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dc.contributor.authorWilson, Eleanoren
dc.contributor.authorMorbey, Hazelen
dc.contributor.authorBrown, Jayneen
dc.contributor.authorPayne, Sheilaen
dc.contributor.authorSeale, Cliveen
dc.contributor.authorSeymour, Janeen
dc.date.accessioned2018-03-01T11:07:04Z
dc.date.available2018-03-01T11:07:04Z
dc.date.issued2014-07-28
dc.identifier.citationWilson, E., Morbey, H., Brown, J., Payne, S., Seale, C. and Seymour, J. (2014) Administering anticipatory medications in end-of-life care: A qualitative study of nursing practice in the community and in nursing homes. Palliative Medicine, 29(1), pp.60-70.en
dc.identifier.urihttp://hdl.handle.net/2086/15319
dc.descriptionOpen access articleen
dc.description.abstractBackground: 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.en
dc.language.isoenen
dc.publisherSageen
dc.subjectanticipatory medicationen
dc.subjectend of lifeen
dc.subjectcommunity nursingen
dc.subjectnursing homesen
dc.subjectdecision-makingen
dc.subjectsymptom managmenten
dc.subjectplace of deathen
dc.subjectqualitativeen
dc.subject'just in case'en
dc.titleAdministering anticipatory medications in end-of-life care: A qualitative study of nursing practice in the community and in nursing homesen
dc.typeArticleen
dc.identifier.doihttps://doi.org/10.1177/0269216314543042
dc.peerreviewedYesen
dc.funderN/Aen
dc.projectidN/Aen
dc.cclicenceCC-BY-NC-NDen
dc.date.acceptance2014-06-28en
dc.researchinstituteInstitute of Health, Health Policy and Social Careen


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