End Of Life

Social perspectives

A persons social perspective is influenced by a number of different social factors. The social relationships a service user has could cause them to worry about the impact their death will have on others such as family, friends, children & colleagues. This worry & concern is often referred to as ‘social pain’ & a service user may include the following:

.loss of relationships: their social placement within the family unit (as a father, mother, grandparent) .loss of role within their community
.worry about how their family will cope emotionally, psychologically &socially after their death. .worry about how their family will manage financially (especially if they are the main income bearer).

These can influence the choices of a dying person in relation to planning of their death& the decisions they make.

Cultural perspectives
Cultural perspectives that may affect a persons views on death & dying will relate to feeling & views which are not always obviously apparent. It may be, for example, that the dying persons culture prevents them from discussing issues surrounding death. Specific medical treatments or intervention may not be allowed within that culture. Language & ethnic background may also present challenges to the way in which their care is planned cultural perspectives may include:

.a dying persons religion
.language
.traditions
.their preference towards medical interventions.

In direct contrast, a service users views on death & dying may be influenced
more positively by their cultural heritage. They may discuss traditions with you in relation to their care plan which are important to them & should be applied.

RELIGIOUS PERSPECTIVES

religion can be defined as being:
.a system of faith & worship with reference to a power commonly described as God.

Religion is a practical way of expressing a persons spirituality in the practice of beliefs & rules by following rituals & religious practices. Service user may want to participate in the planning of these beliefs in order that they upheld before & after death. It is important as a care worker in end of life that you are aware of the different beliefs & practices of different religions. Also a care worker should be aware that within a religion there may be several separate schools of thought & belief for example, within Buddhism there are seven different schools of teaching. Within Christianity there are a number of different churches such as Catholic, Church of England, Pentecostal, Jehovah Witness

Religious factors that can affect a service users views on death & dying may include the following:

.Their religious needs & faith & how they wish these to be respected .medical interventions & treatments which the service user would or would not prefer during their end of life care. .religious matters in relation to diet, prayer & worship routines .the provisions that should be made to ensure that individuals service users can carry out any rituals or religious practices including praying,anointing with oils,periods of fasting of self denial, special diets etc. .the arrangements for priests or other religious fixtures to visit the service user & attend their death/uphold religious beliefs following their death.

As faith is a individual matter it is important to demonstrate respect for individual beliefs by recognising individual preferences.

Buddhism
Buddhist hold a belief that the state of a persons mind upon the time of death will determine the state of their rebirth after death, it is essential that people of the Buddhist faith are given full information about their imminent death in order that they can make preparations because rebirth is a fundamental part of Buddhism. The preparation for death will prevail over rituals associated with their death. Some Buddhists will chose not to have sedative or analgesic medication at this time so they can maintain a clear mind.

There is no single Buddhist death ritual, type of funeral or afterlife requirement. However, some Buddhists do have special needs as death approaches, in order to assist in the passage to the next rebirth wholesome acts such as generosity, kindness &pleasant thoughts are recalled. Peace & quiet in order that meditation can take place is important & some Buddhists will chant in order to influence their state of mind at the time of death.

In some traditions, it is desirable for the body to remain at the place of death for up to seven days to allow rebirth to occur, Although this may pose a problem, a solution is often found as Buddhist are noted for their tolerance, calmness & moderation, rather than for making demands.

Cremation is often preferred by Buddhists as they believe that the body is vehicle that is temporary. Buddhists who are facing death may also request that a monk or nun be present to chant & assist in the passing from this life. Following death, routine last offices are appropriate.

Christianity

There are may different practices of Christianity & each one will take a different approach in their teaching & interpretation of the bible.

A priest may be requested to visit an individual who is approaching death.
The priest may preform one or more holy sacraments. The dying person may also want to take confession & Holy communion, these rituals are important preparations for the service users journey to the next life.

Following death & depending upon the wishes of the family, the body is usually laid out so people can pay their last respects & offer prayers

Hinduism

Individuals of the Hindu faith would prefer to die at home so death in hospital can create a great deal of distress to both the individual & their family.

Its important to the dying person that close family members are present & it is common for the family to stay by the individuals bedside & to be involved in their care as death approaches. The family may also insist on a service users eldest son being present, even if the eldest son is a very small child.

