Unit 73: Report on Supporting People During the Last Days of Life

This report, focusing on Unit 73, explores the critical aspects of supporting individuals during their final days of life. It begins by identifying the common signs of approaching death, such as changes in skin temperature and decreased eating and drinking. The report then outlines circumstances when life-prolonging treatment can be stopped and emphasizes the importance of advance care planning to ensure that individuals' wishes are respected. It also details the signs that indicate death has occurred. The main body delves into the psychological aspects of the dying phase, including emotional changes and the impact on relationships, while also addressing the changing needs of the individual. The report highlights ways to enhance a person's well-being, the importance of partnership with key people, and the use of integrated pathways. It further covers post-death care, including national guidelines, respect for the individual's wishes, and infection control. Finally, the report discusses the impact of a person's death on others and available support systems. The report concludes by summarizing key findings and recommendations for providing compassionate end-of-life care.

UNIT 73: is your unit around
understanding how to support people
during the last days of life

Table of Contents
INTRODUCTION .....................................................................................................................4
MAIN BODY ............................................................................................................................4
1.1The common signs of approaching death.........................................................................4
1.2Describe the circumstances when life prolonging treatment can be stopped...................5
1.3 Importance of any advance care plan. ............................................................................5
1.4 Identify the signs of that death has occurred. .................................................................6
2.1. The psychological aspects of the dying phase for the individual. .................................6
2.2 Impact of the last days of the life on the relationship between individuals and others. . 7
2.3 Possible changing needs of the individual.......................................................................7
3.1 A range of ways to enhance person’s well-being. ..........................................................8
3.2 The importance of working in partnership with key people to support the person’s
well-being..............................................................................................................................8
3.3. How to use an integrated pathway according to agreed ways of working. ...................9
3.4 Key information about the process following death that should be made available to
appropriate people. .............................................................................................................10
4.1 National guidelines, local policies and procedures relating to care after death. ...........10
4.2 Importance of being informed about a person’s wishes for their after-death care........11
4.3 Importance of acting in ways that respect the individual’s wishes for immediately after
death. ...................................................................................................................................12
4.4 Describe agreed ways of working relating to prevention and control of infection when
caring for and transferring a decreased person. ..................................................................12

4.5 Describe the agreed ways for support others immediately following the death of a
close relative. ......................................................................................................................13
5.1 Possible impact of a person’s death on own feelings. ..................................................13
5.2 Identify available support system to manage own feelings in relation to an individual’s
death. ...................................................................................................................................14
CONCLUSION........................................................................................................................14
REFERENCES.........................................................................................................................15

INTRODUCTION
The last few days of an individual’s life is also known as terminal case, or the dying
phase. Everyone in this world experience this phase of dying in different ways and it is
difficult to know when a person is reaching the last few days of their life. Further, it has been
determined that the last stages of a persona’s life can be very stressful and also for those who
are caring for him/her. In these cases, responsibilities of a service provider may vary based on
where the person with any dying disease is receiving care or not. This report is based on
understanding how to support individuals during the last days of life. This will cover,
common signs of approaching death, circumstances when life-prolonging treatment can be
stopped and impact of the last days of life on the relationships between individual and others.
Apart from this it will also explain the importance of working in partnership with the key
people to support the individual’s wellbeing including the importance of being
knowledgeable about a person’s wishes for their after death care. Lastly it will describe ways
to support others immediately following the death of a close relative or friend and importance
of any advance care plan in the last days of life.
MAIN BODY
1.1 The common signs of approaching death.
The following are the common signs of approaching death:
 Coolness :- if a person’s hands, legs, arms and feet increasingly gets cool to the touch
and the colour of their skin may alter and become mottled. These are signs of
approaching death. In elderly adult, their skin can become paper thin and pale with
dark liver spots appearing on hands, feet and face as well (Ahmedzai, 2018).
 Decreased blood perfusion :- in this case skin becomes mottled and discoloured.
Mottling & cyanosis of the upper edges seem to show awaiting death versus such as
changes in the lower extremities.
 Eating an drinking less :- as people become older, their energy needs decreases. The
reason behind this is an individual does not need as much energy as to carry out daily
work, food and drinks seems less necessary. People who are close to death may not
even be interested in some of their favourite food also.

