Aim Whether or not someone can, or should, eat and drink in the last hours and days of life is a dilemma faced by patients, their families and staff. A perception that food or drink has been withheld, and consequently contributed to death, can cause significant distress to bereaved relatives. This project aims to equip Health Care Professionals (HCPs) with the skills to assess the wishes and needs of dying patients, and develop a plan of care with patients and their ´families´ regarding eating and drinking.
Design Following review of local audits of care of the dying and initial training sessions with palliative care staff, a half-day interactive training session was developed focusing on:
• Clinical assessment and benefits
• Professional guidelines and the law
• Ethical decision making in clinical practice
• Conversations and documentation.
The session was refined following feedback from participants, a teaching resource pack developed and team-teaching utilised to ensure consistent delivery by different facilitators. Training was offered to all HCPs working across a locality in the North of England.
Results Training sessions were fully booked with 323 trained in the first six months. Participants were multi professional (nurse 38%, health care assistant 25%, doctor 24%, other 13%) and from a variety of settings (care home 43%, hospital 32%, community 11%, hospice 14%). Feedback was excellent and comments demonstrated the session had been thought provoking and enjoyable.
Lessons Learnt Participants report clinical decision making and the accompanying conversations about eating and drinking for dying patients is challenging. Differentiating between ´food and drink´ and ´clinically assisted hydration and nutrition´ is valuable.
Uniting staff with different experiences stimulated excellent reflective debate and shared learning. Staff report increased confidence to develop and review plans in accordance with patients’ wishes. This session is now part of ongoing end of life training locally.
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