The family may call a Hindu Priest who will preform Holy rites with the dying person . These may include tying of the blessed thread around the neck or wrist of the service user. Holy water from the granges is usually sprinkled over them or used to wet their lips. A sacred Tulsi leaf may be placed in the service users mouth. It is if death is iminant that the family are aware so that they can carry out these important rituals. The family may also wish to place the person on the floor during the final few breaths in order that their body can be returned back to nature.

Some Hindus are very strict about who touches the body after death& some family members may feel distressed if a non Hindu touches it, Close family members usually wash the body & their wishes to do so must always be respected.

Islam

Muslims believe that there is life after death. They believe that when they die they will be judged by their actions. Good deeds will be paid by everlasting life in heaven & bad deeds will be repaid with everlasting life in hell.

When a person of the Muslim Faith is dying, it is essential that privacy is respected in order to give them time to declare their faith.recital from Quran can bring comfort to the person.

As a person is dying they may request a visit from the Imam. The Imam is a Muslim religious leader & the family may recite prayers around the person as they lay on their bed. If the individuals family are unable to attend the bedside any practising Muslim may help. Following death it is important that the care worker do not touch the body if they are not Muslim themselves. A person of the same sex within the service users family should prepare the body. However if care staff need to prepare the body they MUST wear disposable gloves.

Once the service user has died the family member will preform ritual washing, the body is wrapped in a shawl of usually simple white material & afterwards prayers are said for the service user. The body must be buried within 24 hours of death if possible as Muslims believe that the soul departs at the moment of death the service user will be placed with their head turned to the right facing the Muslim holy city Mecca.

Judaism

If the service user is of Jewish faith the family may request that their Rabbi be contacted in order to help with the service users formal confession & also to bring comfort.

Many Jewish people will wish to have kosher food, Kosher meat is slaughtered in accordance with very specific rituals & eating of pork game &shellfish is not allowed. Dairy products such as milk should not be consumed at the same t6ime as meat dishes.

Following death, if the service users son is present then he may wish to close their eyes& mouth. The body should be handled as little as possible by non Jewish people and this should always be respected. If a care workers need to touch the body they should use disposable gloves. It is essential that the body is laid flat, with the hands open, arms parallel & close to the body. The legs should be stretched out before the body is removed & wrapped in a plain white sheet.

The family may request the body to be placed with the feet pointing to the door & to light a candle. It is usual for relatives or friends to keep a vigil by the body & recite prayers. The Jewish Burial Society will collect the body & preform the washing preparations before burial. The burial itself should take place within 24 hours or as soon as possible after death. Orthodox Jews are always buried but non orthodox Jews can be cremated. Under Jewish law the body must remain intact & post-mortems are not normally permitted unless absolutely necessary.

Sikhism

People who follow the Sikh religion believe that the soul re enters the cycle of birth & death after they have died, taking on a different life forms depending on their actions in their former life.

The Sikh religion has a symbolic dress code often referred to as the 5 K’s: .THE KESH:
this refers to uncut hair including beards & moustaches. Hair on the head is kept under a turban. .THE KANGHA:
This is a small wooden comb used by Sikh’s to keep there hair clean and tidy. .THE KARA:
This is a bangle made of steel or iron & is always worn on the right wrist. The metal symbolises strength & the circle symbolises unity & eternity. .THE KIRPAN:
This is a short sword or dagger & is worn as a reminder of the courage of the first five Sikhs who were willing to die for their faith. It is a symbol of bravery & of faith in god &is worn on a belt, which is worn across the shoulder & under the clothes. .THE KACHERA:

These are white short trousers that are worn as underclothing by both men & women.

Individuals of Sikh faith may be comforted by reciting passages from their holy book. This is called the Guru Granth Sahib . A relative or another person from the local temple may also be asked to read if the service user is to ill. Holy water from the Gurdwara may also be given to sip or could be sprinkled on or around the service user.

Following death,non Sikhs are permitted to care for the body of the deceased, however, many families will want to wash & lay out the body themselves. Almost without exception,Sikhs are normally cremated & this should take place as soon as possible.

Spiritual Perspectives

Most people have a spiritual component to their life at some point, just as they have physical,social & psychological components. In this instance,Spiritual needs relate to the needs of a person approaching their end of life may have in regard to their religion,culture,values,beliefs & experiences. Spiritualism tends to come into focus at a time of emotional stress,illness,loss, bereavement & death. As with other dimensions of the person, spiritual needs are highly individualised & can change as other dimensions of a persons health changes.

Support for spiritual needs may be especially important at end of life as the service user starts to consider their own death and dying.

