Table 6

Night time nursing roles of Hospice at Home team

Liaison with community-based staff at night
  • Liaising with out of hours nurses and GPs in order to obtain appropriate symptom relief during the night (repositioning, prescription of medications, administration of medications)

Pharmacological symptom management
  • Administering ‘as required’ and ‘just in case medicines’ such as midazolam, diamorphine, lorazepam, glycopyrronium (qualified nurses only)

Specialist assessment
  • ‘Going in cold’ to homes of new patients with very little prior knowledge in order to assess end-of-life care needs and report back to all concerned. Difficult as environment usually not suited to end-of-life care.

After death care
  • Liaising with family, GPs and funeral homes to initiate post death proceedings

  • Remaining with and comforting carers until body removed from home

  • Safeguarding, passing on to higher authorities any abuse of patients and carers detected during night time conversations

  • Acting as buffers between large families and patients who needed to rest

  • Challenging ineffective drug regimes

Fundamental nursing care
  • Pressure area care, general hygiene, comfort and reassurance

Psychological support for patient and family
  • Offering counselling to distressed patients and family members