Learner name: Ursu Nina

Assessor name:

Signature:
Signature:

Unit start date:

Unit completion date:

Date

Evidence
type/numbe
r

Feedback from assessor

Unit number: Y/503/8689

Unit title: Understand how to provide
support when working in end of life care
Internal verifier (if applicable)
Action (what needs to be completed, by whom
and when)

Learner Feedback (to be completed once the unit is signed as complete e.g. how will completing this unit help in your job role, was it appropriate etc)

1
BHFT. QCF: Y/503/8689. Final 12 November 2015

BTEC Level 3 Award in Awareness of working in End of Life Care

Unit 2: Understand How to Provide Support When Working in End
of Life Care
Unit reference number: Y/503/8689
QCF level: 3
Credit value: 4
Guided learning hours: 33
Unit aim
The aim of unit is to support learners in developing the knowledge and understanding
needed to be able to provide support for individuals and others in end of life situations.

Unit introduction
This unit introduces learners to the current approaches to end of life care. Learners will
examine the impact of national and local drivers on current approaches, and evaluate a
range of tools that can support workers in end of life situations.
Learners will consider models of grief and loss, and how they can be used to support
individuals as they face death. Learners will gain an understanding of the factors that may
affect communication in end of life situations, and examine ways of providing support to
individuals.
Learners will investigate the various symptoms that individuals experience, and Investigate
the different techniques used to relieve these symptoms.

Assessment guidance
This unit must be assessed in accordance with Skills for Care and Development's
QCF Assessment Principles.

Essential resources
There are no special resources needed for this unit.
Workbook appendices at back of workbook:
- Appendices 1-4: Information relevant to completion of workbook tasks
- Appendix 5: Unit learning outcomes, assessment criteria and unit amplification

BHFT. QCF: Y/503/8689. Final 12 November 2015

Workbook: Understand how to provide support when working in End of Life Care
Unit Reference number: Y/503/8689
This Workbook is designed to supplement the learning from the face-to-face taught
sessions, helping to link classroom learning to practice & to support learning in the
workplace. This Level 3 Unit builds on Unit EOL A/503/8085. Some of the activities will be
very similar; however you will be expected to answer in more depth. When you are
working through the activities in this Workbook please do remember that you will need to be
able to show evidence that you have achieved the Learning Outcome for each section and
you should aim to have more than one piece of evidence for each Learning Outcome.
There are a range of activities in this Workbook:
1. Those that involve looking at policy or theory & applying them to your workplace.
2. E-learning activities.
3. Reflective accounts or scenarios where you write about the care you have given to a
service user.
When you are writing about the care you have given to a service user please use I when
describing what you did: for example when writing about a time you supported a service user
when they had lost a close family member or a friend.
When I was helping Mr P to have his bath he started talking to me about another service
user Mrs. J, who had been transferred to hospital and had died there. He said that he
hoped he would not have to go back to hospital. As he was talking openly about this I asked
him what he would like to happen if he became less well? Mr P said that he would really like
to stay in here in the care home as he knew all the staff. I asked him if he had talked to
anyone else about this or had written it down. Mr P said he had not and was only thinking
about it because of Mrs J. I asked him if he would like to talk about this more after his bath,
he said yes he would.
You may like to share some of the information you gain from this Workbook with colleagues
or to create a resource file for your workplace. Please feel free to telephone or email me if
you need any support or guidance as you work thorough these activities.
Good Luck!
Joy Baker
Course Lead (Health & Social Care) Apprenticeship and Workforce Development
Bracknell & Wokingham College
E-mail: joy.baker@bracknell.ac.uk. Tel: 01344 766683
Liz Rankin. End of Life Care Facilitator
Berkshire Healthcare NHS Foundation Trust (BHFT)
E-mail: liz.rankin@berkshire.nhs.uk Tel: 07789504568

BHFT. QCF: Y/503/8689. Final 12 November 2015

Learning Outcome 1:
Understand current approaches to End of Life Care (EOLC)
This Learning Outcome looks at the impact of policy and use of tools which support end of
life care. Take time to review your answers for Unit EOL A/503/8085, Learning Outcome 2
before attempting any of the learning activities.

Analyse the Impact of National and Local Drivers on Current Approaches to EOLC.

Drivers are the influences that make something happen or bring about a change (Skills
for Care).
National Drivers.
The importance of providing high quality End of Life Care in whatever setting that death
occurs was recognised in the End of Life Care Strategy (2008) and remains high on the
political agenda. The Strategy as a National Driver identified 12 key areas with related
actions and recommendations and the EOLC Pathway (Appendix 1); it also provided a
framework and EOLC tools which have led nationally to improved and better co-ordinated
EOLC.
Other national drivers influencing end of life care include: society, pressure groups, the
media, providers of care, Care Quality Commission (CQC), national organisations promoting
best practice in health & social care e.g. National Council for Palliative Care (NCPC), The
Liverpool Care Pathway (LCP) and the Leadership Alliance for the Care of Dying People
(LACDP), National Palliative and End of Life Care Partnership, Coalitions such as Dying
Matters, national or government strategies. (Appendix 1)
Local Drivers
The End of Life Care Strategy (2008) is the main driver influencing local East Berkshire
EOLC Strategies and led to the setting up of a local EOLC steering group and the
development of policies, protocols and tools within East Berkshire to promote quality end of
life care for all.
Ambitions for Palliative and End of Life Care
In 2015 The National Palliative and End of Life Care Partnership, made up of statutory
bodies including the Association of Adult Social Services, NHS England and groups and
charities representing patients and professionals, produced a framework for action building
on the End Of Life Care Strategy. The national framework is called: Ambitions for Palliative
and End of Life Care: A national framework for local action 2015-2020.
The framework recognised that with the increased emphasis on local decision making in
palliative and end of life care provision, local organisations such as Clinical Commissioning
Groups (CCGs), local authorities etc. needed to be responsible for leading and delivering
Palliative and End of Life Care. They wanted the framework to be shared ..with local leaders
in every community whether they work in the statutory, private or voluntary sectors. We
expect them to plan and act, using this framework, so that these ambitions can be brought
into reality.
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BHFT. QCF: Y/503/8689. Final 12 November 2015