Spiritual factors that can affect a service users views on death & dying include: .their expression of religious belief within their spiritual values. .the meaning & purpose of their life & whether they have for filled their ambitions & needs. .environmental perspectives such as their method of burial.

.there reflections upon key life events,love &family relationships. .cultural & family decisions which they would prefer to be upheld during their end of life care .preferences for music, the arts & self expression. This could include their views in relation to creative approaches such as art, poetry, meditation,massage & relaxation techniques that could be used in their end of life care.

A person does not need to have a religious belief to be deeply spiritual.

2.3 Explain why key people have a distinctive role in an individuals end of life care. The Governments end of life care strategy recognises the important role of family, close friends & informal carers for people who are approaching end of their life,Family members & close friends are a vital part of the care team& often feel satisfaction from knowing that they can help with the care & comfort of their loved ones. A person centred approach to caring for individuals who are nearing the end of their lives must involve family &close friends maintaining relationships with family & friends is an essential element of positive care.

2.4 Explain why support for an individuals health & well-being may not always relate to their terminal condition.

When a person is faced with dying, it is not just the loss of life they are faced with. They will also experience many other losses , all of which could impact on their health & well-being for example, a person may lose their: .seance of independence will most certainly

.sense of security
.sense of identity
.aspirations, hopes, dreams & plans for the future
.social role
.earnings
.employment status
.important relationships
.sexual function
.self esteem

there are many other losses that an individual may experience we do not always think of loss in this way, especially when caring for people who are nearing the end of their life,because the ultimate loss of life it is however essential to bear in mind that a person facing death will most certainly be facing loss in other areas of their life all of which could contribute to their ‘total pain’. The concept ‘total pain’ was first used by Dame Cicely Saunders to emphasise the fact that pain is much more than a physical phenomenon.

3.1 Describe the benefits to an individual of having as much control as possible over their end of life care?

Autonomy & choice over health care decisions are major features within the field of end of life care. The advance care planning process allows individuals to exercise control over their end of life care & can provide a number of benefits for the person nearing the end of their life. For example,advance care planning ensures that the individuals can: .express their priorities, which can be Considered at a future time. .identify where they wish to die.

.identify issues which they feel need to be dealt with sooner rather than later. .make professionals aware of their wishes.
.where appropriate, promote important discussions between family members. .reduce the risk of conflicting decisions later in the care process.

In addition,everyone deserves the best quality of care when they are faced with life limiting conditions & death involving service users & giving them control over their end of life care will also ensure that they receive care which is person centred & dignified in approach. Its essential that the individual& the people who matter to them are actively involved in decisions concerning their end of life care.

3.2 Explain the purpose of advance care planning in relation to end of life care?

Advance care planning has been defined within The National Council for palliative care guidance ‘Advance care planning: A guide for Health & Social care staff 2007 as: ‘A process of discussion between an individual & their care providers irrespective of discipline. If the individual wishes, their family & friends may be included, with the individuals agreement, the discussions should be documented, regularly reviewed & communicated to key persons involved in their care!

We can therefore assume that advance care planning is a process that is used to discuss & plan ahead. It involves the discussion & documentation of service users wishes. Family members & friends can be involved if the service user wishes.

The types of wishes & preferences that are commonly discussed are: .Where the individual would like to be cared foe towards the end of their life-this is supported through the preferred priories for care (PPC). .Choices about the type of treatment & care they wish to receive. .Choices about their type of treatment & care they would not wish to receive. .Arrangements in relation to the individuals funeral.

There are two specific areas within advance care planning these are:

1) Advance statement of wished & preferences- this relates to formalisation of what the service users do wish to happen to them in the future. 2) Advance decisions- this clarify s what the service user does not wish to happen to them in the future, The Mental Capacity Act (2005) gives people in England & Wales a statutory right to refuse treatment, through an ‘advance decision.

Once an advance care plan has been drawn up, it is essential that it is reviewed on a regular basis in order to identify any changes in the service users wishes.

3.3 Describe own role in supporting & recording decisions about advance care planning.

I am involved in the process from the beginning, if a service user discuses their wishes & decisions, I must document these accurately & legibly within their care plan, I must let other staff members who provide care for the individual, especially my Senior so they can inform doctors, nurses & also family members of anything a service user has told me so that they are also aware of these decisions, I should support any decisions made by a service user & not let my own thoughts , feelings or views alter the way of offering the service user support.

