Last year 23 September 2012. I had a resident called “Mrs X” she was a 72year-old widowed living at —, a Nursing Care Home. She’s not a religious type of person as she was Atheist. She has lived in the home for the past two years, and during that time I was assigned as her key worker. Mrs X had One Son and 3 grand daughters they are all regular visitors to the home. She has recently been diagnosed with renal failure, and her life expectancy is only a couple of months without dialysis. In the past Mrs X has made it clear that when her “time comes” she wants to be able to stay at Belmont House, and “go quietly”. She has stated that she does not want any treatment that will prolong her life. This means she has chosen not to accept dialysis. A planning meeting, involving Mrs X, her family and health and social care workers has taken place, and a care and support plan has been put in place to help Mrs X to live comfortably at Belmont House.
This has included a discussion, led by Mrs X, about her wishes. She has made it clear that she does not want any medical intervention to prolong her life, and this has been recorded in an ‘advance care plan’. Mrs X’s 3 granddaughters are supportive but her son Mark has difficulty accepting the decision, however he realised it’s her mums decision and to respect her mum’s wishes. As well as input from her GP, Mrs X will be receiving regular support from specialist nurses to manage her symptoms and keep her comfortable. Day-to-day care and support will continue to be provided by the care workers. Mrs X’s granddaughters and Mark will spend time with their Mother each day. This was the first time since I began working at the Palliative care unit that I had been closely involved with someone who is dying, and I was upset and anxious about caring properly for Mrs X. My line manager was responsible for ensuring that I am properly trained and supported so that Mrs X‘s needs and the needs of her family are properly addressed.
In our discussion with my line manager, I was chatted about my concerns, my feelings, and what I seen as the gaps in my expertise. Mrs X is becoming very tired, spending more time resting. Her skin is very fragile and the risk of skin breakdown has increased significantly. I was experienced and qualified care worker, but I and my colleagues need to be highly skilled in managing Mrs X’s skin so that it does not break down causing her addition distress. I was given by an additional training in this area so I feel confident and able to take proper care of Mrs X’s skin. My line manager always works alongside with me on demonstrated good skin care. This gave her opportunity to observe me, and to demonstrate best practice. She also talked to the nurse specialists, to find out if there are any particular creams or equipment that will benefit Mrs X, or if they have any other advice.
My manager given me also a day course for End of life and supporting people to live and die well instantly so I managed to share to Mrs X situation and condition and it works. One day she talked to me about her pass. She said when she was youth she had a puppy and 2years later the dog was died. She’s devastated and don’t know how to deal with it until a day she found out she has terminal ill. I found her one day she cried. I came to the situation of sadness and tearful however I kept in myself, and tried to control and showed my professional experience in dealing with it. I talked to her and cheered her up. I asked how was she spent time with her puppy? She smiled and said, lots of time she was enjoy with puppy walking to the fields together, when puppy was tired she open her tongue out and sit and very quiet. She’s smiled when she’s telling all about her puppy’s story. So I came to the point to ask her family. She’s quiet for a while, and then she said my family just came to visit me when I arrived here except my oldest granddaughter.
They never visit me when I was at my home. I was interested to listen until she said, “one day I’m gone no one stay at my home except my oldest granddaughter. I was surprised which I known every time I saw her family came visited her they are smiled and very chatty to the staff. I went to the staff office and I recorded to the care plan and then I reported to my line manager the story. It was my day off when she passed away. My colleague texted me and I rushed to come and see her before the under taker take her away. I was devastated however I managed to talk to her family and offered their drinks and other basics they needs. Her family appreciated my time and hospitality.
Until then, I was very aware and to look after well with the people dying. And also the relatives concerns and wishes. Sometimes, it wasn’t easy to talk about end of life issues but it’s important to do. Now that we’ve put our affairs in order and talked about what we want, we can “put that in a box” as it were, and get on with living one day at a time, cherishing each day together, as I know it’s going to end