 Sleep more:- it has been observed that I dying person may start to sleep more than
usual, within several months before their end of life. As people get closer to death,
their body metabolism falls, without a natural stable supply of energy, exhaustion and
tiredness easily win out.
1.2 Describe the circumstances when life prolonging treatment can be stopped.
It has been discovered that medical care to prolong life can keep people alive when their
organs stop working well. These treatments help them to extent their life, but do not cure
their illness. These are called life sustaining treatments to extent life can include the use of
machines. Healthcare professionals and healthcare team will talk with a person about the
particular treatment that are part of your care plan. If that person wants, he or she may
involve family and friends in these meetings. The decision to stop treatment is made with the
person’s agreement. But in some cases, it has been found that the decision falls to the
individual’s healthcare proxy or elderly person. If that anyone needs to make a decision
regarding stopping treatment for their loved one’s health, also think regarding their wishes
and values. If required, pursue guidance from other healthcare team members, like a social
worker or mystical consultant. It can be stopped after talking to care providers to learn about
life support care they are receiving from them (Berry and Griffie, 2015.).
1.3 Importance of any advance care plan.
Advance care planning refers to the process by which service users make decisions
that can guide their future healthcare, if they find it unable to speak for themselves. The main
goal or objective of advance care planning is to clarify people’s wishes, needs and
preferences and deliver care to fulfil those needs. Therefore, it is procedure that supports
adults at any age or stage of health and sharing their personal values, life goals, and
preferences about future medical care. It has been observed that in recent years the need for
effective advance care plan is increasing for a range of reasons. Firstly, there are greater
number of people living longer, but not necessarily better. It has been found by researchers
that, advance care planning discussion enhances quality of life and the likelihood that health
care wishes will be fulfilled. Moreover, it allows a person to decide in advance what aid they
want to receive if they become unable to speak for themselves and it provides peace of mind,
a protection for close one’s who could find themselves making crucial decisions on a
patient’s behalf.

1.4 Identify the signs of that death has occurred.
The moment of death of a person is very powerful, even care giver or someone is
present during the process of death he/she will find it. However, no applicable rules govern
what happens when a person dies. Also, when it occurs the attention of care shifts from the
patient to the family and those who provided care (Blinderman and Billings, 2015). Here are
some signs that will tell that death has occurred:
 No breathing for a prolonged period of time.
 No heartbeat.
 Eyes remain fix and somewhat open, with distended pupils.
 Jaw relaxed, with the mouth slightly open.
 No response to efforts to awaken, shaking or shouting.
 Loss of control of bowel or bladder.
 Restlessness and agitation.
 Body colour becomes pale and waxen as blood settles
 Temperature drops
2.1. The psychological aspects of the dying phase for the individual.
Along with changes in character, person’s near to death may suffer from severe mood
swings and they may even be unaware of their sudden moods and activities. Feelings of loss
to emerge as part of the grieving process, is very common, for both the patient and its family.
This sense of loss may be regarding the future, their part in the family, their self-respect or
loss of control. Fear around death and dying is natural and it can eb experienced by the
patient fears about what will happen to their family after they die and how they will survive.
The family of the patient and patient as well may b in rejection about what is happening, and
they may not want to talk to care giver. Further, conflict with the family can be caused due to
rejection. Apart from this, tension, stress and high emotions may also be caused by a difficult
family history that has re-emerged and hasn’t been resolved. Moreover, at the end age of life,

