I am a rehab support worker at flat three of the accomplishments for wellness ( 2009 ) model. within a multidisciplinary squad of nurses. therapy and health care. This brooding history looks at my engagement and part to the attention of an aged gentleman. nursed in his ain place life with his married woman who provided him with nursing attention between his private carer visits. The gentleman was besides having attention from a private bureau and had territory nurse engagement. as his status worsened he had been referred by his physician to a specializer alleviant attention squad who assessed the patient and put him on the Liverpool Care Pathway ( LCP ) . The LPC is a best-practice theoretical account of attention. back uping attention in the last hours/days of life driving the quality of attention we give to patients and relations ( Ellershaw and Wilkinson. 2011 ) . The LCP was developed 1997 as an integrated attention tract enabling us to concentrate on the quality of attention bringing. back uping the person and household demands. Supplying ongoing appraisal. attention after decease. clear certification and screens physical. psychological. societal and religious demands. ( LCP Pocket Guide 2011 ) .

For this contemplation I will be utilizing the Gibb`s ( 1988 ) brooding rhythm as a usher to concentrate on my actions. ideas and engagement but besides to assist me reflect on the ideas and actions of all the people ; carers. household and the patient that were involved. I feel comfy utilizing the prompts in the Gibb`s rhythm as they are clearly set out and follow a logical way I besides feel it is an appropriate tool for this degree of survey. In line with ; the NHS confidentially codes of pattern ( 2003 ) . the Data Protection Act ( 1998 ) and the NMC Code ( 2008 ) I have protected the patients confidentiality and renamed him John. It was agreed that we would provide support to the private bureau attention squad that were already in topographic point as Johns attention demands increased. I have had experience nursing alleviative patients from when I worked on an aged attention ward. but there I had the full support of the nursing staff and had non been a lone worker. I had non had experience caring for a patient on the LCP.

I personally felt reassured to be doubled with bureau carers as I felt they would hold anterior cognition of the household and patient and have a relationship that would be valuable for me to larn from but besides the acquaintance would be reassuring for the household. doing it easier to accept us as new carers in their place. Before my first visit with the patient I thought reflectively about my Fathers go throughing. about how. three old ages ago. he had died in a hospital appraisal unit that was badly equipped to cover with our emotional or my father`s hurting control needs. he was non on a alleviative tract and on contemplation the nursing and caring staff didn`t have the communicating accomplishments or cognition needed to ease a “good decease. ” My father’s decease left me angry and baffled and with a sense that I and the nursing staff should hold done more. Jasper ( 2003 ) discusses that contemplation should be taking our experiences as a starting point for larning. Therefore believing about them in a purposeful manner we can come to understand them otherwise and take action as a consequence. By making this I identified that I needed to hold cognition of the LPC and besides of alleviative attention to guarantee that I provided the best quality attention.

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The NMC codification ( 2008 ) says that people in our attention must be able to swear us with their wellness and well-being. utilizing a high criterion of pattern at all times. That I must confer with and take advice from co-workers when appropriate and I must present attention based on the best available grounds or best pattern. eventually that I must recognize and work within the bounds of my ain competency. Without cognizing John or his household I had decided non to allow my personal experience influence my attention. but that I would besides make all that I could to back up and care for John and non avoid what may be delicate and hard conversations and inquiries. Deborah Murphy. associate manager and lead nurse for the Marie Curie Palliative attention Institute. in an article for the International Journal Of Palliative nursing ( 2011 ) writes: Good clear communicating is polar. it is clear from the experiences of relations and carers that when there is a high degree of communicating and battle. the last hours or yearss of life are managed more efficaciously and with greater attention and compassion.

