About this resource

This resource has been developed for you by the Royal College of Nursing (RCN) and is designed to offer you support in your delivery of appropriate end of life care alongside your existing training, with a particular focus on nutrition and hydration.

Who is it for?

This resource is for any registered nurse, student nurse, health care assistant (HCA) or assistant practitioner working in any healthcare setting or specialism. The aim is to give you an understanding of your role when it comes to meeting the nutritional and hydration needs of people with life limiting illnesses. You can work through this resource at your own pace either all at once, or by one of the “bite sized” pieces of learning whenever it is convenient for you.

What is end of life care?

Every year more than half a million people die in the United Kingdom, and most of these deaths occur in hospitals. While some deaths occur suddenly, the majority of deaths occur after a period of chronic illness. During this time people often require ongoing care which may include end of life care.

End of life care is support for people who are approaching death. It helps them to live as well as possible until they die, and to die with dignity. It also includes support for their family or carers.

Within End of Life care there are few areas that are as medically, ethically, and culturally complex as providing hydration and nutrition to a patient.

Why was the resource developed?

This resource has been developed using information from the 2014 RCN End of Life care survey which showed that staff wanted more education and information around caring for people at the end of life. In addition the resource was informed by an independent review of evidence relating to nutrition and hydration at the end of life and expert opinion. The same issues relating to poor care at the end of life were also identified in the recent Parliamentary and Health Service Ombudsman report, Dying without dignity (2015).

This resource goes some way to address some of the issues raised in these reports.

The content within this resource reflects guidance recommended in the key priorities and principles from the four countries and is therefore applicable and beneficial to nurses across the UK. It also reflects compliance with the RCN’s Principles of Nursing Practice. The resource is not fully comprehensive but provides a broad overview of many topics and is intended to stimulate you into seeking further information in areas of particular interest or pertinence to their area of practice.

This demonstrates the commitments made by the RCN to improve end of life care following more care less pathway (Neuberger 2013).

Learning outcomes

After completing all the sections in this learning resource, you should:

  • know why nutrition and hydration is important to an individual with a life limiting illness
  • have an improved understanding of how to recognise the changing nutritional and hydration needs of the individual at the end of their life and the impact of these changes on those close to them and how to respond to these
  • have improved confidence in communicating and discussing the dying process and its impact on eating and drinking with people reaching the end of life and those close to them
  • be aware of any ethical questions that might arise when providing nutrition and hydration support and how to address these
  • provide good, clear and straightforward information to patients and their families in regard to their nutrition and hydration care
  • be aware of and recognise the barriers or fear individuals and those close to them may feel about discussing the dying process and its impact on eating and drinking
  • have an improved understanding of the need for documented evidence of sensitive communication
  • know how to communicate and have open discussions with individuals reaching the end of their life and those close to them around nutrition and hydration needs and any decisions relating to the withdrawal of this
  • have an improved understanding of the importance of the individual’s and their family’s point of view and experience of end of life care
  • have a greater awareness of the impact a person’s cultural and spiritual beliefs has on the management of their nutritional and hydration needs at end of life.

Feedback

We hope you find this resource useful and enjoy using it. Do show it to your friends and colleagues, and let your employers know about it too. We welcome your feedback about this online induction resource and invite you to share your views about your learning experience.

Reflection

We invite you to complete our reflective learning diary which will comply with the NMC revalidation process.

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