Browsing by Author "Seymour, Jane"

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    Administering anticipatory medications in end-of-life care: A qualitative study of nursing practice in the community and in nursing homes
    (Sage, 2014-07-28) Wilson, Eleanor; Morbey, Hazel; Brown, Jayne; Payne, Sheila; Seale, Clive; Seymour, Jane
    Background: In the United Kingdom, an approach to improving end-of-life care has been the introduction of ‘just in case’ or ‘anticipatory’ medications. Nurses are often responsible for deciding when to use anticipatory medications, but little is known about their experiences. Aim: To examine nurses’ decisions, aims and concerns when using anticipatory medications. Design: An ethnographic study in two UK regions, using observations and interviews with nurses working in community and nursing home teams (n = 8). Findings: Observations (n = 83) and interviews (n = 61) with community nurses. Nurses identified four ‘conditions’ that needed to be established before they implemented anticipatory medications: (1) irreversibility; (2) inability to take oral medication; (3) where the patient was able, they should consent and (4) decision had to be independent of demands or requests from patient’s relatives. By using anticipation medications, nurses sought to enable patients to be ‘comfortable and settled’ by provision of gradual relief of symptoms at the lowest dose possible. They aimed to respond quickly to needs, seeking to avoid hospital admission or medical call-out, while adhering to local prescribing policies. Worries included distinguishing between pain and agitation, balancing risks of under- and over-medication and the possibility of hastening death. Conclusion: Nurses take a leading role in the administration of anticipatory medications. Nurses apply consideration and caution to the administration of anticipatory medications but some experience emotional burden. Education, training and experience played a role in the nurses’ confidence and should continue to be central to efforts to improving the quality of palliative care in the community and nursing homes.
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    Continuous Sedation (CS) Until Death: Mapping the Literature by Bibliometric Analysis.
    (Elsevier, 2012) Papavasiliou, E.; Payne, S.; Brearley, S.; Brown, Jayne; Seymour, Jane
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    From sedation to continuous sedation until death: How has the conceptual basis of sedation in end-of-life care changed over time?
    (U.S. Cancer Pain Relief Committee, 2013) Papavasiliou, E.; Brearley, S.; Seymour, Jane; Brown, Jayne; Payne, S. A.
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    Palliative sedation: Improvement of guidelines necessary, but not sufficient: A reply
    (2015-05-01) Seymour, Jane; Rietjens, Judith; Bruinsma, Sophie; Brown, Jayne; Deliens, Luc; Sterckx, Sigrid; Mortier, Freddy; Mathers, Nigel; van der Heide, Agnes
    Reply to article: Schildmann, E., Bausewein, C. and Schildmann, J. (2015). Palliative sedation: Improvement of guidelines necessary, but not sufficient. Palliative Medicine, 29(5), pp.479-480. https://doi.org/10.1177/0269216315570413
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    The perspectives of bereaved relatives and clinicians about sedation in end of life care: insights from qualitative case studies
    (2014-03) Seymour, Jane; Brown, Jayne
    Background There are few studies which compare the experiences of clinical staff and bereaved relatives about sedation use in end of life care. Aim To report aspects of the UNBIASED study (UK, Netherlands and Belgium International Sedation Study), comparing how UK clinicians and bereaved relatives recall the use of sedation in end of life care. Methods Qualitative case study design using face to face interviews. Setting: Hospitals, the domestic home, and hospices. Participants: doctors, nurses and bereaved relatives involved in care of cancer patients who received continuous sedation until death. Senior clinical staff identified eligible decedents and then nominated the physicians and nurses most involved in their care; they then used their discretion to invite bereaved relatives to take part, at least three months after the death. Findings 22 case studies were completed in the UK arm of the project. Seven cases were complete, in that they had perspectives from at least one nurse (n=10), one doctor (n=9) and one relative (n=7). This presentation focuses on these 7 cases. Relatives recalled that gaining control of some patients' symptoms was difficult to achieve and they regretted the time taken to gain this. Clinicians reported that the movement towards continuous sedation unfolded over time with no particular ‘moment’ of decision making. Careful use of medications to control difficult symptoms without making the patient completely unconsciousness was seen as the ideal by both relatives and clinicians. Some relatives and clinicians were concerned about hastening death; some relatives regretted that this was not possible in UK practice. Relatives expressed a range of understandings about how sedative medications worked. Understanding patients' wishes was important for both relatives and clinicians. Conclusion Detailed case studies can illuminate difficult areas of practice and provide pointers for practice development. Implications for communication and decision-making practice will be explored.
