. Doctors: Doctors specialising in palliative medicine give expert medical advice on managing people with advanced disease. They work closely with palliative care nurses and may visit people at home if needed. Nurses: Some community palliative care teams have nurses who can visit you at home and provide practical care such as washing, dressing and giving drugs. A specialist palliative care nurse will usually arrange care from these nurses. Physiotherapists: Physiotherapists can help ill people to move around. They can also help with pain relief and if you have breathing problems. Counsellors: Counsellors are trained to help people in all types of situations. Seeing a counsellor can help people to understand and express their feelings, and cope better with their situation. Spiritual care coordinators or chaplains: Spiritual care coordinators or chaplains offer spiritual care and support for an individual.
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Task 8 be able to support individuals through the process of dying
Carry out own role in an individual’s care
The complete question is, carry out own role in an individual's care through the process of dying. (2 pages to answer the question) To support individual's care through the process of dying in my own role, means I will use the correct techniques; that include; timings; hygiene; use of equipment; safe disposal; and recording information, to offer appropriate support to individuals and key people such as; family; friends; carers; others with whom the individual has a supportive relationship; when they have been told about the timescales of the individual’s death and the process of their dying. I will treat the individuals with values that adherence to codes of practice or conduct where applicable to my own role and the principles and values that underpin in my work setting, including the rights of children, young people and adults. That include the rights; to be treated as an individual; to be treated equally and not be discriminated against; to be respected; to have privacy; to be treated in a dignified way; to be protected from danger and harm; to be supported and cared for in a way that meets their needs, takes account of their choices and also protects them; to communicate using their preferred methods of communication and language; and to access information about themselves. Preferred method of communication and language can include the individual’s preferred spoken language; the use of signs; symbols; pictures; writing; objects of reference; communication passports; other non-verbal forms of communication; human and technological aids to communication. Also, I have to take into consideration, factors that may affect the health, wellbeing and development of individuals. Such factors may include adverse circumstances or trauma before or during birth; autistic spectrum conditions; dementia; family circumstances; frailty; harm or abuse; injury; learning disability; medical conditions (chronic or acute); mental health; physical disability; physical ill health; poverty; profound or complex needs; sensory needs; social deprivation; and substance misuse. Caring out my own role, to support an individual's care through the process of dying, request a perfect hygiene and use of the personal protective equipment; such as apron, gloves and mask.
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Infection control is very important, washing of hands before and after wearing of personal protective equipment according to my workplace policy. For example; after disposed of my apron, gloves and mask in the clinical waste bin, I will washes and dry my hands thoroughly with the full hand washing technique to not contaminate myself or others. Where possible, I will promote active support that encourages individuals to do as much for themselves as possible to maintain their independence and physical ability and encourages people with disabilities to maximise their own potential and independence. I will provide individuals with privacy and facilities to meet their immediate needs and give them time to adjust to the knowledge that they are dying. I will communicate with the individuals using their preferred method of communication and language, in an appropriate manner, and at a level and pace with which they are comfortable. I will support individuals and key people to identify any information they want. I will work with others people within and outside my organisation that are necessary for me to fulfil my job role, to enable the information requested by individuals and key people to be accessed, within confidentiality agreements and according to legal and organisational requirements, and I will complete records in ways that can be understood by all who are authorised to access them. In my own role, to support individual's care through the process of dying, means I will provide appropriate support and time to individuals who wish to express their feelings and communicate their concerns and to express their beliefs and preferences about their death, but in the same time, I will avoid pressurising them to talk about their death. Where an individual finds it difficult or impossible to express their own preferences and make decisions about their life, achievement of this standard may require the involvement of advocates or others who are able to represent the views and best interests of the individual. Where there are language differences within the work setting, achievement of this standard may require the involvement of interpreters or translation services. Some individuals that have their key people, may want to identify the people they wish to be informed about their death, so I will contact calmly and without delay, the identified people so that they can be with the individuals when they die. I will fulfil any wishes expressed by individuals that are within my own role, responsibility and competence. Appropriate action have to be take to inform others people within and outside my organisation of changes to individuals’ condition and any expressed wishes and preferences, that means I have to record and report on actions, procedures and outcomes within confidentiality agreements and according to legal and organisational requirements within my work place. Last, I have to manage appropriately any of my own feelings that have been aroused by the individual’s death.