3.4 Outline ethical & legal issues that may arise in relation to advance care planning

Ethical dilemmas arise when there is a perceived conflicting duty to the person who is nearing the end of life for example, a conflict between a duty to preserve life& a duty to act in the individuals best interests, or when an ethical principle such as respect for autonomy conflicts with a duty no to harm.

Ethical & legal issues arise within end of life care surrounding the subject of advance decisions to refuse treatment. These decisions can include ‘Do not attempt resuscitation’ orders refusal of mechanical ventilation & artificial feeding. Very often, these advance decisions do not come to light until the individual has lost capacity to make decisions, in such cases,Health care professionals must start from the presumption that the individual had capacity when the decision was made.

Ethical issues may arise if a health care professionals are not aware of an individuals advance decisions to refuse treatment. At present, there is no National Registration system to help professionals establish whether an advance decision has been made,& the service user may not be well enough to inform the team that they have made an advance decision.

The relatives of the individual may not agree with the content of advance decision &, when faced with a loved one’s iminant death, may plead with health care professionals to ignore an advance decision.

Currently in the UK, it is recognised that where death is inadvoidable, life-sustaining treatments such as resuscitation, artificial ventilation, dialysis or artificial feeding may be withdrawn or withheld in such cases the goal of care becomes the relief of symptoms. Basic care & comfort must be provided & can never be withheld.

4.5 Give examples of how an individuals well being can be enhanced by:

I, Environmental Factors.
The environment can have an enormous impact on a persons well being as they approach the end of their life. An environment which is clinical& cold is likely to reinforce to the person that they are living with an illness, while an environment which is homely & warm is more likely to enhance the persons well being. For some people it may be particularly important that they can get outside. A sensory garden can provide the senses with different colours, smells, sounds & textures.

Ii, Non Medical interventions
Non medical interventions will depend on the individual & their abilities. For some people, just having someone there can have enormous impact on their sense of well being. Holding the individuals hand, if this is expectable to them, can be soothing. There are many ways in which symptoms can be relieved using non medical interventions, for example a person experiencing difficulty breathing can be supported to reposition themselves, sitting upright can alleviate the distress that comes with being breathless.

Iii, use of equipment & aids
The use of equipment & aids can help a person to maintain their independence, for example assertive technology can be used to remind a person that it is time to take their medication. There are aids that can help with washing, toileting, eating, drinking, bathing, wheelchair ramps & handrails , and many more to ensure the individual has a sense of independence.

I.v. Alternative therapies

Alternative therapies are also referred to as unconventional therapies. These therapies are used instead of conventional treatments. There are many reasons why people choose alternative therapies, for example, some people fear the side affects of conventional treatments. Reflexology, acupuncture are some forms of alternative therapies.

5.1 Explain the importance of recording significant conversations during end of life care

The wishes of people approaching end of life are not always known by members of the wider healthcare team or the service users families. This can lead to situations where service users are denied the care that is important to them or in the setting where they would want to receive it. This could lead to a situation where the service users wishes & advance decisions are not taken into consideration. Significant conversations could relate to the advance care planning process & may lead to a review of the advance care plan. It is therefore essential that any significant conversations are appropriately recorded, with the consent of the service user.

5.2 Explain factors that influence who should give significant news to an individual or key people

Workplace polices & procedures will indicate who should give significant news to the individual & for their love ones. Surrounding a diagnosis, the individuals doctor will be the one to break significant news to the individual & most would only take the news from a doctor. In some instances clinical nurse specialists may also give the news.

5.3 Describe conflicts & legal or ethnical issues that may arise in relation to death or end of life care.

As a person nears end of their life, there are often difficult decisions to be made. Some of the decisions surround aspects associated with treatments. Other conflicts that may arise relate directly to issues surrounding confidentiality. When a life limiting diagnoses has been made, the service user may not want to tell other members of the family. Equally,family members may be aware of the diagnoses & wish the service user to be told. This raises enormous issues in relation to planning & making advance decisions.

One of the most common issues concerns whether to stop or withhold potentially life, prolonging treatment. Decisions about medical treatment & the withdrawal of treatments can cause conflict between health professionals & family of the person who is dying, especially if the expectations of the family are different from the expectations of the care team.

