Analysis of Northumberland's End of Life Care Policy (NUR234)

This essay provides a comprehensive analysis of the End of Life Care Policy of Northumberland, focusing on its relevance to nursing care. It begins by discussing the significance of evidence-based practice (EBP) in shaping healthcare policies and then identifies the Northumberland policy as the subject of the analysis, providing a rationale for its selection. The essay delves into a critical examination of the policy's nature, development, target audience, research methods, and ethical underpinnings, including a discussion of beneficence, non-maleficence, justice, and autonomy. Furthermore, the essay utilizes the CASP tool to critique two research studies referenced in the policy, evaluating their validity and applicability. The analysis explores how the policy informs EBP and impacts person-centered care, emphasizing the importance of individualized care plans. The essay concludes by summarizing the key findings and reiterating the central themes of the analysis, highlighting the policy's role in improving end-of-life care practices, patient satisfaction and outcomes, and the ethical considerations involved in providing such care.

Running head: END OF LIFE CARE POLICY OF NORTHUMBERLAND
END OF LIFE CARE POLICY OF NORTHUMBERLAND
Name of the Student:
Name of the University:
Author Note:

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Introduction:
The paper aims for discussing a nursing care policy on the end of life care in
Northumberland. End of life care, which is also known as palliative care. The care is a
specific type of care which focuses on the patients, who have very little time left for living
(Thomas, Lobo and Detering 2017). According to NMC code, a nursing staff is responsible
for delivering a quality care to all the patients. The nurses are supposed to deliver an effective
and safe practice. They must also display their skills for prioritizing the patients and
promoting trust and professionalism. The NMC code of confidentiality suggest that the
nursing staffs owe a duty of confidentiality towards their patients (nmc.org.uk, 2020). This
duty involves informing the patients about their conditions and treatment plan appropriately.
The end of life care policies also focus on all these aspects in order to make sure that the
individuals, who are at the end stage of their lives also receive a proper quality of care based
on the NMC code (Myatra 2014). The paper will be discussing the relevance of evidence
based practice in nursing care policy first. After that the paper will be focused on identifying
a policy and explaining the rationale behind choosing that policy. Then a critical analysis of
the policy will be performed. Finally the EBP and the person centred care will be linked with
the policy contents.
Discussion:
Relevance of Evidence based Practice to Nursing Care Policy:
A policy is can be defined as a list of guidelines or to do list during a specific
condition. A policy is generally focused on a specific population. The development of a
policy includes various consideration as it establishes some practice guidelines as rules. The
fields of the considerations include both legal and ethical field (Fimyar 2014). A nursing care
policy or a healthcare policy is mainly directed at the improved health outcome in the

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patients. The focus area of the policies are also involves delivering a proper quality care to
the patients based on the NMC code of nursing (Bradshaw 2016). All these strategies aims
for an improved satisfaction level in the patients along with an improved physical and
psychological health outcome in the patients. The evidence based practices are the nursing
practices, which have been proven to be effective in improving the physical and/ or mental
health outcome in the patients. Those practices are important to be incorporated within a
nursing care plan in order to ensure the efficacy of the whole plan to achieve a nursing goal.
Incorporation of the evidence based practice also ensures the safety of the patients, since the
health outcome will be predictable in the patients (Portney 2020). Both the law and the
healthcare ethics support the use of evidence based practice in the development of a
healthcare policy. This way the efficacy of the policy can be ensured. The possible outcomes
of the policy can also be predicted, since it is easier to evaluate a policy if it is consisted of
evidence based practice. This will also ensure the relative safety of the target population upon
the launch of the policy (Oliver, Lorenc and Innvær 2014). Hence the consideration of the
evidence based practices is essential in the development of the policies including the
healthcare or nursing care policies.
End of Life Care Policy:
Identification of the Policy:
The policy that is selected for this study is an End of life care policy of
Northumberland. The reference number of the policy is CNTW(C)49 (Cntw.nhs.uk, 2020).
The policy aimed for providing a high quality care to the patients, who have long term
condition and nearing the end of their lives day by day. The policy specifically focuses on
keeping the quality of care high, which will include the evidence based and holistic care
approaches. All those approaches will be focused on improving the experiences of the
patients, since there is “only one chance is left to get it right” (Cntw.nhs.uk, 2020).

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Rationale for Choosing this Policy:
There are about 15 million people, who are suffering from long term conditions in
England. Every year the number is increasing (Cntw.nhs.uk, 2020). Those people continue to
suffer as they approach the death. It is an important responsibility of the healthcare staffs as
the members of community to make the last days of those people better by providing them a
variety of treatment and care. This is the reason for choosing this topic and exploring this
policy guidelines in this essay.
Description of the Policy:
The purpose for developing this policy was that the Cumbria Northumberland Tyne
and Wear NHS Foundation Trust (CNTW) organisation recognised the end of life care to be
an important part of the social care, which should be provided to any individual, who are
nearing death due to the presence of some medical conditions in them. The policy was
focused on providing the healthcare staffs a proper guidance for identifying such patients
(Cntw.nhs.uk, 2020). The policy also provides a comprehensive framework that is supposed
to help the healthcare staffs to provide an appropriate and timely care to those individuals
along with their families. The policy explains the duties and the responsibilities of all the
healthcare staffs first. The proper definition of the terms are also explained properly. After
that the policy explains the type of care a dying patient will be receiving or exactly which
points to be addressed when aiming for providing an end of life care to the patient
(Cntw.nhs.uk, 2020). There were a description on the use of some tools, which can be used to
determine the requirements of the patient. The role of leadership and different care plans
within an end of life care pack were also included in the description of the policy. The policy
also explained an end of life care pathway, which is a step by step guide for the healthcare
workers to develop proper care plan for delivering a proper end of life care. The policy also

