Implementing and sustaining evidence-based practices in long-term care.

End-of-Life Care

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    Presentation created by Anne Ediger R.N. BScN, C.H.P.C.N.(C) Tammie-Lee Rogowski R.N., C.H.P.C.N.(C), C.C.H.N.(C) for assessment and planning of the needs of the palliative client.

    Reference: Assessment and Care Planning Of The Palliative Client by Anne Ediger R.N. BScN, C.H.P.C.N.(C) Tammie-Lee Rogowski R.N., C.H.P.C.N.(C), C.C.H.N.(C) Retrieved July 15,2015 from

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    Purpose of the BPI tool is to assess the severity of pain and the impact of pain on daily functions. The tool can be used for patients with pain from chronic diseases or conditions such as cancer, osteoarthritis and low back pain, or with pain from acute conditions such as postoperative pain.

    Assessment areas included are severity of pain, impact of pain on daily function, location of pain, pain medications and amount of pain relief in the past 24 hours or the past week.

    The BPI copyright is held by Dr Charles S. Cleeland (1991). The copyright applies to the BPI and all it's derivatives in any language.

    Retrieved from

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    The CANHELP caregiver questionnaire was designed to evaluate satisfaction with care for older patients with life threatening illnesses, and the family members. A straight forward satisfaction instrument that you can use t rate the quality of care at the programs or organization level.

    Reference: CARENET Canadian Researchers at the End of Life Network. (n.d.). CANHELP Tool.  Retrieved from

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    The CHPCA is the national voice for hospice palliative care in Canada. Advancing and advocating for quality end-of-life/hospice palliative care, its work includes public policy, public education and awareneness.  Website

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    A comprehensive, holistic assessment of individuals and their families at end-of-life.

    Reprinted with Permission from Canadian Hospice Palliative Care Association.  Registered Nurses' Association of Ontario.  (2011). Appendix K of End-of-Life Care During the Last Days and Hours. Toronto, ON: Author.  pp. 114-115. 

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    Established in March 2002 with over 150 participants consisting of national, provincial, territorial and regional practitioners, researchers and decision makers in palliative and end-of-life care. Five priority end-of-life theme areas was considered:  Best Practices and Quality Care, Education for Formal Caregivers, Public Information and Awareness, Research, and Surveillance.  The Strategy ended in March 2007.

    Health Canada. (2007). Canadian Strategy on Palliative and End-of-Life Care: Final Report. Ottawa, ON: Author. Retrieved from © Her Majesty the Queen in Right of Canada, represented by the Minister of Health Canada, 2007. ISBN: 978-0-662-49937-4. Cat. No.: H21-244/2007. HC Pub.: 3439.

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    This link provides information and support for professionals on palliative and end-of-life care, loss and grief.  There is a list of clinical tools and useful resources to enhance palliative and end life care. Website

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    This information fact sheet is developed as a supplement to the RNAO Nursing Best Practice Guideline document for nurses. The nursing best practice guideline End-of-life Care During the Last Days and Hours is available for public viewing and free to download at

    Registered Nurses’ Association of Ontario. (2011).  Care In The Last Days And Hours Of Life.  Toronto, Canada: Author.  Retrieved from

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    Diseases such as chronic obstructive pulmonary disease or congestive heart failure run a more fluctuating course and result in death in a less predictable timeframe than diseases such as renal disease or dementia. Each exacerbation can lead to remission (and future exacerbation) or death; knowing which will occur on any given admission is extremely challenging. General indicators of poorer prognosis (life expectancy of only weeks to many weeks) include poor performance status, impaired nutritional status and a low albumin level.

    Registered Nurses’ Association of Ontario. (2011). Appendix E of End-of-Life Care During the Last Days and Hours. Toronto, Canada: Author. pp103-105 .


    1 Minnesota Hospice Organization. National hospice organization medical guidelines for determining prognosis in selected non-cancer diseases: a physician’s guideline. St. Paul: Hospice Minnetsota; 1996. 2 Pfeifer, M. End of life decision making: special considerations in the COPD patient. Medscape G Med. 1999; 1(3). Available from: 3 Derfler, M., Jacob, M., Wolf, RE., Bleyer, F. & Hauetman, PJ. Mode of death from congestive heart failure: implications for clinical management. Am J Geriatr Cardiol. 2004; 13(6): 299-304. Source: Pereira, J. L., Associates. Pallium palliative pocketbook: A peer-reviewed, referenced resource. 1st Cdn, Canada: The Pallium Project; 2008. Reprinted by permission of The Pallium Project 4 Sachs, GA, Shega, JW, Cox-Hayley, D. Barriers to excellent end-of-life care for patients with dementia. J Gen Intern Med. 2004; 19: 1057-63. 5 Allen, RS., Kwak, J., Lokken, KL., Haley, W. End of life issues in the context of Alzheimer’s Disease. Alz Care Quart. 2003; 4(4): 312-30.

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    Residents with severe dementia or other end stage diseases eat less as part of the natural progression of their disease. Research at end of life suggests that as residents eat and drink less they do not suffer from hunger or thirst. This session will focus on “Comfort Feeding Only” (CFO), when oral intake is not sufficient to sustain life, and if prolonging life with artificial hydration is not consistent with the residents' wishes (as expressed by the resident or their substitute decision maker (SDM)).

    This webinar is intended for long-term care leaders facilitating practice change and direct care staff that will benefit from understanding CFO process and the goal of the feedings to achieve comfort by employing the least invasive and potentially most satisfying way to provide nutrition. During this webinar, participants will:

    • Understand process followed to identify gap, develop policy and implementation of CFO
    • How to have a conversation with resident, family/SDM for comfort feeding only
    • Learn different implementation strategies to initiate CFO
    • Know strategies focusing on safe positioning and swallowing
    • Recognize symptoms such as dry mouth that can be alleviated with minimal oral intake and/or oral care

    Presented by Dr. Evelyn Williams and Jennifer Wong - Veteran's Centre Sunnybrook Health Sciences Centre in collaboration with Registered Nurses’ Association of Ontario (2017). Comfort Feeding Only(CFO): Managing Feeding at End-of-Life. RNAO You Tube. Retrieved from