This learning resource is for nursing staff across all health care settings, including health care assistants, nursing associates, registered nurses and specialist nurses caring for people in the last year of life. The resource includes signposts to articles, blogs, podcasts and links to RCN resources to improve knowledge on end of life care.

• Fundamentals of nursing care at the end of life
• How will this guide help me?
• RCN Principles of Nursing

The four UK countries—England, Wales, Scotland and Northern Ireland—have their own guidelines for caring for people in their last few hours, days, weeks or years of life.  All provide valuable recommendations for professionals to deliver the best possible care for individuals at the end of life. Nursing staff must be familiar with their local policies and guidelines.

• National guidance and legislation
• Key terms in assisted dying and assisted suicide

A high level of communication skills is the single most important tool a professional can have when dealing with people with a palliative illness and at the end of life. Conversations about death and dying or a request for assistance to die can be challenging, emotional and complex.

• Communication
• Communication skills
• Challenges in communication
• Assisted dying
• Further information

People with a life-limiting illness should have the opportunity to have conversations with their health care teams to set out their wishes for the future. This process is known across the nations by different terms: Advance Care Planning (ACP) (England, Wales, Northern Ireland), Anticipatory Care Planning (Scotland) and Future Care Planning (Wales).

• Advance care future planning
• Planning for emergencies

Effective symptom management is fundamental to high-quality care at the end of someone’s life. It plays a crucial role in improving the comfort and overall quality of life for individuals living with advanced progressive illnesses, as well as those who are approaching the dying phase. At the heart of good palliative and end of life care is the commitment to understand and respond to what matters most to each person.

• Symptom management
• Key principles of symptom management
• Pain
• Breathlessness
• Nausea and vomiting
• Constipation
• Noisy respiratory secretions

Delirium is a complex neurocognitive syndrome and is common in those receiving palliative care.  (Featherstone et al. 2021). Delirium is complex with many underlying physiological causes. The information below highlights indicators of delirium at the end of life, considering biological, social, psychological, and spiritual factors.

• Anxiety delirium terminal agitation and distress
• Signs and symptoms of delirium at the end of life
• Terminal agitation, terminal distress and terminal anguish

As individuals approach the end of life, their oral intake often decreases significantly. The desire for food and drink tends to diminish, and dehydration during this time does not lead to discomfort; it is a normal part of the dying process. This stage can be distressing for families and caregivers; hence, providing reassurance and clear explanations is essential.

• Nutrition and hydration
• Remember the 7 Ps

Difficult questions can arise at any point when caring for someone approaching the end of life. These questions can take many forms and can relate to decisions around treatments and future care planning.

• Ethical considerations

Each person will have cultural, spiritual, and religious beliefs that will shape the care you give.

• Cultural and spiritual needs

The need to give personalised compassionate care does not end when the person has died, but continues with care after death, including supporting friends and families with bereavement. Each death is a unique experience, shaped by the nature of their illness, their expressed wishes, and their social, cultural, spiritual, and religious beliefs.

• Care after death

Providing end of life care is deeply meaningful but can also be emotionally demanding, often resulting in cumulative grief, burnout and compassion fatigue. Self-care is a critical, conscious practice supporting physical and mental well-being, enabling health care professionals to maintain resilience and deliver compassionate care.

• Self-care

You can use appropriate reflective templates to complete the case studies. These can be used as part of your NMC revalidation. Use this resource to answer the questions, ensuring you also reflect on and relate the content to your own clinical practice.

• Case studies
• Case Study 1: Communication skills - Navigating difficult conversations
• Case Study 2: Pain management - Complex opioid titration
• Case Study 3: Nausea and vomiting - Holistic management
• Case Study 4: Breathlessness - Acute distress and family anxiety
• Case Study 5: Ethical considerations - Disagreements on escalation
• Case Study 6: Nutrition and hydration - Decisions at the end of life
• Case Study 7: Spirituality and religion - Respecting religious practices at the end of life
• Case Study 8: Advance care planning - Initiating and acting on ACP discussions
• Case Study 9: Care after death - Providing holistic support
• Case Study 10: Managing terminal agitation
• Case Study 11: Assisted dying
• Student nurse case study 1: Understanding the dying process
• Student nurse case study 2: Providing emotional support to families
• Reflective account template
• Podcasts

• References