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guides a healthcare staff about their duties and responsibilities after the patients’ death, which
will involve addressing the needs of the family of the dead patient (Cntw.nhs.uk, 2020).
Critical Analysis of the Policy:
The Nature of the Policy:
The policy is a health care policy, which can also be described as a regulatory policy.
The policy aims for improving a specific practice, which is directly associated with the field
of healthcare. This is also a social policy, since it is based on a social problem (Alcock 2014).
The policy is mainly a guideline for the healthcare workers or staffs to guide them to perform
their social duties properly. Thus it is a regulatory policy, which regulates the decision
making and the activities of the healthcare staffs, when they are proving an end of life care to
the patients with long term medical conditions (Tatalovich and Daynes 2019).
Reason for Its Development:
There is a huge number of patients, who are living with long term medical conditions
and nearing death day by day. The CNTW organisation, which was the developer of this
policy, recognised the end of life care to be an integral part of the social care and health,
which should be provided to any individual, who are nearing death due to the presence of
some medical conditions in them. The main purpose of this policy development was to
provide the healthcare staffs a proper guidance for identifying such patients and to guide
them through the care period and even after the death of the patients (Cntw.nhs.uk, 2020).
Target Audience:
The target audience for this policy is the healthcare staffs mainly, which includes,
doctors or physicians, all the nursing staffs (both qualified and unqualified) and midwives
(Cntw.nhs.uk, 2020). The policy makes all the healthcare staffs aware of their duties and

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responsibilities along with guiding them through a step by step process to develop a proper
and high quality care plan for the dying patients.
Main Research Methods used in Developing the Policy:
The developers of this policy mainly explored different counsel guidelines to
determine the actual duties and responsibilities of different healthcare staffs that are
associated with their profession. In order to find the proper definition of the terms, various
internet resources were used. The policy developers also explored various guidelines and
survey studies to determine various strategies that can be applicable for the end of life care.
The researchers used various resources and they analysed those information prior to
developing this policy (Cntw.nhs.uk, 2020). Thus the research method can be considered to
be qualitative.
Ethical Underpinnings:
The ethical consideration mainly involve four aspects, such as beneficence, non-
maleficence, justice and autonomy. Like all the healthcare policy, the ethical consideration is
also an important part for the end of life care policy (Sprung et al. 2014). The end of life care
policy advices the healthcare staffs to provide a high quality and person-centred care for the
dying person (Cntw.nhs.uk, 2020). Thus this policy considers the principle of beneficence.
The additional consideration about the patient’s safety implies that the principle of non-
maleficence were also taken into consideration. Prioritising the patients determining their
individualistic needs and providing them appropriate information on their condition and care
plan can be considered as following the principle of justice. Respecting the wishes of the
patients falls under the principle of autonomy.

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Critiquing the Reference Studies using CASP tool:
There were various references used for describing this policy. However, most of them
was other policies or guidelines and various descriptive internet resources (Cntw.nhs.uk,
2020). The CASP tool or the Critical Appraisal Skills Programme is used for analysing some
specific kind of research studies, such as case studies, qualitative researches, cohort studies,
systematic reviews and various others. From the reference list of this policy a case study and
a systematic review was selected for conducting an analysis using the CASP tool.
The first reference that was selected for this analysis was a case study. The case study
was focused on determining the challenges faced by a healthcare staff in making a right
decision (theclinicalnetwork.org, 2012). Thus it can be said that it was clearly focused on an
issue. The authors analysed all the aspects of the circumstances separately to determine all
the challenging factors and thus there was an appropriate method followed to find the
answers of the focused issue. The results of the study can be considered to be valid. All the
cases were described precisely. However, the cases were not focused on any specific
population, which can be considered acceptable though, since the issue addressed in the case
study was not focused on any specific population either. The number of the case studies can
also be considered to be sufficient and thus it can be decided that the presentation of the case
studies were sufficiently acceptable. There were no case study that was taken as a control
trial. Thus the study can be considered to have some selection bias. The authors of this study
did not consider the possible bias that might be associated with the study
(theclinicalnetwork.org, 2012). The study treated all the groups equally and no group cannot
be identified that was not addressed. The study successfully identified the challenging issues
associated with the right decision making as a result. The authors considered all the important
variables and thus the results of the study were believable. The results of the study can be