The framework for action includes an overarching vision and six ambitions or
principles for how care should be delivered to those nearing death at a local level.
The six ambitions are:
1) Each person is seen as an individual
2) Each person gets fair access to care
3) Maximising comfort and well being
4) Care is coordinated
5) All staff are prepared to care
6) Each community is prepared to help
(www.endoflifecareambitions.org.uk)

Task 1 (3 questions)
The EOLC Strategy identified 12 key areas (see appendix 1). Reflect on the care you have
given to an EOL service user and their family/carers.
Analyse to what extent the 3 key areas below were addressed by your team or the
wider community service when caring for the service user.
Also, consider if there are any changes that you would recommend for future care to
ensure these areas are better addressed.
1. Identifying people approaching EOL
2. Rapid access to care
3. Involving and supporting carers

1. The people that approach EOL can be people that suffer of one of fallow diseases:
Alzheimer
Dementia
Motor Neuron Diseases
Cancer
Old age

2. Rapid access to care in Care Home

Care Home is a controlled environment where the residents or any change in them
conditions are closely monitored and the next steps will be fallowed:
Inform GP
asses the medical condition of resident,
the resident will be on EOL care
change of medication - if necessary provide medication for EOL
amount of care, asses if the needs are changed and what are the new requirements;
ensure that the psychological, spiritual and psychical needs are met.

Ensure dignity and Privacy is maintained.

As part of our care philosophy all staff in our Care Home follows our own core principles
which ensure everyones privacy and dignity is maintained at all times:

Choice and control we give all of our residents as much choice as is possible
around both their care and environment.
Communication we ensure that staff communicate clearly to our residents and
listen to their views.
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BHFT. QCF: Y/503/8689. Final 12 November 2015

Privacy all of our staff are aware of the need for privacy. All of our residents have a
single room with en suite facilities. Doors are lockable from the inside if people prefer
this and staff always knock before entering anyones room.
Social inclusion we recognize that the community and families play a vital role in
the well being of our residents. We encourage residents to stay fully involved in all
aspects of community life.
Personal hygiene our staff ensure that our residents are encouraged to maintain
high levels of hygiene in every stage (e.g. high level of care in EOLC when the
residents is incontinent) to ensure that they do not feel embarrassed or humiliated
Maintain independence people keep a level of self respect if they can be as
independent as possible. We will always be there to help, but also seek to promote
independence for our residents wherever this is possible.
Pain management controlling pain is paramount when dealing with someones
dignity. We have staff trained in pain relief and recognizing the signs of pain if
someone is unable to express this verbally.
Eating and nutritional care we encourage people to retain independence with
eating and drinking, but recognize that their dignity may be compromised if they
become messy as a result. We deal with this in a sensitive manner and reduce any
stigma that may result.

3. Involving and supporting carers

Nursing home is an environment where the resident is already assisted by dedicated
carers and nurses with their daily needs, they recognise the staff, the environment is
familiar, they are aware about what is happening around them so from this point of
view there are not relevant changes.
For this reason most of the times the family or the residents prefer that within the last
weeks/days of life to remain in the nursing home instead to be sent into the hospital
for prevent traumatic experiences in a new environment and without a relevant result.

(1.1) A considerable amount was written and reported in the media about the Liverpool Care
Pathway (appendix 2). What were the main areas of concern and what happened as a
result of these concerns?
The LCP should be a way to ensure that the patient died a peaceful and dignified death but
sometimes was used as a tick box exercise
The communication is the main problem in LCP the families not always know the
relatives are on LCP and will died;
The terminology is confusing and disturbing
Hydration & nutrition not always addressed properly
Use of syringe pumps not always explained
(1.1)

What needs to be in place to ensure that the Six Ambitions of the Ambitions for
Palliative and End of Life Care are in place within your work setting?

1.1 For ensure that the six ambitions of the Ambitions for Palliative and EOL Care are in
place within my work setting we should have an individualised care plan Planning my
future care focused on the 5 priorities of care.