The World Health Organisation ( 2010 ) defines alleviative attention as: An attack that improves the quality of life of patients and their households confronting jobs associated with life endangering unwellness. through the bar and alleviation of agony by agencies of early designation and faultless appraisal and intervention of hurting and other jobs. physical. psychosocial and religious. It is besides our responsibility to back up John and his wife`s in their determination for John to decease at place. Department of wellness ( 2008 ) patients should hold a pick over the attention they receive and where. On my reaching at Johns I met the private attention worker. Gail ( made up name ) . waiting for me outside the house. we sat in my auto as she wished to rapidly discus the patient. The auto being more private than the street and she did non desire to hold the conversation in John`s house for fright of upsetting his household. She informed me John was now merely being nursed on the bed and that motion seemed to do hurting and agitation. John besides had a force per unit area sore under his pot crease and was taking small or no diet and merely sips of H2O which was straitening his married woman.

Gail besides informed me that although John appeared to be kiping he was in fact really cognizant of his milieus and his general wellness had declined greatly in the last 48 hours. This was John`s forenoon visit. John`s married woman was tired and agitated because John had slept severely and she had been awake all dark go toing to John and told us she was afraid to go forth him entirely. I introduced myself. placing my occupation rubric and which nursing squad I was from and reassured her we would take good attention of John and that she could take this clip to sit and hold some breakfast and a cup of tea in peace as Gail knew John and was familiar with his demands. John although tired was chatty and we gained consent to rinse and alter his nightshirt. we had to be really careful making this as motion and touch caused John uncomfortableness. John declined to be rolled on the bed so we were unable to rinse or analyze his sacrum. On observation Gail pointed out that Johns sore appeared worse than the twenty-four hours before and was concerned that we had non rolled John to rinse his sacrum.

Talking to John we established he had had a good wash the dark before. had non had his bowels moved since and that the wash had caused him trouble which had kept him wake up all dark. John was more disquieted for his wife`s wellness and deficiency of remainder. I went to the kitchen and talked to john`s married woman. explained that I would wish to phone the territory nurse ( DN ) who was supplying lesion attention to describe and set up a visit and that John was clean and comfy explicating why John had non had a full wash. I besides talked to John`s married woman about seeking to set uping a dark sit. Using the contact Numberss in the LPC booklet I contacted the DN to describe the status of john`s wound site and arranged a visit for later that twenty-four hours and with consent contacted my squads nurse co-ordinator to explicate the DN visit and about set uping a dark sit. I did this so our patient records could be rapidly and accurately updated and the information cascaded to my co-workers before their visits. I so documented all actions and conversations in John`s notes. Decision

John`s married woman was visited by a nurse from the alleviative squad and a dark sit was arranged. she was worried that she may non be at that place when John died but was reassured that the Sitter would be experienced and professional and would wake her if John worsened in the dark. This reassurance allowed her to rest and our increased input besides allowed her to return to being John`s married woman and non John`s nurse. With the LPC I felt I had all the information needed to supply quality attention to John. the tract besides empowered me to back up his married woman through effectual communicating ( Ellershaw and Murphy. 2003. ) It besides allowed me deliver attention in a patient centred and holistic manor as the accent was John`s needs non our nursing desire to “tick boxes” . As suggested in The End of Life Strategy ( Dept. Health 2008 ) . “How we care for the death is an index of how we care for all ill and vulnerable people.

It is a step of society as a whole and it is a litmus trial for wellness and societal care” We continued to input nursing attention for John until his passing. John Died pain free and in his ain place his demands met and his determinations and wants at the bosom of his attention ( Dept. Health. 2011 ) . his household supported through this hard clip. The LCP provided all of us with a tool to ease joined up working and the proviso of close seamless attention. after reading John`s attention program I knew his and his family`s wants. his diagnosings and past medical history. it was besides noted that John and his married woman had a strong Christian religion. The attention program besides contained a list of all the carers and attention squads involved along with their contact inside informations. which made communicating and multi-disciplinary working easier. In acknowledgment of all the carer’s nurses and physician and the regard and difficult work involved presenting this consequence I feel that it needs to be written that although the LPC is a great tool. any tool is merely every bit good as the worker that uses it.


Deborah Murphy. ( 2003 ) . Nurses’ perceptual experiences of the Liverpool. International Journal of Palliative Nursing. . 9 ( 9 ) . 375-381.

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