Administering anticipatory medications in end-of-life care: a qualitative study of nursing practice in the community and in nursing homes

Wilson, Eleanor, Morbey, Hazel, Brown, Jayne, Payne, Sheila, Seale, Olive and Seymour, Jane (2015) 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: 60-70. doi:10.1177/0269216314543042

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Author Wilson, Eleanor
Morbey, Hazel
Brown, Jayne
Payne, Sheila
Seale, Olive
Seymour, Jane
Title Administering anticipatory medications in end-of-life care: a qualitative study of nursing practice in the community and in nursing homes
Journal name Palliative Medicine   Check publisher's open access policy
ISSN 0269-2163
1477-030X
Publication date 2015-01
Year available 2014
Sub-type Article (original research)
DOI 10.1177/0269216314543042
Open Access Status
Volume 29
Issue 1
Start page 60
End page 70
Total pages 11
Place of publication London, United Kingdom
Publisher Sage Publications
Collection year 2015
Language eng
Formatted abstract
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.
Keyword Anticipatory medication
End of life
Community nursing
Nursing homes
Decision-making
Symptom management
Place of death
Qualitative
‘Just in case’
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online before print: 28 July 2014.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
 
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Created: Tue, 21 Oct 2014, 11:57:14 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work