2
Evaluate how a range of tools for End of Life Care can support
the individuals and others: 1) Gold Standards Framework meetings 2) EOLC register &
EOLC Guidance 3) Advance Care Plan 4) Individualised End of Life Care Plan.
6
You will be given handouts on all four End of Life CareBHFT.
toolsQCF:
to consider.
Y/503/8689. Final 12 November 2015

Task 2:
Choose 3 of the 4 EOLC tools and evaluate the extent to which they would be useful in practice.
Include in your answer:
i
An explanation of the extent to which they support the service user
ii
Allow discussions to be initiated, recorded and shared as appropriate.
iii
Any other advantages/disadvantages?
Gold Standards Framework meetings
Gold Standards Framework also know as End of Life Care Meeting or Palliative Care Meeting has the
main goal to:
Indentify - the patients in the final year of life and to identify approximately where they are on
their EOL trajectory using GSF Needs Based Coding for estimate possible current and future
needs and to be able to better plan and provide best care also to include them in GSF register
Asses needs Asses the likely needs of patients, clinical and personal, current and future.
Holistic assessment
Advance care planning
To be considered carers needs early
Plan for better care develop an action plan of care, use 7 Cs key tasks, anticipate current and
future needs, practice multidisciplinary meetings, team work with district nurse clinical specialist,
Community Matrons,
EOLC register & EOLC Guidance
A palliative care register should be produced listing all the patients receiving palliative care and likely to
be in the last 12 months of life.
The main goals are
to keep them condition manageable in the community
to ensure rapid access to services and to met them needs(ex. repeat prescription, visit by
relevant practitioners, etc.)
Advance Care Plan
Advance Care Plan is a structured discussion with patients and their families or carers about their wishes
and thoughts for the future. Although such discussions may have occurred informally before, it was not
occurring with all relevant people or being communicated to others. So the offer of an advance care plan for
every appropriate person is now recognised as very important and a key part of good care
The process of Advance care planning includes many elements essentially helping people approaching the
end of their life to describe and clarify

What they want to happen

What they dont want to happen

Who will speak for them

Individualised End of Life Care Plan

Any resident in EOLC should be assessed and in base of them Advanced Care Plan and after
discussion with relevant parties a End of Life Care Plan should be implemented and should contain all
wishes and wills of resident before and after.
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BHFT. QCF: Y/503/8689. Final 12 November 2015

Task 3: (1.3) Analyse the stages of the end of life care pathway
In the first unit you reflected on the extent to which the care you delivered to a service user
was delivered using the stages of the End of Life Care Pathway.
Review the EOLC Pathway (appendix 3) and analyse each stage. List to what extent each
stage is implemented at your place of work and identify where and how improvements (if
any) could be made to ensure that stage of the pathway is properly addressed?
End of life care pathway:
Step 1
Liaise with clinical personnel: GP, District nurse regarding the persons condition
Understand if the latest test result or treatments suggest deteriorating in the persons
condition.
Observe the service user daily for any changes in their signs and symptoms that
would lead to understand the person is nearing the last few days of life e.g. noisy
respirations, mottled skin, fatigue, agitation, loss of appetite, increased incontinence
or loss of consciousness.
Step 2
Assess the service users current level of communication and their mental capacity,
including how much they wish to know or can understand when talking with them.
Arrange for a competent person to talk to the service user about their prognosis and
provide the person with accurate information about their condition, respecting their
right of denial and without giving false hope.
Assessment, advance care planning, personal preferences and wishes or advance
decisions to refuse treatment in place or review if already exist a GSF meeting
between GP, service user and/or family, care home, nurse, multidisciplinary specialist
and other persons implicated will be hold for planning the further steps of EOLC.
Indentify a named person for the service user to liaise with about care and treatment
Discuss with the patient or family (if the persons lack capacity) how much
involvement they want in decision making when nearing the end of life.
Step 3
Coordination of care
Strategic coordination
Coordination of individual care
Rapid response services
Step 4
Delivery of high quality services in different settings respecting the patient wishes
Step 5
Care in the last day of life provide the EOL medication if necessary, review of
needs and preferences for place of death, recognition of wishes, support for both
carer and patient
Maintaining hydration discuss the importance of hydration including just sips of
water with the service user or family
Step 6
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Care after death recognition that end of life does not finish at the point of death,
verification of death, care and support of carer and family including emotional and
practical bereavement support.
In our care home EOLC process is very complex and fallow the national and home
procedures. Every case is different and we treat all of residents in an individual
approach so in case of EOLC there is a team meeting shared decision making
(professionals and family), having as baseline the advance care plan and others tools
as GSF, EOLC or Palliative care meeting, the decisions are always made in the best
interest of the resident.
For this I cant tell how to improve or to change something because always is
individual and fallow the wishes of patient and family having the professionals advice
and support.

Learning Outcome 2:
Understand the individuals response to their anticipated death
(2.1) Evaluate models of loss and grief
(See appendix 4 for more information on the three models of grief and loss)
Models that describe loss & grief can help us to understand the range of emotions an
individual can face during loss & bereavement. These models give us an idea of what is
considered normal or usual; they can help us not only provide appropriate care to the
individual but also to identify when an individual may need specialist help.

Three models of loss & grief

1) Kubler-Ross (1969): Five Stages of Grief
2) Worden(2010) : The Four tasks of mourning
3) Stroebe and Schutt (1999) : Dual Process Model

Task 4
-

Explain the extent to which two of the models could help you understand the
reactions a service user or their family might experience when faced with loss and
grief.

Also identify any problems or limitations with each model.