5.4 Analyse ways to address such conflicts.

Advance care planning can go a long way to avoiding conflicts of interest, because it enhances a discussion of end of life issues between the services user, the family & the people who are providing care. Even more importantly it provides reassurance that the service users wishes will be upheld even when they have lost capacity to make decisions. Advance care planning can therefore prevent confusion & conflict when end of life decisions need to be made. It is easy to see how lack of advance care planning, good education & clear channels of communication between the service user, care staff, family & specialist palliative care team can help in avoiding such conflict.

6.1 Describe the role of support organisation & specialist services that may contribute to the end of life care

When an individual is diagnosed with a life limiting condition it is essential that all steps are taken in order to meet their individual needs. Following a through assessment, an individual care package, which will call upon the skills & knowledge of a wide range of people, will be drawn up in partnership with the individual.

In addition to the support that can be provided by health & social care workers,there are a number of supportive organisations & specialist services that can make valuable contributions to supporting a person who is nearing the end of their life.

When a person is diagnosed with life limiting condition, their G.P will usually inform their local social services department. Although social services do not provide specialist palliative care services, they may be able fulfil a number of roles & offer a range of services which, when combined with palliative care services, can contribute significantly to an individuals total care package within their own home . They can provide & refer individuals to a range of services which may include one or more of the following:

.provision of needs assessment-social services have a legal obligation to assess care needs |& to provide any services that have been highlighted as necessary.

.provision of carers assessment-carers providing informal care are entitled to have their needs assessed.

.home care- this is the care provided within the individuals home.

.support & advice through community support teams- community care teams assess the needs of the individual within their home& help the individual to sustain independent living skills.

.Day centre services- these provide social stimulation as well as involving the individual in a range of activities, such as hobbies & crafts.

Hospital social work teams-if an individual is admitted to hospital, their needs must be assessed before they returned home in order that necessary services can be put in place prior to discharge.

.Assistance & advice regarding benefits – many people who are diagnosed with life limiting condition may not realise that they may be entitled to benefits.

.provision of specialist equipment- this may be needed in order to ensure that the person remains as independent as possible.

.provision of housing adaptations – adaptations to the home include items such as grab rails, wheelchair ramps or specially designed showers.

. care home facilities – if a persons conditions deteriorates, it may become necessary to consider the need to move in to a residential care home.

Hospice care
Dame Cilcely Saunders was founder of hospice movement. She used the term to refer to a place providing specialist care for dying people, building St Christopher’s Hospice in london, the worlds first purpose- built hospice. A hospice provides person centred medical, nursing & emotional care free of charge for individuals who are being treated for a life limiting condition & their family.

Hospices can provide respite care & also provide palliative care to help& other distressing symptoms that can be experienced by people as they near the end of their life.

Volunteers & voluntary groups
Volunteers & voluntary organisations play a very important role in supporting people who are needing the end of their life, voluntary organisations are formally structured, non profit making, independent organisation.

Grant Making Charities
The association of charity officers is a national umbrella body for benevolent charities. These are charities that provide aid & advice to needy
individuals. The association links individuals who are in need with national & local grant making charities that may be able to help them. Grant making charities are charities that can give financial assistance in certain circumstances.

Organisation that can help with aids & equipment & adaptation

Aids, equipment & adaptation may be essential in ensuring that an individual can remain as independent as possible for as long as possible. Social service may be able to help with these if they are identified through the assessment process.

National organisations for specific health conditions

There are some organisations that provide information relating to specific conditions for example, the Alzheimers society is a charity that works to improve the quality of life of people living with dementia. National Organisations for specific health conditions can provide information about the individuals condition, support for the person & their families & may also be able to give guidance on specific issues.

6.2 Analyse the role & value of an advocate in relation to the end of life care The word advocacy is derived from the latin advocare which means “to call ones aid” it related to standing up for an individual of group who are unable to do this themselves. An advocate therefore help service users to express their needs and wishes.

If a person needs support with making choices about their care or expressing their views,they should be able to use a free advocacy service.
Advocates:
.are independent of health & social care services
.support the person with decision making & speaking for themselves.
.represent the views of people who are unable to represent their own views.

The Mental Capacity Act also set the independent Mental Capacity Advocate (IMCA) service. This service helps vulnerable people who cannot make some (or all) important decisions about their lives. The IMCA service means that certain people who lack capacity will be help to make difficult decisions, for example in relation to medical treatment choices, or where they live & choose to die. It is aimed at people,who do not have relatives or friends to speak for them a lack of mental capacity could be due to:

.a stroke or brain injury.
.a mental health problem
.a dementia-related condition
.a learning disability
. unconsciousness

6.3 Explain how to establish when a advocate maybe beneficial

advocary services are crucial when people are more vulnerable because ,they behave learning difficulties or are being treated under a section of the mental health act . Advocary services may need to be called upon when a person has been assessed as lacking capacity. Health and social care workers must always assume that a person has capacity to make decisions unless an assessment has proven that it is lacking.