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    The perspectives of clinical staff and bereaved informal care-givers on the use of continuous sedation until death for cancer patients: The study protocol of the UNBIASED study
    (Bio Med Central, 2011) Seymour, Jane; Rietjens, Judith; Brown, Jayne; van der Heide, Agnes; Sterck, Sigrid; Deliens, Luc
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    Using continuous sedation until death for cancer patients: A qualitative interview study of physicians’ and nurses’ practice in three European countries
    (Sage, 2014-07-25) Seymour, Jane; Rietjens, Judith; Bruinsma, Sophie; Deliens, Luc; Sterckx, Sigrid; Mortier, Freddy; Brown, Jayne; Mathers, Nigel; van der Heide, Agnes
    BACKGROUND: Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses. METHODS: Qualitative case studies using interviews. SETTING: Hospitals, the domestic home and hospices or palliative care units. PARTICIPANTS: In all, 57 Physicians and 73 nurses involved in the care of 84 cancer patients. RESULTS: UK respondents reported a continuum of practice from the provision of low doses of sedatives to control terminal restlessness to rarely encountered deep sedation. In contrast, Belgian respondents predominantly described the use of deep sedation, emphasizing the importance of responding to the patient's request. Dutch respondents emphasized making an official medical decision informed by the patient's wish and establishing that a refractory symptom was present. Respondents employed rationales that showed different stances towards four key issues: the preservation of consciousness, concerns about the potential hastening of death, whether they perceived continuous sedation until death as an 'alternative' to euthanasia and whether they sought to follow guidelines or frameworks for practice. CONCLUSION: This qualitative analysis suggests that there is systematic variation in end-of-life care sedation practice and its conceptualization in the United Kingdom, Belgium and the Netherlands.
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    What do we know about the application of the Mental Capacity Act (2005) in healthcare practice regarding decision making for frail and older people?: a systematic literature review
    (Wiley, 2015-11-26) Hinsliff-Smith, K.; Feakes, R.; Whitworth, G.; Maghaddam, N.; Cox, K.; Dening, T.; Seymour, Jane
    In England and Wales, decision‐making in cases of uncertain mental capacity is regulated by the Mental Capacity Act 2005. The Act provides a legal framework for decision‐making for adults (16 and over) who are shown to lack capacity and where best interest decisions need to be made on their behalf. Frail older people with cognitive impairments represent a growing demographic sector across England and Wales for whom the protective principles of the Act have great relevance, as they become increasingly dependent on the care of others. However, while the Act articulates core principles, applying the Act in everyday healthcare contexts raises challenges for care providers in terms of interpretation and application. This paper presents a review of the published evidence documenting the use of the Act in healthcare practice, with particular reference to frail older people. Our aim was to identify, review and critically evaluate published empirical studies concerned with the implementation and application of the Act in healthcare settings. A systematic approach was undertaken with pre‐determined exclusion and inclusion criteria applied across five electronic bibliographic databases combined with a manual search of specific journals. This review reports on 38 empirical sources which met the inclusion criteria published between 2005 and 2013. From the 38 sources, three descriptive themes were identified: knowledge and understanding, implementation and tensions in applying the Act, and alternative perspectives of the Act. There is a need for improved knowledge and conceptualisation to enable successful incorporation of the Act into everyday care provision. Inconsistencies in the application of the Act are apparent across a variety of care settings. This review suggest staff need more opportunities to engage, learn and implement the Act, in order for it to have greater resonance to their individual practice and ultimately benefit patient care.