The Kubler-Ross and Stroebe and Schutt (Dual Process Model) models help me to
understand better the reaction of service users or their family that might experience when
faced with loss and grief and was easier to recognize the stage of this models when I met
people in EOLC.
I think both of models cover well what we feel and our reaction and also have limitations
because each person is so different and our reaction are so unpredicted and unexpected in
hard moments.
There is not a recipe, there is not a way to feel or to do we are individual and unique, most of
the time is important also who is near us because that persons can see more clear, can
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BHFT. QCF: Y/503/8689. Final 12 November 2015

guide us to something else a new experience a new beginning or only make us to

understand it is the time to do peace and to accept because the life is this sometimes bittersweet, even if we speak about death.
Kruber Ross 1969: Five Stages of Grief

Kubler-Ross' first stage is Denial. In this stage, grieving people are unable or
unwilling to accept that the loss has taken (or will shortly take) place. It can feel
as though they are experiencing a bad dream, that the loss is unreal, and they
are waiting to "wake up" as though from a dream, expecting that things will be
normal.
After people have passed through denial and accepted that the loss has occurred
(or will shortly occur), they may begin to feel Anger at the loss and the
unfairness of it. They may become angry at the person who has been lost (or is
dying). Feelings of abandonment may also occur.
Bargaining. In this stage, people beg their "higher power" to undo the loss,
saying things along the lines of, "I'll change if you bring her (or him) back to me".
This phase usually involves promises of better behavior or significant life
changes which will be made in exchange for the reversal of the loss.
Once it becomes clear that Anger and Bargaining are not going to reverse the
loss, people may then sink into a Depression stage where they confront the
inevitability and reality of the loss and their own helplessness to change it.
During this period, grieving people may cry, experience sleep or eating habit
changes, or withdraw from other relationships and activities while they process
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BHFT. QCF: Y/503/8689. Final 12 November 2015

the loss they have sustained. People may also blame themselves for having
caused or in some way contributed to their loss, whether or not this is justified.
Finally (if all goes according to Dr. Kubler-Ross's plan), people enter a stage
of Acceptance where they have processed their initial grief emotions, are able
to accept that the loss has occurred and cannot be undone, and are once again
able to plan for their futures and re-engage in daily life.

Dual Process Model of Coping with Grief by Stroebe and Schut (2001),

This natural process helps us find the balance between facing the reality of our
loss and learning to live our life after loss. This explains why many of us feel like
we are on an emotional roller coaster, and you may find it helpful to know that
this too is normal.
Loss-oriented responses include grieving, crying, thinking about your loved
one and that strong desire to curl up under the covers and never come out.
Restoration-oriented responses include learning new skills, such as how to
manage the family finances, forming new relationships, and taking on roles your
loved one may have left vacant. During restoration-oriented activities, you are
able to focus on day-to-day tasks and get at least temporary relief from the
emotional drain of your loss.
So when you are in a raw state of grief, how do you know what normal is? Most
of us will experience grief on a physical, emotional, psychological, and spiritual
level. You may feel distracted, tired, agitated, forgetful, and even be short
tempered with innocent bystanders. Stomachaches and frequent sighing is not
uncommon. You may find that one moment you are crying, and in the next
moment you are laughing over a happy memory. There is a long list of common
responses to loss, and generally speaking as long as you have no strong desire
to hurt yourself or someone else, your grief i normal
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BHFT. QCF: Y/503/8689. Final 12 November 2015

(2.2) Describe how to support the individual throughout each stage of grief

(2.3) Explain the need to explore with each individual their own specific area of concern
as they face death.
(2.4) Describe how an individuals awareness of Spirituality may change as people
approach End of Life.
Within your care environment you may not see people very often after they have been
bereaved. However, people can experience grief or loss before death, this may be the
service user grieving for their loss of independence or their loved ones grieving as death
approaches. You may have service users who are themselves grieving the death of a loved
one and you will have to support them through this process. What is important to individuals
will vary and the role of religion & spirituality in their life will be different, may change over
time and can change as death approaches. Some service users may practice their faith
regularly whereas others may have a strong sense of spirituality but do not adhere to any
religious group.
2.2 The communication and emotional support are important factors in assisting
someone that pass thought any of stage of grief like I told any person is different
and the response should be individual, it is important that the person feel the
love and psychologically, psychically (if necessary) and emotionally support from
family, friends and people that need to offer care and assistance (nurse, carers,
etc.). In my work place most of the residents suffer from a Mental problem and
sometimes there are not change in them behaviour (seem to dont understand
that are near end) In this case we make sure they receive the best care and are
comfortable and free of pain, them wishes and wants as in Advance care Plan are
respected, the dignity and privacy is maintained in all aspects, also we try to
make possible they will spend as much time as possible with people that they
love.
2.3 In my case is difficult to explore them concerns due to them lack of Mental
Capacity to communicate them concerns. We try to understand, anticipate them
needs and to ensure they will receive a high level of care, treatment and support
that they need for be comfortable and free of pain.
2.4 The awareness of Spirituality I think it is a very important way to change the
perception of what is happening even if you are the person in the last days of
life, you have someone that is in this situation or in any stage of our life. To try
to understand the souls needs to try to understand the sense of life, the life
stage will help everyone to make peace, to forgive and forget and to open the
heart and mind to a another kind to understanding and to live and love the
present moment.
Like someone told to me We are coming and we are going this is sure, important
is the journey, to understand what is important for us, to do experiences, to grow
all times as individual and soul and to discover who you are, to be in love and
in connection with yourself and others and if is possible with the Universe, this
will make all of us reach and in that moment the fear to everything (inclusive
death) will disappear .