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Contribute to addressing any distress experienced by the individual promptly and in agreed ways (1 page to answer the question)
Contribute to addressing any distress experienced by the individual promptly and in agreed ways through the process of dying. Addressing any distress experienced by the individual promptly and in agreed ways through the process of dying, do echo to understand the distress due to end of life care through the process of dying for an individual. End of life care encompasses palliative care, which focuses on managing pain and other distressing symptoms, providing psychological, social, and spiritual support to individuals, and supporting their key people such as; family members; friends; individual's carers; and others with whom the individual has a supportive relationship. Palliative care can be provided at any stage in the progression of an individual’s illness, not only in the last days of an individual’s life when the focus of treatment has generally moved from trying to actively manage disease and prevent deterioration to managing the individual’s symptoms and keeping the individuals comfortable. The most difficult and sensitive decisions through the process of dying are often those around starting, or stopping, potentially life prolonging treatments such as cardio pulmonary resuscitation, renal dialysis, clinically assisted for nutrition and hydration, and mechanical ventilation. These treatments have many potential benefits including extending the lives of the individuals who otherwise might die from their underlying condition. But in some circumstances they may only prolong the process of dying or cause to the individual unnecessary distress. The benefits, burdens and risks of these treatments are not always well understood and concerns can arise about over or under treatment, particularly where there is uncertainty about the clinical effect of a treatment on the individual, or about how the benefits and burdens for that individual are being assessed. Doctors and nurses, with other members of the team, such as; line manager, religious representatives, specialist nurse, occupational or other therapist, social worker, GP, district nurses, nurses who specialise in a specific disease, specialist palliative care nurses, physiotherapists, counsellors, spiritual care coordinators or chaplains, and key people involved in the decision making process may also be unclear about what is legally and ethically permissible, especially in relation to decisions to stop a potentially life prolonging treatment.
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Adapt support to reflect the individual’s changing needs or responses (3 pages to answer the question)
To adapt support to reflect the individual’s changing needs or responses, make think why the individual needs or responses are changing. Individual’s changing needs or responses can be cause due to many factors. Be aware of possible signs of dementia in the individuals with whom you work. Dementia is a term used to describe various different brain disorders that have in common a serious loss of brain function that is usually progressive and eventually severe, in an individual previously unimpaired, beyond what might be expected from normal aging. That means, when individuals seen confused in their needs or responses, it's can be cause of dementia. In the majority of situations, change might be in relation to; changing environments (example ward to ward, hospital to home, home or hospital to residential care); changing physical and/or mental conditions and functioning; and sudden disability. Adapt support to reflect the individual’s changing needs or responses are best meet with an Advance Care Planning. Advance Care Planning is a process of discussion between an individual and the people in their support network. It usually takes place when it is expected that an individual’s condition is likely to deteriorate and following serious deterioration, the individual may not be able to make decisions or communicate their wishes. Make decisions or communicate the wishes of the individuals, pass through by many methods of communication, including; the individual’s preferred spoken language; the use of signs; symbols; pictures; writing; objects of reference; communication passports; other non verbal forms of communication; human and technological aids to communication. An Advance Care Planning must be reviewed regularly and will include the type of care and support the individual requires as things change.
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What an Advance Care Planning plan and discussion is likely to include? An Advance Care Planning plan and discussion is likely to include: -
Any concerns the individual may have
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Their most important values or personal requirements for care and support
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Their understanding about their illness
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Preferences about the care or treatment that may be beneficial and available in future
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Where they might want to be at the end of their life
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Whet her they need to make a Will
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What arrangements they would like to be made after death, for example, funeral, flowers, gifts, donations
Some individuals will be proactive and feel the need to discuss all of these, whilst others may not wish to discuss it at all. Individuals can make decisions about medical treatment and procedures which are legally binding, for example, an individual can request that they are not resuscitated if their heart stops. This will be dependent on the individual’s views and culture and any requirements an individual has must be carefully documented. In my work place; a dementia residential nursing home, there are a number of different conditions that lead to dementia, including Alzheimer's disease, vascular disease (including stroke) and dementia with Lewy bodies. There are 750 000 people with dementia in the UK. Each individual will experience dementia differently, but there will usually be: -
A decline in memory, reasoning and communication skills
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A gradual loss of the skills needed to carry out daily activities
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Confusion
Symptoms of dementia can be classified as either reversible or irreversible and include loss of memory, confusion and problems with speech and understanding. Page 108 of 120
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Especially in the later stages of the dementia condition, an individual affected might be disoriented about the following: -
Time; for example, not knowing what day of the week, day of the month, or even what year it is.
