Brian Nyatanga

Avoiding burnout syndrome in palliative care

British Journal of Community Nursing October 2014 Vol 19, No 10 515

Knowledge of impending death and its effect on quality of dying.

The literature on communication skills and breaking bad news tends to take the view that health professionals should endeavour to tell patients about their impending death. The core of the argument often focuses on how we should impart such negative news sensitively, and rarely discusses whether giving such information makes a difference to the patient’s quality of dying. Indeed, it would be helpful to understand whether such knowledge leads to a dignified death. There is also little discussion about how such information helps the patient’s family during dying and after the death of the patient. The argument in favour of telling patients about their imminent death is rehearsed as follows: the information helps patients to make decisions about their death. It helps patients to ‘put their house in order’ and review their social networks and key relationships. Such knowledge, it is argued, empowers patients to deal with some of the difficult existential issues they face in life, and more so as they prepare for the end of life (Steinhauser et al, 2001). However, we need to remind ourselves of the possible negative impact that such knowledge might have. For example, the knowledge of impending death might heighten the level of existential anxiety and psychological struggle to try to hold on to life. This struggle is even more painful when it is clear to the patient and relatives that it will not reverse the situation. The knowledge of impending death might provoke feelings of regret and guilt regarding goals that have not been achieved, possibly leading to a perception of a failed life, or having failed others. Patients may feel they have to leave instructions behind (perhaps through a will) about what should happen to their estate. For some, knowledge of impending death is a constant reminder of their own state of inevitable ‘nothingness’.

Dying matters: you asked, I answered

British Journal of Community Nursing May 2015 Vol 20, No 5 255

Palliative care in the community and the friends and family test

British Journal of Community Nursing September 2014 Vol 19, No 9 463

The challenges of dying: lessons for palliative care.

British Journal of Community Nursing February 2015 Vol 20, No 2 99

Using complementary therapies in palliative care

British Journal of Community Nursing April 2015 Vol 20, No 4 203

Men and the challenge of prostate cancer

Most men over the age of 50 have an extra health consideration to take into account with regard to the possibility of prostate cancer. A worrying trend is occurring: in the 1990s, bowel and lung cancer were more common in men than prostate cancer. However, by the end of 1998, prostate cancer was the most common cancer in men in the UK, accounting for 25% of all new cases (Office for National Statistics (ONS), 2011). This cancer is most common in men over 65, although current thinking (Cancer Research UK, 2011) suggests that its development begins at a much earlier age than that. This is why it is important to consider having checks around the age of 50 years. According to Ben-Shlomo et al (2008), men of African decent tend to be diagnosed at much younger ages and their prostate cancer grows faster than in men of other races. The fact that early-stage prostate cancer tends to be symptomless (silent) means that men may not always give it priority and get it checked by their GPs. Compared with many other cancers, prostate cancer grows slowly. This means that it can take 10–30 years before a prostate tumour gets big enough to cause symptoms or for doctors to find it (National Cancer Institute, 2014). It is therefore important that health professionals prompt men to be aware of this disease and consult their doctor for a chat or test. Community nurses are in a privileged position as they visit men in their own homes to initiate this discussion, and this may take several visits as some men may take longer to act on the advice. The anatomy and physiology of the prostate is given in Figure 1. The prostate is a small gland the size and shape of a walnut that helps to make semen, which carries sperm from the testicles through to the penis during ejaculation. The prostate lies low in the pelvis, below the bladder and in front of the rectum and surrounds part of the man’s urethra.

Quality end-of-life care as a public health problem

British Journal of Community Nursing December 2014 Vol 19, No 12 619

Giving a voice to the bereaved through palliative care research.

British Journal of Community Nursing August 2014 Vol 19, No 8 411

Extending virtual wards to palliative care delivered in the community

A study by the Nuffield Trust (Blunt et al, 2010) .concluded that around 35% of all hospital admissions in the NHS between 2004/05 and 2008/09 were classified as emergency admissions with an estimated cost of £11 billion a year. These figures have been rising year on year, with reasons cited including people living longer, increases in chronic disease (of which cancer is arguably one), and increasing economic constraints on health-care budgets (Blunt et al, 2010). There is now a drive to prevent such unplanned admissions and to allow people to remain in their own homes. Although there is currently no clear evidence to show that preventative measures to stop emergency admissions are cheaper than admitting patients to hospital, a number of preventative measures are in place and some others are being piloted. For example, in Worcestershire, community teams use virtual wards (VWs) as a means of keeping patients at home as much as possible. VWs aim to quickly identify patients at high risk of being rushed into hospital at short notice, and to prevent such admissions. The article by Joanne Jones and Andrea Carroll on p.330 details the work of the Enhanced Care Team in Wyre Forest, Worcestershire implementing VWs and its impact on reducing unplanned hospital admissions. One question to be considered is whether VWs integrate the work of primary, community and social care at the three different levels of service provision often viewed as important for providing palliative care: macro (policy and organisational input); meso (clinical multidisciplinary working) and micro (individual Enhanced Care Team involvement with the patient). A further question then arises regarding the impact of VWs and whether they serve their purpose of reducing avoidable emergency admissions into hospital for all patients identified as being at high risk. VWs use a predictive risk model (Wennberg et al, 2006) to assess whether patients are at high risk of emergency admission. However, Wennberg et al (2006) note that the ways in which this model is used by community healthcare professionals varies across the country. For example, the model has been used to identify patients for community matrons to support, and in some instances to select which patients should be offered telephone-based health coaching and advice. Elsewhere, as in Worcestershire, the model has been used to identify patients who are offered multidisciplinary integrated care without coming into hospital—hence the idea of a virtual ward. It is clear that the tool is multi-purposed and is a welcome addition to community activities.