Aim of the Course

This course aims to develop the knowledge and clinical awareness required to assess common end-of-life symptoms systematically, recognise distress and deterioration, initiate appropriate action within the learner’s role and evaluate the person’s response.

It promotes compassionate, evidence-informed and person-centred care that protects dignity, respects preferences and avoids both undertreatment and inappropriate intervention.

Scope of the Course

This course is suitable for:

1. Registered nurses
2. Nursing associates working within their scope
3. Senior carers and team leaders
4. Healthcare assistants and care assistants
5. Support workers
6. Care-home and nursing-home staff
7. Community health and social care staff
8. Staff supporting adults with advanced or life-limiting illness

The course primarily concerns adults receiving end-of-life care in care homes, nursing homes, community services and comparable settings in England.

Course completion does not independently establish competence or authority to:

1. Diagnose that a person is dying
2. Diagnose the cause of a symptom
3. Prescribe or alter medicines
4. Select doses or administration routes
5. Administer medicines without legal authority
6. Start a continuous subcutaneous infusion
7. Make decisions about clinically assisted hydration
8. Make DNACPR or treatment-escalation decisions
9. Verify death

These activities require the appropriate professional authority, practical training, competency assessment, prescription or legal medicines mechanism, and organisational authorisation.

Staff must follow the person’s individualised care plan, current prescriptions, advance care planning documentation, local symptom-management guidance and escalation procedures.

What This Course Covers

The course covers:

1. Principles of end-of-life symptom assessment
2. Recognising possible last days of life
3. Holistic and person-centred assessment
4. Communication and supported decision-making
5. Pain assessment and non-verbal indicators
6. Breathlessness and respiratory distress
7. Respiratory tract secretions
8. Nausea and vomiting
9. Constipation and bowel obstruction
10. Agitation, anxiety and delirium
11. Fatigue, weakness and reduced consciousness
12. Mouth care, thirst and dry mouth
13. Nutrition and hydration
14. Skin integrity and pressure-area care
15. Urinary symptoms and retention
16. Fever, sweating and temperature discomfort
17. Seizures and palliative-care emergencies
18. Anticipatory medicines
19. Subcutaneous medicines and syringe pumps
20. Non-pharmacological comfort measures
21. Reassessment and treatment response
22. Recognition of reversible causes
23. Escalation and specialist advice
24. Documentation, handover and family support

Learning Outcomes

By the end of the course, learners should be able to:

1. Define end-of-life symptom assessment.
2. Distinguish palliative care from care during the last days of life.
3. Recognise changes that may indicate a person is approaching death.
4. Explain the uncertainty involved in recognising dying.
5. Conduct a holistic symptom assessment within their role.
6. Use baseline information and the individual care plan.
7. Communicate sensitively with the person and family.
8. Apply the principles of the Mental Capacity Act 2005.
9. Explain the limited scope of a DNACPR decision.
10. Assess pain using self-report and observational information.
11. Recognise possible non-verbal indicators of pain.
12. Assess breathlessness and respiratory distress.
13. Explain the limitations of pulse oximetry.
14. Recognise and respond appropriately to respiratory secretions.
15. Assess nausea, vomiting and bowel symptoms.
16. Recognise possible constipation or faecal impaction.
17. Distinguish possible delirium from anxiety.
18. Investigate reversible contributors to agitation.
19. Assess mouth discomfort and provide appropriate mouth care.
20. Support eating and drinking safely without coercion.
21. Explain the individualised approach to clinically assisted hydration.
22. Assess skin, positioning and personal-care needs.
23. Recognise urinary retention and other urinary concerns.
24. Identify symptoms requiring urgent clinical review.
25. Explain the purpose of anticipatory medicines.
26. Apply safe checks before administering prescribed medicines.
27. Describe the purpose of subcutaneous medicines and syringe pumps.
28. Use appropriate non-pharmacological comfort measures.
29. Reassess the person after every intervention.
30. Recognise uncontrolled symptoms and escalate promptly.
31. Document assessments, interventions and outcomes accurately.
32. Work within professional competence and organisational policy.
33. Explain why end-of-life status must not be used to dismiss new symptoms.
34. Recognise that online learning does not establish clinical or medicines competence.

Further Reading and References

1. NICE NG31: Care of dying adults in the last days of life — recommendations on recognising dying, communication, hydration, symptom control, anticipatory prescribing and individualised care.
2. NICE QS144: Care of dying adults in the last days of life — quality statements concerning assessment, shared decision-making, hydration and individualised care planning.
3. NHS England: Palliative and end-of-life care — national information supporting personalised care based on the person’s priorities, preferences and wishes.
4. Mental Capacity Act 2005 — the legal framework governing capacity, supported decision-making, advance decisions and best-interests decisions in England and Wales.