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Place; for example, not knowing where they are or getting lost.
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Person; for example, not knowing who they are or others around them.
Adapting support to reflect the individual’s changing needs or responses, make think to provide active support to enable individuals and key people including; family; friends; carers; others with whom the individual has a supportive relationship, to identify and communicate any changes that have taken place or are about to take place and the impact they have had/may have on their lives and their preferences associated with the change. I will use the correct techniques and methods; that include; timings; hygiene; use of equipment; safe disposal; and recording information, to use or need to develop to cope with and manage the change. Also, I will identify any risks associated with the change. Risks could include the possibility of danger; damage and destruction to the environment and goods; injury and harm to people; self-harm; bullying; abuse; and reckless behaviour. I will identify with individuals and key people, the expertise and experience they have and that which is available within their own support groups to enable them to prepare for the change. I actively support individuals to identify and communicate any additional resources, support or expertise they need to adapt to and manage the change, by supporting individuals, key people and others to identify any risks associated with the individuals’ preferred options to deal with the change. I will work with individuals, key people and others to plan how they will deal with and manage the change and any associated risks, agreeing how the processes and outcomes will be monitored and reviewed.
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Assess when an individual and key people need to be alone (1 page to answer the question)
It's easy to know when an individual, and when key people need to be alone, because there are signs that show an individual, and key people including; family; friends; carers; others with whom the individual has a supportive relationship; signs that show they need to be alone.
Signs that show you need to be alone Everyone has their own unique traits that bubble to the surface when in need of some personal space. You need to learn to recognise your own signs, but if you have trouble doing this the general rule is that if you start pushing people away then you need some time alone. Some examples are: -
Being mono-syllabic; conversations are supposed to be fun two-way social interactions
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Itching to be elsewhere; if you are out and you desperately want to be home then go and take some time for yourself
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Unexplained moodiness; if you feel cranky for no reason, you probably need some time alone
Usually individual and key people need to be alone when they are sad, or when they feel depressed.
To assess when an individual, and when key people need to be alone are very important, especially in case of support an individual at the end of life care. Having time alone, helps the individual and key people, to relax, to put things in perspective, and to think for after the death of the individual at the end of life care. Losing a loved one means a total change in the routine of own private life; we always regret what we did not said, and the absence of the individual in everyday life is the harder to accept. The time can heal but the heart can't forget. Page 110 of 120
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Task 9 be able to take action following the death of individuals
Explain why it is important to know about an individual’s wishes for their after-death care (2 pages to answer the question)
It is important to know about an individual's wishes for their after death care to know their last wills, by being aware of their wishes including cultural or spiritual needs, will help to respect the beliefs of the individual; what the individuals want for their after death care. To know about an individual's wishes, beginning with the transition from home, and having regard to the least restrictive alternative, the individual’s wishes should be considered at all stages of the care process. There is a role for an independent advocate in assisting the individual at the end of life to make a decision about their care and treatment, if and when required. In this regard, knowledge of the individual’s wishes or any advance directive made prior to the onset of incapacity should be central to decision making. While there is no legislation at present to underpin advance directives, either formal and informal, they are a means of ensuring wishes are respected following the onset of incapacity and not just at the end of life. It is important to show respect for desires and wishes of the individuals while providing for their holistic needs (physical, social, psychological and spiritual.) Respecting the rights and wishes of the individual pass through the communication with the individuals at the end of life and their key people; key people are those people who are important to an individual’s health and social well being. These are people in the individual’s life who can make a difference to their health and well being. Key people can help in assisting individual at the end of life, in eliciting competent care and support compatible with their wishes. Also, it is fundamental to establish a compassionate effective communication and information giving in all care interventions, such as; maintenance of comfort, dignity, safety and respect for wishes for the individuals at the end of life, and their key people.