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applied on a global basis. There was no other evidence based studies were considered for
concluding this study.
The next reference was a report that used a systematic review, to address different
inequalities in the end of life care (Cqc.org.uk, 2016). The results of the review can be
considered to be valid. The study was focused on four distinct objectives and there was a
wide variety of scholarly resources, which were used to develop this study. The authors used
those resources effectively in this study. There was a scope of incorporating more reference
studies to prepare this review report. However, the authors successfully explained all the
problems and possible strategies to overcome those problems effectively with the use of the
references. There was no consideration of the quality of the studies that were used to develop
this review report. There was no clear comparison presented between the studies to determine
the reasonability of combining the study results (Cqc.org.uk, 2016). There was a clear
representation of the findings, which gives a clear idea about the ‘bottom line’ results. There
was no consideration on the validity of the result. Thus it cannot be determined from the
study how precise the results were. The study can be applied to the local population, since the
report addressed the problem from a local perspective. However, parts of those results can be
applicable globally also. The study successfully addressed all the important outcomes and
thus the study was worth the cost.
Evidence Based Practice in the Policy:
The evidence bases practices are the practices that have been proved to be effective in
various scholarly research studies. The efficacy of those practices for solving a particular
health problem has been viewed from a neutral perspective and in the end it was found to be
effective (Ellis 2019). The policy considered the evidence based practice to be essential for a
safe healthcare practice. The purpose of this policy development was to ensure the patients,
who are at the end stage of their lives receives a high quality care, which will involve

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evidence based practice and holistic practice approach, aimed at improving the patient
experiences. The different plans within an end of life care pack, which were developed for
the dying patients’ care, was based on a framework, which can be considered as an evidence
based framework. The first step of the care pathway was an open and discussion with the
patient on the risk factors or triggering factors, which might lead to a sudden death
(Cntw.nhs.uk, 2020). This is an evidence based approach, which ensures the patient is more
prepared for the death before its actual approach. The step four of the care pathway focuses
on delivering a high quality service under different setting (Cntw.nhs.uk, 2020). This care
approach must also include different evidence based practices in order to ensure the quality of
care and promoting the safety of the patients. All the suggested practices mentioned in this
policy to be incorporated in the end of life care can be considered were the evidence based
practices, including the practice of application of CPR in the patients (Cntw.nhs.uk, 2020).
Every aspect of the development of the policy involved evidence based practices, since that is
the only way the developers of the policy could ensure the safety and quality of the practice
guidelines.
Impact on Person Centred Care:
The person centred care is another care approach in the field of healthcare that ensures
a high quality of care that is being delivered. This type of care is focused on determining the
specific requirement of a particular patient first. After that a care plan is developed
addressing those specific requirements of that particular patient. Finally a person centred care
approach involves delivering the specific care according to the plan (Eaton, Roberts and
Turner 2015). The rationale behind using this approach is the fact that different individual has
different requirements in physical, emotional, social and spiritual level. Thus the care plans
for each individual must be different in order to invite the best outcome. This approach is also
evidence based and thus have been found to be effective in improving the patient outcome.

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The policy addresses this approach specifically and all the practice guidelines were
based on this aspect. The policy recognised the requirement for the person centred approach
in a high quality end of life care (Cntw.nhs.uk, 2020). The end of life care approach mainly
focuses on making the last days of life better in the patients with long term medical
conditions. Thus it is very important to determine all the physical, emotional and spiritual
needs of those patients along with the social needs on an individualistic basis. Only then it
will be possible for the healthcare workers to deliver the proper care of them. The policy
described many activities that were based on this aspect significantly, such as providing the
patient proper information, pain and other adverse symptoms management in the patients and
the family oriented plans (Cntw.nhs.uk, 2020). Hence it can be decided that the end of life
care is a person centred care approach that addresses the requirements of every dying
patients, who are receiving that care.
Conclusion:
Hence it can be concluded from the above discussion that a policy is a list of
guidelines or rules that are directed at a specific population, who are intended to follow those
guidelines. A nursing care policy or a healthcare policy is mainly directed at the nursing
staffs or the healthcare staffs. The evidence based practices are the nursing practices, which
are important to be incorporated within a nursing care plan in order to ensure the efficacy of
the whole plan to achieve a nursing goal. The CNTW(C)49- End of life care policy is a policy
that is local to Northumberland. The policy was focused on providing the healthcare staffs a
proper guidance for identifying such patients. The policy is a health care policy, which can
also be described as a regulatory policy and/ a social policy. The Cumbria Northumberland
Tyne and Wear NHS Foundation Trust (CNTW) organisation recognised the end of life care
to be an important part of the social care and thus they decided to develop this policy. The
target audience for this policy is the healthcare staffs mainly, which includes, doctors or

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physicians and all the nursing staffs. The research method that was used for this study can be
considered as a qualitative method. The two reference studies that were used in this policy
development can be considered to be moderately valid. The policy considered the evidence
based practice to be essential for a safe healthcare practice. The person centred care is another
care approach in the field of healthcare that ensures a high quality of care that is being
delivered. The policy recognised its requirement in delivering a high quality end of life care
and thus the policy guidelines have been developed focusing on this aspect.
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