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End-of-Life care for older people in the acute hospital setting
  1. Liz Onslow
  1. Liz Onslow is Nursing Advisor for Older People — Acute Care, Older People and Long-term Conditions Team, Parliamentary and Health Service Ombudsman, London. Email: Lizonslow{at}aol.com

Abstract

Hospital-based staff members, particularly nurses, provide the majority of end-of-life care for older people. Older patients who are dying in hospital have complex end-of-life care needs as a result of increased risk of drug reaction, iatrogenic disease and comorbidity, which are often superimposed on pre-existing mental or physical deficits. This article discusses the challenges faced by nurses who wish to provide effective end-of-life care in the hospital setting. It examines the difficulty nurses experience providing such care in the face of their limited training and experience related to end-of-life care. The importance of nurses recognising when a patient is dying and accepting that fact without a demoralising sense of failure is discussed, along with the need for open and inclusive conversations about death and dying, involving the dying patient, the patient’s family and the multidisciplinary team. The need to provide person-centred nursing care via the use of an integrated care pathway specifically designed for dying patients and adapted to the hospital setting is discussed. Conflicts of interest: none

  • Communication
  • Education
  • End-of-life care
  • Older patients
  • Secondary care

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