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Individuals through the process of dying in hospitals and in nursing homes need to require good quality fundamental care, such as; attention to their comfort, dignity, safety and respect for their wishes. As their needs become greater and their levels of distress become more difficult to address, some may require enhanced, advanced and ultimately complex care. Complex care may involve specialists in palliative care, but it might equally involve experts in psychological or spiritual well being, if that is where the need exists. Knowing their wishes after their death will be respected, the individuals through the process of dying will feel a bit relieved and free of obstacles to feel in peace, because they know their wishes and beliefs including cultural or spiritual needs, will be respected.
Carry out actions immediately following a death that respect the individual’s wishes and follow agreed ways of working (3 pages to answer the question)
Exemplification: Actions may include: - Attending to the body of the deceased - Reporting the death through agreed channels - Informing key people
Agreed ways of working will include policies and procedures where these exist
Carry out actions immediately following a death that respect the individual’s wishes and follow agreed ways of working, and attending to the body of the deceased, mean caring for the body. The funeral director will take care of your relative’s or friend’s body and will wash them.
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This process is different for different religions and cultures but usually involves carefully washing and drying the body, closing the eyelids, and making sure their mouth is supported while closed. The person’s hair is tidied and sometimes washed. The funeral director will also ask if you’d like them to be dressed in any specific clothes, such as a favourite outfit. If you’d like to help the funeral directors wash and dress your relative or friend, let them know as soon as possible so they can arrange this. Some people want to be embalmed. This is when the body is disinfected and treated with chemicals to help preserve it. Blood is drained out of the body and replaced with embalming fluid. This is carried out at the funeral directors.
Carry out actions immediately following a death that respect the individual’s wishes and follow agreed ways of working, and reporting the death through agreed channels, mean you need to take the medical death certificate - and birth and marriage certificates - to the registrar’s office in the area where the death occurred. This needs to be done within five days. Some registrars’ offices have an appointment system, so check before you go. You can find the number of your local registrar’s office listed under Registration of births, deaths and marriages in the business section of your local phone book. It may also be on the envelope containing the death certificate. If you’re not able to go yourself, another person can act as an ‘informant’ and register the death for you. Before you attend the registrar’s office, it’s helpful to think about how many copies of the death certificate you might need. You can buy ‘certified copies’ for a small charge at the time of registration. These are duplicate original certified copies and not photocopies. You’ll usually need one certified copy for each life insurance policy (or similar) that you need to claim. At the registrar’s office, they will enter details of the death in the register and give you a certificate of burial or cremation. You need to give this to the funeral director. The registrar will also give you a certificate of registration of death, if this is needed for social security purposes. Your district or palliative care nurse can give you information about what to do when someone dies.
Carry out actions immediately following a death that respect the individual’s wishes and follow agreed ways of working, and informing key people such as; family members, friends, others who were important to the well being of the individual, means to inform the personal GP of the dead individual. Page 113 of 120
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What the GP will do? If your relative or friend dies in a hospital or hospice, the nursing staff will be nearby. They will guide you through what needs to be done over the next few hours. If your relative or friend dies at home, you’ll need to let their GP or district nurse know what’s happened within a few hours. The GP or a district nurse will come as soon as possible to confirm the death. This is also known as verifying the death. If the GP comes, they will verify the death and give you a medical certificate for the cause of death with a form called Notice to informant, which tells you how to register the death. If a district nurse comes, or you have to call an out-of-hours doctor, they can verify the death but you may need to get the death certificate from your GP the following day. When you have the medical death certificate, you need to take this to the local registrar’s office to register the death.
