Eleanor’s blog – July 2014

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Last month I wrote about the importance of finding out about someone’s spirituality to help you provide good quality personalised care and support. I wrote about the need to consider spirituality in its widest context so that we could better understand a person’s values, beliefs and motivations. Knowing what gives meaning to a person’s life, the factors that have contributed to shaping their identity and which bring comfort in times of need and distress, is particularly important when caring for people at the end of their life.

Over the past two years there have been regular reports in the press concerning the need to improve the quality of end of life care. Each one has yet again highlighted the need to improve communication between health and social care practitioners and the person, their relatives and carers. In addition a lack of sensitivity and failure to meet the person’s individual needs have been consistent omissions in the care provided.

Each one of us would choose to have a ‘good death’ but does that mean the same to each of us? There are definitely some similarities in what we would choose e.g. to be free from pain, to be cared for where we feel safe. However, there are also differences too, for example where we would like to die.
Understanding someone’s spirituality can help health and social care practitioners to understand what lies behind the choices that the person makes about their care at any stage of their life but particularly those they make, if they can, at the end of their life. Knowing this enables practitioners to work with the person, their relatives and carers to provide appropriate and sensitive care in their preferred place of care.

The current focus in health and social care is to support more people to die at home. This assumes that dying at home is everyone’s preferred choice, whereas in reality this isn’t necessarily the case. Some people would prefer to die somewhere other than at home, be that in a hospice, hospital or care home. This choice is often made because the person does not what their relatives to bear the burden of caring for them or doesn’t want the memories of their last days to linger in their home after they have gone as they feel this may distress their family more. For others they just feel safer being in a place in which they have more immediate access to care and support.

Getting end of life care wrong through a lack of understanding of the person’s individual needs and preferences can make a difficult time more difficult for the person and those around them. It can also have a lasting impact for the person’s relatives and carers and complicate their grief as they struggle with feelings of guilt and anger if what happened went against the person’s wishes, values and beliefs or these were ignored altogether.
Over 50% of complaints received in hospitals relate to just these types of issues, where a lack of communication and understanding of the individuals’ needs and wishes have led to poor end of life experiences for the person who died and their relatives and carers.

One way to improve the quality of end of life care is through having a conversation with the people you care for and support and/or their relatives and carers about their spirituality. These conversations provide a place to explore these important issues and documenting the person’s values, beliefs, preferences can then be used to inform future care plans. If we plan for something it is more likely to happen. Recent research around future care planning has shown that when these are in place the person is more likely to be cared for in their preferred place with better organised and co-ordinated care.
So one way to increase the chances of the person having what they would consider to be a ‘good death’ is to know what that means for them and to use this information to plan ahead in time to make it a reality.
You can find out more about improving end of life care and spiritual care here.
Until next time …..