According to the mental capacity act, there are two questions that need to be answered in order to assess capacity. 1) is there an impairment of or disturbance in the functioning of a persons mind or brain 2) is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?

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6 Understand the role of organisations and support services available to individuals and key people in relation to end of life care

6.4 Explain why support for spiritual needs may be especially important at end of life. Spirituality is what gives meaning ,value and purpose to our lives. It is what make our thoughts and beliefs unique to us . Sometimes a person spiritual needs ,feeling and culture may not be obvious and can be overlooked due to poor communication or the intensity of a person’s care requirements it could be easy to shy away from discussing the service over fear due to concerns about upsetting them further or not being able to deal with the consequences of what they may say

6.5 Describe a range of sources of support to address spiritual needs

However much support you give , there may be times when service users do not wish to discuss their concerns with you. It is at these times when addition support can be offered. Some specialist nurses within the palliative care team are able to offer support,but consideration should also be given to contacting a chaplain,minister, priest or any requested spiritual representative in order that the individual can address their concerns.

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7 Be able to access support for the individual or key people from the wider team

7.1 Identify when support would be offered by other members of the team

It is important to recognise your boundaries in relation to the provision of end of life care so that you know when other members of the team may need to be called upon. Many healthcare professionals can be involved in providing end of life care and the type of support will depend on the needs of the service user. Hospital doctors and nurses,G.P’s ,community nurses and councillors,social services, religion ministers,complementary therapists or physiotherapists are only a few of the professionals who may be called upon for support. Most hospitals have specialist palliative care teams that coordinate these services. Working beside general staff, they deliver end of life care to service users and their families in many care environments

A physiotherapist may be needed when a person’s joint become stiff . A religious minister may be called upon as some religious people feel better when they pray, Community nurses may be needed to administer medication via injection or syringe driver if a person is in pain that can not be controlled by oral medication or the service user can not take medication orally. If a person is struggling to come to terms with their imminent death then a councillor may be required to give professional advice.

 Support individuals at the end of life

9 Be able to take action following the death of individuals 9.1 Explain why is important to know about an individuals wishes for their after-death care . It is important to recognise that end of life care does not stop at the point of death. The period following the death of a service user can be a very emotional time for all concerned, including the individuals family and friends other service users and other members of the care team. 9.2 It is essential to be aware of the person wishes following their death in order that they can be upheld .Some people may determine all aspects of their care following their death, including the specifics of their funeral. Some may wish to donate their organs following death and it is important that care staff are aware of this in order that the wish can be fulfilled. It may be that due to religion or culture a person has specific wishes following death that need to be carried out. A person may have a specific outfit they wish to wear or on item that they want with them.

9.3 Describe ways to support key people immediately following an individuals death. Some families may choose to be with their loved ones as they approach death. However, not everyone will choose to be present as the person dies ,some people may find the situation too painful and may have previously expressed that they would prefer to be contacted when the person dies .Its is vital to establish the families wishes before death occurs.

For some people, the act of visiting the deceased may be too painful and they may wish to remember the person as they were. For this
reason , some families may choose not to spend time with the body. It is essential that health and social care workers remain non -judgemental and respect the wishes of the family.

Ensure that the family have access to a quiet area if possible , offer them drinks or show them where the facilities are to make one . Be there for them if they need someone to talk to and offer comfort.

It is important to remember others who may be affected by the death ,this could be other members of staff or other service users who have got to know and like the person and may want to offer their respects or attend the funeral .

 Be able to manage own feelings in relation to the dying or death of individuals

10.1 I am quite a friendly and approachable person and don’t tend to show my emotions in front of people who don’t know me personally, with that I am a very supportive and caring person, I have very supportive work friends ,friends and family who I know if I need to I am able to go and speak to them about my feelings over death or dying

10.2 We have a great network within the work place, we are able to approach our managers and seniors with problems regarding death and dying, I have a fantastic husband and friends to support me when I need it . There are also local and national services which support carers and care workers in dealing with grief. I tend to feel talking my problems through and having a ( shoulder to cry on ) helps me to deal with death and dying.