The Last 48 Hours of Life in Long‐Term Care: A Focused Chart Audit

Hall, Pippa; Schroder, Cori; Weaver, Lynda

doi:10.1046/j.1532-5415.2002.50117.x

Cited by 131 publications

(98 citation statements)

References 28 publications

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“…Nevertheless, substantial proportions of patients dying in hospitals or nursing homes were shown to have received poor symptom control and insufficient emotional support [10][11][12][13][14][15]. The study to understand prognoses and preferences for outcomes and risks of treatments among bereaved relatives in the USA also concluded that many patients dying in hospitals have unmet needs concerning symptom relief and psychosocial care [11,16].…”

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confidence: 99%

The last 3 days of life in three different care settings in The Netherlands

Veerbeek

Zuylen

Swart³

et al. 2007

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Introduction Little is known about the characteristics of dying in different care settings, such as the hospital, the nursing home, or the home-care setting. Materials and methods We measured the burden of symptoms, medical and nursing interventions, and aspects of communication during the last 3 days of life within each of these settings. We included 239 of 321 patients (74%) who died in one of these settings in the southwest of The Netherlands, between November 2003 and February 2005. After the patient's death, a nurse filled in a questionnaire. Results Pain and shortness of breath were more severe in hospital patients as compared to nursing home and homecare patients, whereas incontinence was less severe in hospital patients. Several medical interventions, such as a syringe driver, vena punctures or lab tests, radiology or ECG, antibiotics, and drainage of body fluids were more often applied during the last 3 days of life to hospital patients than to nursing home and home-care patients. This also holds for the measurement of body temperature and blood pressure. In the hospital setting, the patient and the family were more often informed about the imminence of death of the patient than elsewhere. The general practitioner and other professional caregivers were less often informed about the imminence of death of hospital patients than of other patients. Discussion We conclude that pain and shortness of breath were more severe among hospital patients, whereas incontinence was more severe among nursing home and home-care patients. Hospital patients relatively often receive medical interventions and standard controls during the last 3 days of life. In hospital, communication about impending death seems to take place more often shortly before death.

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The last 3 days of life in three different care settings in The Netherlands

Veerbeek

Zuylen

Swart³

et al. 2007

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“…Residential aged care facilities are a recognised place of dying (Hall et al, 2002;Wowchuk et al, 2007) and will be more so in the future, therefore, it is important for managers and staff to acknowledge this aspect of their service delivery and determine ways in which end of life care issues can be addressed, in a proactive approach to care. It is noteworthy that both facilities needed to improve various aspects of end of life care and that both groups identified similar concerns in end of life care, however, each facility prioritised their thematic concerns differently.…”

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confidence: 99%

“…Palliative literature has predominately been related to symptoms and symptom management in people dying from cancer (Brandt et al, 2005;Hall, Schroder & Weaver, 2002). Interestingly, symptom management in non malignant disease was highlighted in the literature of the 1960s, but it did not gain the recognition it deserved.…”

Section: End Of Life Symptoms In Non Malignant Diseasesmentioning

confidence: 99%

“…Firstly, dyspnoea has been identified by a number of authors as occurring frequently in dying people (Brown, & Von Roenn, 2004;Goodridge, Bond, Cameron & McKean, 2005;Hall et al, 2002). For example, Goodridge et al (2005) identified dyspnoea in most of the 15 deaths the authors reviewed over a six month period.…”

Section: The End Of Life Symptom Of Dyspnoeamentioning

confidence: 99%

“…The authors' concerns were reiterated by Von Gunten (2005), who estimated "1.4 million persons" in the United States die with undertreated dyspnoea (p. S93). Similarly, Hall et al (2002) performed a retrospective chart audit of 185 residents' notes, who had died in five Canadian long term care facilities, focusing on the last 48 hours of life. The authors identified "almost one-quarter of those with dyspnea, the most prevalent symptom in this study, had no documented intervention" (p. 505).…”

Section: The End Of Life Symptom Of Dyspnoeamentioning

confidence: 99%

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Dying in a rural residential aged care facility: An action research and reflection project to improve end‐of‐life care to residents with a non‐malignant disease

Rowley

Taylor

2011

Int J of Nursing Practice

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Rowley, J 2010, 'Dying in a rural residential aged care facility: an action research and reflection project to improve end of life care to residents with a non-malignant disease ', PhD thesis, Southern Cross University, Lismore, NSW. THESIS DECLARATIONI certify that the work presented in this thesis is, to the best of my knowledge and belief, original, expect as acknowledged in the text, and the material has not been submitted, either in whole or in part, for a degree at this or any other University. Special thanks, is reserved for my husband Greg, whose loving, extensive support helped me to achieve completion. In addition, to our children Dylan and Amber, who lovingly supported me throughout this journey.This thesis is dedicated to the memory of my father, Donald Raymond Riley.iii ABSTRACT This qualitative research explored end of life care provided to people dying with a non malignant disease in two Australian rural, residential aged care facilities.Residential aged care facilities provide end of life care for many people dying from non malignant diseases. The illness trajectory in non malignant diseases can be difficult to predict and symptom management can be challenging.Further, as the Australian population ages, the demand for optimal end of life care for frail, older people is anticipated to increase. Therefore, this study aimed to explore issues as identified by nurses and relatives of residents dying from a non malignant disease in order to examine ways in which nurses can provide nursing care that maximises the likelihood of a good death, identify the barriers nurses perceive to prevent optimal end of life care to dying residents, and explore the relationships between nurses and relatives of the dying resident, with the intention of improving care.Following ethical clearance, 14 aged care staff overall within both facilities were recruited to the project. Participants included Registered Nurses, Enrolled Nurses, Assistants in Nursing and other aged care staff personnel, all of whom were in a carer relationship with a dying resident. In addition, eight relatives of dying residents were interviewed, using individual, face to face, semi structured interviews.Taylor's (2006) 13 step action research and reflection method was incorporated into five main phases, including foundation building, reflection on practice iv stories, identifying thematic concerns, action plan creation, implementation and critical reflection. In both facilities, group meetings were held weekly for up to 19 weeks. Data were gathered using combinations of reflective drawing, practice stories, interviews and surveys.Relatives' interview transcripts were incorporated into the nurses' group meetings, so that end of life care issues of importance to relatives were shared, with the intention of assisting the nurses to examine the nature of aged care nursing and relationships that occur with relatives of the dying resident. This project demonstrated that it is possible to establish a working relationship with aged care nurses, with no prio...

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