Task 5:
Identify a service user or carer who has experienced or anticipated a loss while you
were caring for them.
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BHFT. QCF: Y/503/8689. Final 12 November 2015

Write a sentence or two outlining who they were and the events that occurred
Describe the knowledge, skills and resources you required to support them through
all the stages of loss and grief.
Explain why it was important to explore with them their own specific concerns as they
or their relative/friend faced death.
Did they express any thoughts about spirituality, describe these? Also, describe how
their views or an individuals views in general may change as they approach the end
of their life.

I know a wonderful woman (she is my friend) married with two children 15 years old at that
moment and 5 year ago she discovered she has cancer (I noticed she passed through the
five stages of Kubler-Ross model).
I was all time near her in this journey (was a journey and a strong experience for me also),
because Im doing yoga, I study psychology and Im passionate about new age philosophy I
tried to involve her in a research of herself, later when she accepted finally the diseases and
make peace with herself she begun to check the reason of diseases, she found a lot of
answers in spirituality, learned to heard her soul and her body, what she really wish and is
important for herself not others, also she changed life-style and her alimentation and now is
much better, the diseases is stable but in the same time seem to dont be any more
important this fact.
She did the changes in her life and when I speak with her she tell to me how happy is now
and also she tell me that diseases save her life because now she know what is important
and every day is a new beginning, a new lesson, a new experience and that make her
happy.
This is only an example how to transform a negative experience in something positive.
It is easier to fall in depression when we are ill and is very hard to feel positive also is very
difficult to change your habits and I think the illness is an alarm sign that tell us we need to
do something and we receive a lot of this alarm signs along our existence.
What we need to learn and to teach others is to listen our body to be all time in change, to
live beautiful, to do something for ourselves every moment and also to accept the death as
part of life, as something natural, to remember we are humans and more important than how
much we live is how we live our life.
Also to prevent is more important, more easy and not so expensive that to cure.

Learning Outcome 3:
Understand factors regarding communication for those involved in End
of Life Care
3.1 Explain the principles of effective listening and information giving, including the importance of
picking up on cues and non-verbal communication
3.2 Explain how personal experiences of death and dying may affect capacity to listen and
respond
appropriately
Being
able to communicate with service users, with those who are significant to them, with
3.3 Give
of internal
and
external
coping professionals
strategies forwith
individuals
and
others
otherexamples
staff and with
the wide
range
of healthcare
whom they
come
intowhen
facingcontact
death and
dying
is essential if we are going to be able to provide sensitive and effective end of life
3.4 Explain
thethe
importance
ofwe
ensuring
channelsofofeffective
communication
are in place
with others
care. In
earlier Unit
lookedeffective
at the principles
communication,
at the
importance of giving information at the right level and right time and at being able to
communicate difficult information sensitively.
People express their feelings in words but they may also communicate emotions or concerns
by giving cues. Cues are.an indirect verbal or a non-verbal expression of (or a hint
13

BHFT. QCF: Y/503/8689. Final 12 November 2015

at) an individuals concerns, anxiety or other negative emotion, indicating their need for
information or emotional support. (Zandbelt et al, 2007)
While we are at work we all try to act in a professional way i.e. not allowing what is going on
in our own lives to affect the care we provide for service users. However, you may have
experienced death and dying in your personal life and this can impact on how you approach
the death of a service user, even though sometimes we are unaware of this; personal
experiences can also affect how we respond to service users concerns.
We all cope with emotional concern and stress differently and find our own coping
mechanisms. Some people manage to cope with difficult situations with little support from
others, appearing to have strong internal coping strategies. However, most people rely both
on internal and external coping mechanisms. Internal coping mechanisms are where a
person draws on their own life experiences, applying past experiences or tested strategies to
the situation which then helps them to cope. Whereas external coping mechanisms are
support systems from other people or situations e.g. gaining help or insight through talking to
others about their experiences or increasing ones sense of control by gaining information
about a particular concern.

Task 6:
Answer the following questions

3.1 Explain in detail the principles of effective listening.

The principles of effective listening are:
Listening should be a process of hearing the other person
Not only what is said but other aspects of communication
List some things which we have to be aware of before we give information (e.g. to check you have
understood what is being asked before answering etc.)
Clarify what they want to know
Clarify what they already know
Clarify how much information they want
Are they happy to discuss the matter now?
Who do they want to have the conversation with?
Do they want a family member with them?
Are you confident to have this discussion?
Are you the correct person to have this conversation?
Write examples of verbal and non-verbal cues which people may give.
Non verbal clues
Eye contact
Anxiety
Non sleeping
Lack of concentration
Fidgeting
Appearing to withdraw and become less talkative
Facial expression
Reluctance to socialise and to join in conversation
Inappropriate humour
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Loss of appetite
Crying

