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HOW DO COMMUNITY NURSES DECIDE WHEN TO USE ANTICIPATORY PRESCRIPTIONS IN END OF LIFE CARE AND WHAT DO THEY WORRY ABOUT? FINDINGS FROM A QUALITATIVE STUDY
  1. E Wilson1,
  2. H Morbey2,
  3. J Brown3,
  4. S Payne2,
  5. C Seale4 and
  6. J Seymour1
  1. 1University of Nottingham, UK
  2. 2Lancaster University, UK
  3. 3De Montfort University, UK
  4. 4Brunel University, UK

    Abstract

    Introduction In the UK, a key approach to improving end of life care has been the introduction of ‘anticipatory’ or ‘just in case’ prescriptions (APs). Nurses are often responsible for deciding when to use APs, but little is known about their experiences.

    Aim(s) and method(s) To examine nurses' decisions, aims and concerns when using APs for patients cared for in the community. An ethnographic study in two UK regions, with community nursing teams and nursing homes. Observations and interviews were conducted with nurses involved in using APs.

    Results Observations (n=83) and interviews (n=61) with community nurses. Nurses identified five ‘conditions’ that needed to be established before they implemented an AP: a) irreversibility; b) no other methods of relief; c) patient unable to take oral medication; d) where the patient was able, they should consent; e) decision had to be independent of demands or request from patient's relatives. By using APs, nurses sought to: enable patients to be ‘comfortable and settled’ by provision of gradual relief of symptoms at the lowest dose possible. They aimed to respond quickly to needs, seeking to avoid hospital admission or medical call out. Nurses sought to ‘do it by the book’, adhering strictly to local prescribing policies and guidelines. Some worried about: distinguishing between pain and agitation, balancing risks of under and over medication and the possibility of hastening death.

    Conclusion(s) Nurses have a leading role in the administration of APs. Nurses applied consideration and caution to the administration of APs with the expressed aim of relieving symptoms and distress.

    • Supportive care
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    • Supportive care

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