Conversation 3: Good example

Location, own home. In the room is D/N , Patient and Daughters Laura and Sasha. 1 year later assessment of symptom control /care planning.

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Evidence of ongoing assessment and interventions such as supplying pressure relieving cushions, raised toilet seat, zimmer, commode for beside the bed, urinal.
Family will be struggling as supporting father for a year but now there is a change in condition - stamina of the family is crucial in coping with the ongoing deterioration and uncertainty of the future - refer to Mishel 's work on Uncertainty

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Setting the scene
Building rapport
Letting them know she remembers the last interaction
The RCN Survey highlighted the importance of inter and intra- team working

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Empathy
Assessing how he has coped with the knowledge received last week and his understanding

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Grief can impact on a spouse’s quality of life quite significantly and it is always helpful to know what family's previous experience of death and dying is. There is a risk if it wasn't good.

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Acknowledges the level of grief- consider separate support for this
eg spiritual care or bereavement counselling

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Grief is so complex - important to acknowledge all experience of loss
Sometimes within families there is not the recognition of each others grief

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Facilitating an advance care planning conversation that is patient led- taking the opportunity to support

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Patient led
Responding to queues
Preparing for bereavement

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Patient led
Responding to queues
Preparing for bereavement

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Important to establish the communication with children
Consider using Marie Curie or Macmillan Cancer Support literature

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Practical suggestions re improving quality of life – involving family and grandchildren in adapting lifestyle to the natural decline that is occurring
Consider finding new ways of communicating where appropriate

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Summary
Includes value of advance care planning
Plan
Human element of caring

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Final check re symptoms as had got distracted with the patient agenda which is the most important but still have to check re the symptoms - and to remember the need to asses s and manage constipation
Oral assessment crucial
Holistic assessment - physical, psychological, social and spiritual

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