Over time, end of life care has been heavily influenced by the systems of religion, ethics and spirituality. The Sikh religion was started by Guru Nanak Dev Ji in 1469. It has a unique philosophical understanding of life, death and God which can be relevant to commonly encountered clinical scenarios. Concepts such as ‘Ik-Oankar’, Hukam (God’s will), ego and karma all influence how practising Sikhs respond to situations in everyday life. Understanding the spiritual underpinnings of the Sikh religion is therefore important for clinicians caring for this group of patients. This article will explore the fundamental concepts of the Sikh religion and how these apply to common scenarios encountered within palliative care.
Aim: The aim was to gain an understanding of what the United Kingdom (UK) Punjabi Sikh community understands and thinks about advance care planning (ACP). This is in response to evidence showing a lack of service usage by Black, Asian, and Minority Ethnic groups. Methods: Surveys containing questions about the impressions of terms, advance decisions for care, do-not-attempt-resuscitation, and lasting power of attorney were taken to targeted community groups; these included community day centers, sporting groups, temples, and social media circles. Surveys were available in both Punjabi and English languages. Results: A total of 311 surveys were received in total. There was a 50/50 gender split and a mixed group of ages; 75% were born in the UK and 15% were born in Punjab, India. Only a third had some understanding of what ACP meant. Nearly 50% of the participants did express wishes toward the end of their life, however only a third of the respondents knew how to access services. Cardiopulmonary resuscitation was felt to be mandatory by 36%. Sixty percent thought that their decision would be legally binding in relatives who do not have capacity. Conclusion: This study showed that wishes for religious rites were common, however many do not know how to make them known. If they do know about services, then people are highly likely to engage with the ACP process.
Warren, et al., 2021, Nursing Times. 117: 34) and developed for the Palliative and End of Life Care module as part of the Post Qualifying programme.Evidence shows us that people with learning disabilities experience extensive health inequalities which impacts on mortality (Heslop et al., 2013; NIHR, 2020). In addition, the quality of palliative care received by this group can contribute to poorer outcomes that are often avoidable (Hospice UK, 2021). Using suitable methods of communication to impart information in a format that allows for deeper understanding opens potential for greater quality of life and expectancy (Heslop et al., 2013; NIHR 2020). Aim To practice the skill of 'Breaking Bad News' to people with learning disabilities, by using actors in simulated patient scenarios. Methods On MS Teams in small groups, with a facilitator, to engage all learners in an interactive, authentic and safe experience with an actor. Varied scenarios were used to demonstrate breaking bad news to a person with learning disabilities. Results Reflective evaluative feedback from students demonstrate a deeper confidence in breaking bad news. This included a perceived lessening of anxiety when involved in discussing Breaking Bad News in practice generally after being involved with simulation. Confirmation of online simulation as a valuable practical skills-based learning experience. Conclusion This is now embedded in the Post Qualifying Introduction to Palliative and End of Life Care module and is applicable to a wider workforce approach including practitioners both generalist and those working within Learning Disabilities and End of Life Care. This is a focus of co-author doctorate studies.
Fatigue is a particularly vague, yet significant symptom, which is commonly encountered in primary care. It affects a wide range of patients and has many causes. With an ageing population, fatigue is more likely to be multifactorial towards the end of a person’s life, and this can provide challenges in recognition and management. Patients are often incapacitated due to their fatigue and helping to manage it can lead to an improved quality of life. This article aims to briefly summarise the symptoms of fatigue, how to recognise it and the various causes. Current literature on the management of fatigue in end-of-life care, including pharmacological options, is critically reviewed.
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