Policies and procedures that are include in agreed ways of working that underpin the care of deceased individuals, can be meet when dealing with a deceased person's money and property. (See page 18)
Accessing a deceased person's property 'Property' includes houses, real estate generally, shares, antiques, jewellery, works of art, and intangible property such as patents and copyrights. If the deceased held property in their sole name, and they left a valid will dealing with the property, then the property will usually pass in accordance with the will. If the deceased left no valid will, or a will that did not deal with the property, it is dealt with under the law of intestacy. If the deceased held property with another person or persons, the deceased's executor or administrator needs to find out how the property was owned. Where the property is a house, there should be written documentary evidence of the type of ownership. Jointly owned property If the deceased person owned property with another person or persons as 'beneficial joint tenants', the deceased person's share automatically passes to the surviving joint owner(s). Property owned as joint tenants does not form part of a deceased person's estate on death. But the value of the deceased person's share of jointly owned property is included when calculating the value of the estate for Inheritance Tax purposes. In other cases, where the deceased person owned property with another person or persons, the deceased person's share of the property forms part of their estate and is dealt with by the executor under the terms of the will or by the administrator under the law of intestacy. Page 114 of 120
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Describe ways to support key people immediately following an individual’s death (2 pages to answer the question)
There are many ways, immediately following an individual's death, to support key people such as; family members, friends, others who were important to the well being of the individual. Classic ways are to present your sincere condolence to the key people, to write a letter of condolence, to say some words of sympathy. The death of a loved one is a personal emotion and people handle their grief in several different ways. Grief is an intense and powerful emotion for the bereaved. It is possible to support key people through the grieving process with compassion, understanding and kindness.
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Cultures have different ways of coping with death The grief felt for the loss of loved ones occurs in people of all ages and cultures. Different cultures, however, have different myths and mysteries about death that affect the attitudes, beliefs, and practices of the bereaved. Personal experiences of grief are similar in different cultures. The ways in which people of all cultures feel grief personally are similar. This has been found to be true even though different cultures have different mourning ceremonies and traditions to express grief. Cultural issues that affect people who are dealing with the loss of a loved one include rituals, beliefs, and roles. Helping key people to cope with the death of a loved one includes showing respect for the family’s culture and the ways they honour the death. Death, grief, and mourning are normal life events. All cultures have practices that best meet their needs for dealing with death. Other members of the team, including; line manager; religious representatives; specialist nurse; occupational or other therapist; and social worker; who understand the ways different cultures respond to death, can help key people of these cultures work through their own normal grieving process. Spiritual support can help best, when losing a loved one.
Task 10 be able to manage own feelings in relation to the dying or death of individuals
Identify ways to manage own feelings in relation to an individual’s dying or death (3 pages to answer the question)
Ways to manage own feelings in relation to an individual’s death, take time. Page 116 of 120
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After the death The death of someone close to you is a very significant event in a person’s life and everyone reacts differently. You may feel shocked and numb, as though you cannot believe that it has happened. You may have lots of overwhelming emotions, such as feeling extremely upset and angry. Many people find they also feel very relieved that their relative or friend can now be at peace. Most cultures and religions have processes or rituals that they carry out at the time of death. It’s important for you to do what you feel is right. There may be some things that you need to do. However, you don’t usually need to do anything straight away, so you don’t have to feel rushed. You can just sit with your relative’s or friend’s body for a while. Many people like to sit and talk or hold hands, and see their relative or friend at peace, especially if the last few hours or days were a strain. You may want to have someone there to support you. It may help to ask them to contact other people to let them know, if you don’t feel up to telling them. A spiritual or religious adviser can also support you and carry out any processes or rituals that are important to you and your relative or friend.
Emotional effects The death of a partner, relative or close friend is an extremely difficult situation to face and you may feel very upset, anxious and distressed. Immediately after the death, and for some time afterwards, you may feel numb and find it hard to believe that the person is dead. It’s common to feel angry that they have died. This anger may be directed at the person them self for leaving you, or at other people, such as family members or health professionals, for not being able to save them from dying. The feeling of missing the person can be overwhelming. Many people continue to see or hear the person who has died, and have a strong sense of their presence. For example, some people walk into a room and have an experience of seeing the person sitting in their favourite armchair. Other people have vivid dreams in which they see the dead person as fit and well. These are perfectly normal experiences, although they can be shocking and upsetting. Page 117 of 120
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My professional experience Working with individuals living with dementia is a very rewarding job. Undeniably you become close to your residents and the departure (and not the death, because this is not the end) of a resident affect me at different levels, but I always try to stay professional and to think this way, this is the last cycle of physical life, and this is normal. I am not worried because I know everything is true; Jesus; the life after death; and meeting of loved ones. Having faith makes things easier and acceptable.
