End of life care

“Here we will explain to you your job role and accountability. We will inform you of what to expect of your employer and what they should expect of you. We will highlight the importance of working within your job role and how to fulfill your duty of care.”

Death is an inevitable part of our job role. We look after those who are at their final stages of life. We are entrusted to carry out our roles with dignity and efficiently. Taking into account the needs and wishes of the individual. We aim to support their choices at end of life to fulfill the individuals desires even when they are unable to communicate. Documentation of end of life decisions are so important, to complete these early on means the individual can have comfort in knowing those caring for them have a clear understanding of the individuals wishes and preferences.  There are many contributing factors that change an individuals decision, we aim to explain this to you so you too can be holistic in the end of life care you provide to an individual. 

At the end of life.

Pray End of life Caught an angel – Tony Luciani. Photo (left) subject to copyright

In general within a care setting most deaths are expected, as the individual ages or has a condition that is deteriorating it is good practice to plan ahead, those who are preparing will have an end of life or advanced care plan. This will stipulate the individuals wishes and preferences. As a health care assistant you must ensure you acknowledge and adhere to all wishes and preferences held by the individual. Music and environmental choices, religious and cultural aspects are all the choices that makes an individuals death as unique as they are and must be respected as such. speaking to family, friends and professionals all requires documentation.

Your role will include:

Washing and dressing, at this stage of an individuals life it is not required to have a shower or bath. Moving of an individual at the final stage can cause more damage than necessary. By this stage the individual would have lost all mobility and strength in their muscles. Transferring would include use of machinery such as a hoist. Light bed baths and a gentle freshen up with a warm flannel is acceptable. Continue to wash areas that have cream applied regularly as the skin must be clean before new application and some creams are flammable which left unattended can become a fire risk.  

Keeping accurate records of the individuals daily care received and interactions had, any medication, personal care, creams, positions charts, pressure areas, continence aids, food and fluid charts, by the very final stages of life individuals will be nil by mouth where they are unable to eat and drink, you may need to provide mouth care, where a small soft baby brush or lip balm may be available to clean around the lips and mouth to remove any phlegm or mucus expelled.

Skin will change colour and become withdrawn on the body, pulling the facial features back and revealing an open mouth, breathing becomes slower and saliva is reduced. This is why mouth care is so important.

Syringe driver: some individuals require a syringe driver to provide regular medication administration, these must only be used and supplied by the nurses on duty, there must be two nurses present to check, supply and administer the drug through a syringe driver. Do not under any circumstances administer or help with the administration of a syringe driver if you are not a nurse. When providing personal care with a syringe driver be very aware of the box and the tube that leads to the injection point, do your best to roll the individual away from the injection point and ensure the box is safely moved the to head or foot of the bed.

If you notice any changes with the individual report to the nurse immediately.

After death.

Follow the wishes of the individual. A person’s death is as unique as they are and should be conducted as per their choices if they have recorded them. This can vary based on life experiences, personal choices – including:

Cultural aspects of an individuals life can path the way for their choices in life, marriage and death. What we feel, believe or need spiritually can influence our funerals, such as 

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Individuals religion will guide their decision process for example to plan to have a reading of: The last rites, in Catholicism, are the last prayers and ministrations given to an individual of the faith, when possible, shortly before death. Click each point for detailed guidance.

After an individual passes they will require a gentle wash, hair brush and to be dressed in their clothing of choice, ready to be collected by their service of choice. if you do not yet feel comfortable to take part in the laying out, discuss with your team leader/line manager or manager, to gain extra support and help. By buddying up or standing to one side just observing. You can speak to other colleagues about their experience, having open discussions can also contribute towards professional growth, it can be used as evidence in NVQ or supervisions within work.

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Duties after death will include: 

Speaking to the relatives and friends, other staff members and professionals to inform them of the individuals passing.

Documenting final records and collecting personal items and effects for family to collect.

 This time spent with all participants should be a calm, relaxed experience while continuing to treat the individual with respect and dignity.

Have an unanswered question? Contact us today and we will help you to find an answer.

Grievance path - for the loss of someone.

During our research we have found there is not much support for health care assistants who have experienced death and need support.

As a health care assistant, who is part of an individual’s daily life, you will experience a bond, it is only natural. We would not be in our job roles if we were not genuine, kind, approachable people who an individual can build a rapport with and trust to provide care and support through physical and mental wellbeing. This will mean that when an individual passes we will too experience grief in the same way we would when losing a loved one, sometimes to us it can reflect on a time of losing a grandparent or parent.

Even the most experienced staff member must take time to reflect on a death of a patient. We can always ask ourselves ‘Could that have gone any better? Or worse?’ As each experience will differ from the next we will continue to learn through our own self-reflection and understanding.