patient’s family may so signs of anxiety and agitation. This may further result from
unresolved problem with the individual or with another person (Brooks, 2015).
2.2 Impact of the last days of the life on the relationship between individuals and others.
Significant burden is carried by patients and cares in last days of a person’s life and
their requirements often go un-met. The relationship between individual and society is very
close. The reason behind this is essentially society is the custom, ground rules and regulatory.
Therefore, these things are crucial to know how humans act and communicate with each
other. Impact of last days of a person’s life adversely affect the relationship between that
person and others, as conflict and emotional difficulties occurs while negotiating end of life
decisions, and disapproval over discontinuing treatment and place of death. As it is obvious
that end of life decisions in families are tough and emotional site of family relation. These
difficulties of end of life decision situations build a range of dilemmas for family members,
as they need to take decision for their loved one’s at their end days of life. They may
experience challenges in acquiring the information needed to make a good decision and any
wrong decision may affect their relationship. This is because, they may be uncertain about the
right decision to make even there is advance care plan in place. Moreover, they may also face
a contradiction between perceiving death as a burden or as a benefit.
2.3 Possible changing needs of the individual.
The essential part of medical care at the last days of life is comfort care. The goal is to
prevent suffering as much a possible and to enhance quality of life while respecting that
person’s wishes who is dying. Care providers required to be alert to meet a person’s spiritual
or cultural needs at the end days. For an individual this may include making sure they have
contact with a religious leader, while another may desire their favourite music composer’s
music to be played quietly but constantly throughout the time. Some desires to be surrounded
by their families and friends, others want to be alone. Basically it has been discovered that
person who is dying, needs care in four key areas; physical comfort, mental & emotional
needs, spiritual problems and practical tasks. Apart from this, their families also requires
support. Moreover, people who are at their end days of life may not be able to tell their
family that are feeling too hot or cold, therefore, they must to learn the signs of patient’s
actions and behaviour (Cherny, 2014).

3.1 A range of ways to enhance person’s well-being.
While caring for a person at the end of his/her life, the most crucial thing that can be
done to help a patient maintain dignity at last days of life is to remember that care is being
done for someone with different needs, experiences, and desires. Everyone at this stage wants
to be treated with respect. here are some ways to improve well being of a person in last days
of life:
Information about pills Assist the dying person, and those crucial to
them, understand and get most from their
tablets.
Ways to share material about medications Guarantees correct information about the
dying individual’s present medications.
Offer ways for those vital to the dying
person to take part in this procedure.
An agreed list of medicine Includes medication to treat indications that
are likely to occur in the last days of life.
Even go beyond the basics to assist to recollect self-importance in their appearance. Make
efforts to maintain their self-esteem at the last days of their life and keep them comfortable.
Moreover, focus on preventing, treating, reducing or eliminating discomfort.
3.2 The importance of working in partnership with key people to support the person’s well-
being.
Working in partnership in health and social care brings together distinct organisations
so that they can benefit from pooled expertise, resources & power sharing. The purpose of a
partnership is to improve the proficiency and quality of service provision. Below are the
importance of working in partnership with key people:
 It leads to improve and enhance results for people throughout their care period, and
support is readily available & accessible (Connell, 2016).
 Working in partnership termed as an effective means of aiding workforce
involvement and providing best possible services to people in need.

 It has been discovered that better work can be done by heath & social care services
and partners together to make sure that the needs of those individuals are more
predicted.
 Endorses mutual provision, inspiration and the discussion of ideas among staff,
helping the allocation of expertise, information and resources for training and good
practice, leading to more manageable tasks related to person’s well being.
3.3. How to use an integrated pathway according to agreed ways of working.
Integrated care pathways are constructed multidisciplinary care plans which point
vital steps in the care of service users with a specific clinical issue. Further, it is considered as
a map of the process included in managing a common clinical condition or situation. In
addition, they are also means of making better systematic collection of clinical data for
auditing and for promoting change in practice. Further, differences from the pathway may
happen as clinical independence is practiced to meet the needs of the individual patient. This
can be utilised as a tool to integrate local and national plans into everyday practice, handle
clinical risk and meet the needs of clinical supremacy. The first step to use integrated
pathway recognise members of the multidisciplinary team that are to be included. Once, they
have been identified, they need to discuss the current patient’s map and this procedure needs
to be followed through clinical attendance, in-patient treatment and discharge from hospital.
 Ask the person to read the information regarding agreed ways of working (Glaser and
Strauss, 2017).
 Provide them examples of policies and processes from the followed organisation.
 And finally when pathway has been developed it is being documented and this is
further included in the standards of good present practice.
3.4 Key information about the process following death that should be made available to
appropriate people.
 Request death certificates :- this is the very first step to contact the Vital Statistics
office in the state in which the death occurred and obtain several certified copies of
the death certificate.