My personal experience I lost my father the 25 November 2006 at 10.30am, heart attack at home, fatal, no time to say goodbye. I remember my last words, I said in French "À plus le père." (French is my mother language) "À plus le père" mean "See you later father" The 25 November 2006 at 10 am, the ambulance car and the people from hospital were at home, checking my father health, speaking in a "professional hospital language" I couldn't understand anything and I did not understand the gravity of the situation. I thought my father would be back after few days in hospital, this is why I said "See you later father" It’s may sound stupid now, but I really thought my father would be back home after few days in hospital, and everything gonna be alright after that. In 2006, I wasn't believer. I mean I was like everybody from my age in France, you know this "the science explains everything" attitude. I heard it's a "two year question" to accept to lose a loved one. This is bullshit, everybody personal life is different; the one who wrote that is a moron. I was 23 and it took me more than three years to accept the death of my father and to do the mourn I’m a level designer/texture artist of video game in France. www.droppeddeadgame.com My artworks helped me during this period of time to survive without my father around me, in my life. Page 118 of 120
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HSC 3048 Support individuals at the end of life by Gaël Romanet
We are now in 2013 and it is still difficult for me to write this, the words open my scars that I believed closed. My father was manic depressive with bipolar trouble, he fell at the age of 33 in this shit, there no other word. When my father was 33, I was 3 years old; it means that I have known my father, all the time sick and sleeping, inactive, drop dead on the bed due of the strong medicaments. Not capable to start and to finish something during 20 years. I did feel very angry about it, I mean I was angry inside me because of the inactivity of my father, but it was not his fault, to fall in severe depression and to not be able to make surface, to take the bull by the horns, to fight for me. I grow up like this, my mum done what she could. She has never left my father. The video games were the only way for me to exteriorise all this pain. I'm still angry inside me against all the people of my village in France that never came in 20 years, to help, to give a hand to my father, to finish the construction of the family home. I don't believe in friendship because sooner or later you will be disappointed. I am not worried, I am now in peace because I met Jesus, and I know they all will be judged by their acts. Also, I met my girlfriend; I left everything for her, my job in France, my family, and the family home. My girlfriend is born on 25 November, date of my father's death. Friday, March 14, 2008, in the afternoon, I was digging in my garden in France by turning the ground with my shovel, when I found a metal box with a letter inside, wrote by my father, addressed to me, to tell me he love me.
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gaelromanet.com/HSC3048.pdf
HSC 3048 Support individuals at the end of life by Gaël Romanet
Utilise support systems to deal with own feelings in relation to an individual’s dying or death (1 page to answer the question)
Support systems to deal with own feelings in relation to an individual's dying or death would be the workplace setting and family and friends. The death of someone close can be a life changing experience. If you are the primary caregiver of someone you love, this experience can affect every aspect of your life for some time. It is natural to grieve the death of a loved one before, during, and after the actual time of their passing. The process of accepting the unacceptable is what grieving is about. Often portrayed as a grief “wheel”, these stages do not necessarily follow a set order. Some stages may be revisited many times as an individual goes through a grieving period. Shock emotional; release depression; loneliness; and a sense of isolation physical; symptoms of distress; feelings of panic; a sense of guilt; anger or rage; inability to return to usual activities; and the gradual regaining of hope. Acceptance as we adjust our lives to reality. Most people who have lost someone close go through all or some of these stages, although not necessarily in this specific order. This kind of healthy grieving can help a person move through a significant loss with minimal harm to self, either physical or mental. My own support systems to deal with own feelings in relation to an individual's dying or death is my faith in Jesus. If you woke up suddenly, every night at 3.33am, during a large period of your life, I hope you know what it means; it's The Lord Jesus Christ who knocks at you, maybe he want to tell you, "I want a special relationship with you" Believe! Everything is true, it is the truth.
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gaelromanet.com/HSC3048.pdf