Identify why it is important to pick up these cues and describe what may happen if they are missed.
It is important to pick up these clues because sometimes we can loss important information if we take
in consideration only verbal communication
3.2 Explain how you think personal experiences may affect your ability to listen and to respond
appropriately
Our personal experience can affect us in different way:
We can identify with the service users problem let the emotions to guide us and dont be
professional and impartial
We can become immune due to hard experiences in our life so we dont give all the
consideration to others people problems thinking are not so significant.
3.3 Give examples of internal and external coping strategies for an individual or those significant
to them when facing death and dying.
Internal coping strategies
Past experiences of lost
Faith/Spirituality/Religion
Ability to reflect
Sense of humour
Ability to be distracted
Psychological make up
External coping strategies
Family/Friends/Relationship
Hobbies/Interest/Therapy/Sport
Complementary therapy
Spiritual/Religious support
Professional support/ Access to support groups
3.4 Explain the importance of ensuring that effective channels of communication are in place with
others and why this is important. (Include professionals, family/carers etc.)
The communication is very important in this stage with family and professionals for this is necessary to
have a continue dialog with the GP; Community nurse, hospital, church to offer the best care and to
ensure that the residents receive the best care and them wishes are respected.

Learning Outcome 4:
Understand how to support those involved in End of Life Care situations
4.1
4.2

Describe emotional effects of caring for people at the End of Life.

Evaluate possible sources of support for staff in End of Life situations.
Working in the Short Term Support and Rehabilitation Team (SRS&RT) you might only care
for a service user for a very short period of time, this means you have to build a relationship
with them very quickly which can be challenging emotionally. It is important that staff
know how to access support.
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BHFT. QCF: Y/503/8689. Final 12 November 2015

Task 7:
Identify 3 colleagues working in EOLC situations and ask the following questions:
(Include
their role)
1
HCA

2
Cleaner

3
RGN

Describe the emotional effects of

caring for people at the End of Life.
distressed, pressure, tearful, sad/low
mood/ depression, fear, shock, anger,
anxious, sense of futility, feeling of
missing someone part of own life,
feelings of inadequacy/impotent, feeling
of guilty, less compassion, loss,
bereavement, narrowed view on life &
death .....
distressed, pressure, tearful, sad/low
mood/ depression, fear, shock, anger,
anxious, sense of futility, feeling of
missing someone part of own life,
feelings of inadequacy/impotent, feeling
of guilty, less compassion, loss,
bereavement, narrowed view on life &
death.....
distressed, pressure, tearful, sad/low
mood/ depression, fear, shock, anger,
anxious, sense of futility, feeling of
missing someone part of own life,
feelings of inadequacy/impotent, feeling
of guilty, less compassion, loss,
bereavement, narrowed view on life &
death.....

Identify & evaluate possible sources of support for

staff in these situations
Training, involve the staff in team activities, discussion
about resident in a positive way remember his good
moments, supervision, activities for staff,
psychological, emotional, professional, spiritual
support

Training, involve the staff in team activities, discussion

about resident in a positive way remember his good
moments, supervision, activities for staff,
psychological & emotional & professional support

Training, involve the staff in team activities, discussion

about resident in a positive way remember his good
moments, supervision, activities for staff,
psychological & emotional & professional, spiritual
support

Task 8

4.3
4.4

Identify areas in group care situations where others may need support in EOLC situations
Outline sources of emotional support for others in EOLC situations

Identify areas in group

care situations where
others may need
support in EOLC
situations

Home manager, registered nurse, carers, auxiliary staff, family, friends,

etc.

Outline sources of
emotional support for
others in EOLC
situations

Different way to support people implicated in EOLC are:

Training, supervision, new activities that help to keep away from the
recent event and involve the staff in other activities, psychological &
emotional & professional, spiritual support etc.
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BHFT. QCF: Y/503/8689. Final 12 November 2015

Entity that can give support in EOLC situations

Social worker
Local Macmillan services
Marie Curie nurses
Religious/Spiritual or Cultural
Dying matters
Cruse Bereavement Care

Learning Outcome 5:
Understand how symptoms might be identified in End of life Care
5.1 Identify a range of symptoms that may be related to an individual's condition, pre-existing
conditions and treatment itself
5.2 Describe how symptoms can cause an individual and others distress and discomfort
5.4 Identify different techniques for relieving symptoms

Task 9
This Learning Outcome looks at the symptoms an individual may experience at the end of
life and encourages you to identify different ways to manage them, including both medication
and non-drug treatments. Some service users will be diagnosed with a new condition such
as cancer, but many will also have pre-existing conditions causing symptoms e.g. arthritis.
At the end of life pre-existing conditions and new conditions may cause symptoms but
sometimes the treatment of these symptoms may cause further symptoms e.g. morphine
taken to treat pain may cause constipation &/or nausea.
Please complete chart on next page:

Consider service users you have cared for at end of life

i) identify some of the symptoms they have experienced (physical, psychological, emotional) ii) Identify the
condition or treatment) iii) State how symptom causes distress to service user and others iv) Identify treat
the symptom
Symptoms: (Include
State the most likely cause How can symptom cause
How can symptom
physical, emotional,
of symptom? (Condition
distress to service user?
distress to others?
psychological symptoms) or Pre-existing condition
or Treatment)
e.g. Back pain
Arthritis (a pre-existing
If pain uncontrolled, could cause Distressing for fami
condition) or cancer
issues with mobility, sleeping,
friends to witness, f
(condition)
mood etc.
helpless
e.g. Confusion
Constipation (condition) or
Service user could injure
Distressing to witne
pre-existing condition
themselves or cause distress if
confused family me
(dementia) or Morphine
aware of confusion
friend
(treatment)
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BHFT. QCF: Y/503/8689. Final 12 November 2015

Anxiety

Dementia, Mental diseases,

Pain, Heart diseases,

Could harm himself or others,

cause of distress,

Aggressively

Mental diseases,

Could harm himself and others,

high stress for others,
unpredictable behaviour

Headaches

Cancer (condition), mental

diseases,

Coma

Terminal illness, vascular

accident, hart attack, etc.

