Facilitator: Step 5 Welcome group, housekeeping, register (handout 1). Ice breaker of choice if you wish. Ground rules to flip chart for weekly display.

Review / Recap Step 4 workshop review Review of ‘To Do’ List Reflection discussions Step 4 revisit/summary – ask participants to identify one thing they learned from the step 4 workshop Discuss homework completions – ‘To Do’ list and reflection piece Facilitator to emphasise that evidence may be used for QCF end of life unit, award, certificate – if undertaking now or in the future.

Objectives Step 5 objectives: • Recognise the changes that occur in the dying phase • Identify the role of the Domiciliary Care Worker in the dying phase • Have an understanding of the use of End of Life Care Plans for the dying patient and the care of the individual on a syringe driver • Know how to care for relatives, significant others, other individuals and colleagues with professionalism and sensitivity • Support religious, cultural and spiritual care Progress through ppt as prompt screens

Care in the last days of life Step 5 Care in the last days of life “ It is vital that care workers can recognise the dying phase and take appropriate action. How someone dies remains a lasting memory for relatives, friends and care workers.” The Route to Success in End of Life Care – achieving quality in domiciliary care Review RTS workbook pages 19-20

Changes in the dying phase Anticipated changes Unexpected changes Unexpected improvement in condition Pain Breathing pattern change Chest secretions Altered level of consciousness Change in facial features Colour / temperature change Incontinence Nausea/vomiting Agitation Discussion with participants of their experiences of the changes in the dying phase, support sheet 8, additional facilitator handouts of symptoms and role Include unexpected improvements Discuss the role of the DCW Leading to syringe driver use (anticipatory prescribing as covered prior step 3 discussion) next slide...

District Nurse responsibility Syringe driver use Continuous medication delivery method via the subcutaneous layer Management of: Pain Nausea/sickness Secretions/breathing difficulty Agitation District Nurse responsibility Insert picture of local syringe driver used. Syringe driver model for discussion and demonstration of handling if possible *not for demonstration of use Discuss when to contact the District Nurse about the syringe driver

End of Life Care Plan (or equivalent) Should provide clear guidance on: Physical : ensure comfort Psychological : reduce distress & anxiety Religious / spiritual : respected & addressed Social : involvement of loved ones Discuss and explain the End of Life Care Plan that is being implemented in your locality ( pass around to look at – discuss if seen in use in domiciliary care setting) Discuss how this may change care worker’s role and support in last days of life

Care of others Support Practical Relatives Financial Friends Physical Neighbours Emotional Significant others Practical - may include transport, accommodation, meals, pets, possessions, INFORMATION & EXPLAINATION Financial – may relate to signposting for funding, parking, increased care needs, Physical – provision of care to the individual, assistance to relative, involvement in care delivery Emotional - ... Emotional support, information in understandable terms, honesty, Consider the extent that others want to be involved and participate in care in balance with what the individual's preferences are/were Does the individual wish for the family/carer/significant others to be involved in discussions?

Religious, cultural and spiritual care Religion: a specific set of fundamental beliefs, values and practices Culture: ideas, customs, values, behaviours and attitudes of society Spirituality: relates to or affects the human spirit; deeply individual www.queenscourt.org.uk/spirit/ Group work – review religious customs cards/handouts and feedback key points to group about the identified religious beliefs Facilitator to identify the importance of knowing the individuals beliefs and values to ensure they are met prior to and after death. Emphasis also of cultural differences and spirituality Direct to website Relevant handouts may be added

Objectives Step 5 objectives: • Recognise the changes that occur in the dying phase • Identify the role of the Domiciliary Care Worker in the dying phase • Have an understanding of the use of End of Life Care Plans for the dying patient and the care of the individual on a syringe driver • Know how to care for relatives, significant others, other individuals and colleagues with professionalism and sensitivity • Support religious, cultural and spiritual care Progress through ppt as prompt screens

Onwards... ‘To Do’ List Reflective practice Evaluation of session Next session: Step 6: Care after death on: