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

2. 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.

3. 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

4. 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

5. 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...

6. 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

7. 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

8. 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?

9. 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
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

10. 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

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