If pain uncontrolled could cause

issues with mobility, sleeping,
mood, etc.,
Cant communicate his needs,

Depression

Mental diseases, cancer,

Pressure sore

Terminal illness, bed bound,

18

Low mood, agitation, introvert,

refuse care medication, food
and fluid, etc.
Pain, infection, open wound

Distressing to witne
residents, a confuse
member or the staff
home
Distressing to witne
residents, a confuse
member or the staff
home
Distressing for hims
and family

Distressing to witne
residents, a confuse
member or the staff
home

Click here to ente

Distressing for patie

BHFT. QCF: Y/503/8689. Final 12 November 2015

Appendix 1: EOLC Strategy (2008) 12 Key areas

1.Raising the profile
- EOLC Steering group: Health, Social
Care & Lay participants.
- EOLC & Dementia Steering Group
3.Identifying people approaching
EOL
- GPs hold regular MDT EOLC/Gold
Standard Framework meetings to
identify EOLC patients
- Information shared with colleagues
4.Coordination of care
- Multidisciplinary meetings as above

7. Delivery of high quality services in

all locations
- Community, Hospitals, Hospice, Care
Homes

9. Involving and supporting carers

- Lay participation in all steering groups
- Implementation of Care Act

11. Measurement and research

- Local audits

2. Strategic commissioning
Clinical Commissioning Groups led by GPs ,
current goals include reducing deaths in
hospital & people dying in their place of choice
4. Care planning
- Developed Berkshire Planning my future
Care
-Individualised Care Plan for the Dying Patient
6. Rapid access to care
- 24 hour community nursing Via BHFT Hub
- 24 hour access to Specialist Palliative Care
Service
- Marie Curie night nursing service
8. Last days of life and care after death
- Liverpool Care Pathway being replaced with
Individualised Care Plans
- DNACPR forms
- Anticipatory prescribing
- Thames Hospice
- Bereavement Care
10. Education/ training & continuing
professional development
- Identifying training needs & delivering training,
upskilling GPs & nurses (community, hospital
and care homes) on prognostication &
communication
12. Funding
- EOLC training and development posts

National drivers web links:

-

CQC: CQC
Dementia Strategy (2009) Dementia Strategy
End of Life Care Strategy (2008): EOLC Strategy
Gold Standards Framework: http://www.goldstandardsframework.org.uk/home
Leadership Alliance for the Care of Dying People (LACDP) (2014) LACDP

National Care of the Dying audit for hospitals (May 2015) NCDHA
National Institute for Health & Clinical Excellence:
http://www.nice.org.uk/media/EE7/57/EoLCFinalQS.pdf
National Palliative and End of Life Care Partnership
www.endoflifecareambitions.org.uk
Public Health England (2014) EOLC Profiles for Clinical Commissioning Groups
http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/ccg_profiles
Six Steps to Success: Domiciliary Care: Six Steps to Success Dom Care
The route to success in end of life care - achieving quality in Domiciliary Care
(2011)
http://www.nhsiq.nhs.uk/resource-search/publications/eolc-rts-dom-care.aspx

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BHFT. QCF: Y/503/8689. Final 12 November 2015

Appendix 2: Liverpool Care Pathway:

LCP was a tool to manage care in the last days of life when the multidisciplinary
team agreed the person was dying. Concerns about the way LCP was being used
appeared from 2009.
Independent Review of the LCP under chairmanship of Baroness Julia Neuberger
(2013) led to report: More Care Less Pathway (July 2013)
It concluded when the LCP was used properly, patients died a peaceful and dignified
death. However, the LCP sometimes used as a tick box exercise especially where
there is a background of poor care
Problems of communication identified:
Families did not always know person was dying
Terminology confusing and disturbing
Hydration and nutrition not always addressed properly
Use of syringe pumps not always explained
LCP to be phased out by June 2014
34 recommendations
An Individualised EOLC plans for each patient to be developed, focusing on: 5
Priorities of Care
Recognised: if patient condition deteriorates unexpectedly they ..must be
assessed by a doctor competent to judge if change is potentially reversible
or the person is likely to die
Focus on communication & transparent decision making with patients & families
Communication must be regular and proactive..
Content & outcome of all discussions must be documented and accessible to all involved
in the persons care

More Care Less pathway. A review of the LCP. More Care Less Pathway

The Leadership Alliance for the Care of Dying People (LACDP). One chance to get it
Right: One Chance to Get it Right

Appendix 3: End of Life Care Pathway (EOLC Strategy, 2008)

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Appendix 4: Three models of loss & grief.