 Probate the estate :- if that dead person has a will, it possibly named an executor who
is in-charge of conducting final wishes and disturbing property. Further, if a person
died without a will, a list is given by state laws of those who could serve in this
capacity. It is essential for dead person’s family members to note that since property
transferred at death is governed by state law, the details will vary from state to state.
Further, they may also consult an estate attorney to receive support through probate
process.
 Notify financial institution :- once death certificate is received and the letters also, the
family must contact any insurance firm where the decedent has a policy. Some
policies such as; mortgage cancellation plans, individually owned policies and
policies issued by associations provides benefits if a death resulted from an accident.
 Contact service providers :- interact utility firms and other service providers to alter or
discontinue services such as; television cable, internet and telephone lines can be
disconnected immediately. Further, this may also include to see over bank and credit
card statements to find other less obvious monthly recurring payments.
 Notify government agencies :- finally, inform correct government agencies to start or
end benefits. This means that, the surviving spouse or family of a dead person
receives a one time death amount from the Social security administration (Hindmarch,
2016).
4.1 National guidelines, local policies and procedures relating to care after death.
The guidelines have been created by National Palliative Care Nurse Consultants and
undertaken in partnership with NHS National End of Life Care Programme. They were
developed in response to the lack of training and direction for the profession on caring for
patients after death. Further, the endorsement of guidelines has been done by the Royal
College of Nursing and the Royal College of Pathologist. In addition to this it has been
revealed that guidance for staff accountable for care after death states that it can be made less
stressful by discussion while the patient is still alive, regarding problems such as organ
donation.

 Honouring the spiritual and cultural wishes of the decreased person and their family.
 Making sure that deceased and their relatives have their privacy and dignity respected
at all times.
 Honouring individual’s wishes for organ and tissue donation.
 Making sure the health and safety of every person who comes into contact with the
body.
 Further, ensuring accurate certification procedure have been followed (Hui, dos
Santos, Chisholm and Bruera, 2015).
 Confirming that if death is being referred to the coroner no action is taken which
might impede establishing the cause of death.
These new guidelines state to care after death instead of the formerly used last offices in a
thoughtful move always from military and religious implications. However, initially aimed at
nurses, they are intended to be relevant to all workers engaged in the care pathway.
4.2 Importance of being informed about a person’s wishes for their after-death care.
It has been proven by studies and researchers that the discussion between family
members can greatly enhance the end of life planning and decision making. People who have
decided end-of-life care with their families generally have shorter stays in intensive end of
life care with their relatives simply have shorter stays in intensive care units. Furthermore,
they can prevent efforts to work cardiopulmonary resuscitation and rather enable a natural
death to occur. Family members and patients who are prepared for after death wishes of care
help them to provides an invaluable gift to patient's loved ones. The discussion can be
between the richest and the most intimate friends, assisting families to overcome the
communication barrier. For example, some family members may desire to help with personal
acre in acknowledgement of individual's wishes, culture and religious requirements. After
death acre includes offering family present the chance to engage in the procedure and
supporting them to do so, facilitating individual's last wishes for organ and tissue donation,
and so on (McLaren, 2015).

4.3 Importance of acting in ways that respect the individual’s wishes for immediately after
death.
Dignity at the end of someone's life was one of the number of programmes
established from Nationals service framework for older people. It has been suggested by
some experts that when death of a person is near, music allow them to feel comfortable and
relaxed. Listening to music might also evoke memories those present in care. Further, it has
been determined that just being present with a dying person is enough and it is necessary to
fill the time with talking or activity. It has been stated that people who find ways to help may
welcome the chance to aid the family by knowing and acting in ways that respect the
individual's wishes for immediately after-death
4.4 Describe agreed ways of working relating to prevention and control of infection when
caring for and transferring a decreased person.
Infection prevention control is not simply a problem for hospitals, many infections
diseases can spread within care homes, where huge number of people may obtain infection. It
can be a major issue of illness between residents of care homes, which can lead to being
admitted to hospital. Prevention refers to the key step in halting the transmission of these
microorganisms. Restricted recommendations exist for preventing the transmission of these
microorganisms in the system of health care in the community and the home. Further, it has
been discovered that the infection of foundation prevention and control in the health care
environment is the use of routine practices, involve the usage of hand hygiene at all times and
the use of personal protective materials. These equipments further involve; gloves, gowns,
masks, eye protection and face protection including environmental control such as; cleaning
of surfaces. In addition, some of these exercises cannot be readily applicable in the home and
should be practice to the available resources, person's situation and potential pathogen. The
most important aspect of infection prevention and control activities is hand hygiene as it
decreases the burden of microorganisms on the hand and reduces the chances of transmission
to other people (Rosenberg, 2015).