The experiences of family members witnessing the diminishing drinking of a dying relative in hospital: A narrative inquiry.

BACKGROUND: The optimal management of diminishing drinking at the end of life is contentious. Clinicians and family members may understand the phenomenon differently and hold divergent priorities regarding care. Family members can be distressed by diminishing drinking and its management, particularly when in a hospital environment. AIM: To explore the experiences of family members when witnessing the diminishing drinking of a dying relative. DESIGN: A narrative inquiry methodology, derived from pragmatism. SETTING AND PARTICIPANTS: Thirteen recently bereaved family members were recruited through the bereavement services of three UK hospitals. Inclusion criteria included having an adult relative who died in hospital of any diagnosis more than 48 hours from admission and who had had noticeable diminishing drinking. FINDINGS: Participants experienced diminishing drinking as an unfolding process that was part of overall decline. They all believed it to be detrimental. Three groups of responses were identified: promoting, accepting and ameliorating. Supportive measures included offering equipment to support drinking, staff being present and communicating about expectations and care management aims. CONCLUSIONS: There is potential to improve family members' experiences through re-conceptualisation of diminishing drinking aligned to their experiences, supporting family members by listening to their experiences with insight and strengthening their agency within the management of their relatives with diminishing drinking.

The experiences of family members witnessing the diminishing drinking of a dying relative: An adapted meta-narrative literature review.

BACKGROUND: Addressing the concerns of family members is an important aspect of palliative and end-of-life care. One aspect that commonly causes family caregivers concern is the decline of patients' oral fluid intake in the last few days of life. AIM: To map the narratives in which family members' experiences of witnessing the diminishing drinking of a dying relative have been researched, review the findings within each narrative and consider directions for future research. DESIGN: An adapted meta-narrative review approach. DATA SOURCES: The Cumulative Index of Nursing and Applied Health Literature, Medline, PsycINFO, Psycharticles and Scopus databases were searched for relevant research published between January 1982 and December 2017. Quality was assessed using the Quality Assessment and Review Instrument. RESULTS: A total of 22 papers met the inclusion criteria. No study focused specifically on the experiences of family members when witnessing the diminishing drinking of dying relatives. However, research about diminishing drinking was identified within studies broadly focusing on cancer cachexia, clinical decision-making about hydration and/or nutrition and support in a hospice context. The research indicates that family members' experiences of diminishing drinking vary with their views about the significance of drinking, dying well and their expectations of themselves and healthcare professionals. CONCLUSION: While some understanding of the topic can be inferred from research in related areas, there is a paucity of information specifically about family members' experiences when witnessing the diminishing drinking of a dying relative.

The management of hypercalcaemia in advanced cancer.

Hypercalcaemia is common in patients with advanced cancer. If detected, it usually responds to palliative treatment and patients' distressing symptoms will improve markedly. However, if left untreated hypercalcaemia is potentially fatal. It can be difficult to detect as its symptoms can also be attributed to other common aspects of advanced malignancy. It is therefore essential that nurses are aware of the underlying physiology and can identify which patients are at risk of becoming hypercalcaemic. Hypercalcaemia often recurs and can become increasingly difficult to treat. Such refractory hypercalcaemia requires sensitive and considered management with advance care planning, particularly as difficult treatment dilemmas may arise if and when malignancy advances.

Understanding best practice within nurse intershift handover: what suits palliative care?

Following identification of the limitation of nurse intershift handover within a specialist palliative care unit, a review of the research literature is undertaken. The aim is to identify and appraise what is known about best practice within nurse intershift handover and evaluate the implications for practice within a specialist palliative care inpatient unit. The retrieval of literature identified 19 pertinent research papers which were critically analyzed. Three main themes emerged within the literature: purpose; type; and content of handover. Only two studies had been carried out within a generalist palliative care context; however, five sub-categories emerged that may be significant in meeting the demands of specialist palliative nursing. These were: clinical decision-making; staff support; maintaining confidentiality while handling sensitive information; patient involvement; and type of information exchange. All themes are presented within this article. The literature review suggests that traditional verbal nursing handover may be the most advantageous handover method within inpatient specialist palliative care, though attention to structure and focus is vital.