1) Kubler-Ross (1969): Five Stages of Grief
a. Denial
b. Anger
c. Bargaining
d. Depression
e. Acceptance
More recently the area of bereavement and grief has greatly enlarged its understanding of
how loss is experienced; resulting in the challenging of some older theories, including those
of Kubler-Ross. Criticism included that:
a) Stages were more accurate in describing how someone with a terminal diagnosis
may move from denial through towards acceptance (Murray-Parkes, 1993)
b) Inexperienced took stages too literally (Worden, 2010)
c) Stages do not allow for the complex nature of grief or the fact that people will
experience grief in many diverse ways as a result of their own different and often
complex physical, psychological, social and spiritual needs and their available family
and social support. (Hall, 2011)

2) Worden: The Four tasks of mourning (2010)

- Rather than a single event to get over Worden believes grief is a process
people need to work through & come to terms with. He describes 4 key tasks
which allow the grieving person to take action and do something; they also allow
for the person to be influenced by external interventions.

The 4 tasks are:

a. To accept the reality of the loss
b. To process the pain of grief
c. To adjust to a world without the deceased
a.
External adjustments: depending on their relationship to the deceased
b.
Internal adjustments: Challenge of adjusting to own sense of self
c.
Spiritual adjustments: causes changes in the sense made of the
world, challenging values and philosophical beliefs.
d. To find an enduring connection with the deceased in the midst of embarking
on a new life.
Considerations:

There are not phases to work through in a fixed progression

Tasks can be revisited, worked through several times
Several tasks can be done at the same time

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BHFT. QCF: Y/503/8689. Final 12 November 2015

3) Stroebe and Schutt: Dual Process Model (1999)

During bereavement people undertake loss and restoration oriented coping.

1) Loss orientation refers to the concentration on & dealing with the experience of loss
i.e. yearning for the person who has died and involves a range of emotional
reactions, some giving pleasure & others causing pain; happiness that the person is
no longer suffering and despair at being left alone.
a. The emotions come and go, often emotions are unanticipated
b. Initially negativity predominates but as time passes this negativity diminishes
c. Not stages that need to be passed through but more an oscillation between
methods of functioning
2) Restoration orientation: refers to problem-focused coping: attending to the
demands of a changed life, including diversion from the loss.
Does not refer to what has been achieved but more what has to be done to cope with
the stress i.e. what someone has to do to avoid sitting alone every night etc.
3) Oscillation refers to: way in which the bereaved will move between confronting and
avoiding the stressors related to their grief.
a Allows for time-out
b Some benefits to temporary denial
c Cannot grieve without a break

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BHFT. QCF: Y/503/8689. Final 12 November 2015

Appendix 5: Learning outcomes, assessment criteria and unit amplification

To pass this unit, the learner needs to demonstrate that they can meet all the learning outcomes for the unit. The assessment criteria

Assessment Criteria

Learning Outcome

Understand
current
approaches to end of life care

1.
1
1.
2

Analyse the impact of national and local drivers on current

approaches to end of life care.

Eviden
ce
Locatio
n
Task 1

Evaluate how a range of tools for end of life care can

support the individual and others

Task 2

Analyse the stages of the local end of life care Pathway

Task 3

Evaluate models of loss and grief

Task 4

Describe how to support the individual throughout each

stage of grief

Task 4

Explain the need to explore with each individual their own

specific areas of concern as they face death

Task 5
Q

Describe how an individuals awareness of spirituality may

change as they approach end of life

Task 5
Q

Explain the principles of effective listening and

information giving, including the importance of picking up

Task 6
Reflecti

Date
Achieve
d

1.
3

Understand an individuals response to

their anticipated death

2.
1
2.
2
2.
3
2.
4

Understand factors regarding

communication for those involved in end

3.

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BHFT. QCF: Y/503/8689. Final 12 November 2015

of life care

3.
2
3.
3

Understand factors regarding

communication for those involved in end
of life care

Understand how to support those

involved in end of life care situations

3.
4

4.
1

4.
2
4.
3
4.
4
5
5.
1

on cues and non-verbal communication

Explain how personal experiences of death and dying may
affect capacity to listen and respond appropriately

Give examples of internal and external coping strategies

for individuals and others when facing death and dying

Explain the importance of ensuring effective channels of

communication are in place with others

ve
account
Task 6
Reflecti
ve
Account
Task 6
Reflecti
ve
Account
Task 6
Reflecti
ve
Account

Evaluate possible sources of support for staff in end of

life situations

Task 7
Questio
ns

Evaluate possible sources of support for staff in end of

life situations

Task 8
table

Identify areas in group care situations where others may

need support in end of life care situations

Task 7
Questio
ns
Leaflet
EOL201

Outline sources of emotional support for others in end of

life care situations

Identify a range of symptoms that may be related to an

individuals condition, pre-existing conditions and
treatment

24

Task 8
table

BHFT. QCF: Y/503/8689. Final 12 November 2015

5.
2

itself
Describe how symptoms can cause an individual and
others distress and discomfort
Describe signs of approaching death

5.
3
Identify different techniques for relieving symptoms

5.
4

25

Task 8
questio
n
Task 8
questio
n
Task 8
Table

BHFT. QCF: Y/503/8689. Final 12 November 2015

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BHFT. QCF: Y/503/8689. Final 12 November 2015