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

End-of-Life Care

The following resource is designed to assist Long-Term Care (LTC) homes with the implementation of the End-of-Life Care During the Last Days and Hours Best Practice Guideline. Documents found in this resource are evidence-based, but it is not a program plan. Each LTC home is unique and each home is in various stages of guideline implementation. LTC homes are advised to use the resource at their discretion. For those resources that have copyright notations, it is recommended that LTC homes obtain permission from the primary author prior to implementing them within their setting. The Toolkit is a dynamic resource, and is being updated and revised on a regular basis by the LTC Best Practices Program team. Visit this site often to see what's new!

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Clinical Indicators of Decline – RNAO Appendix E

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 .

PDF icon AppE_EndofLifeBPG2011_pg103to105.pdf
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Frommelt Attitude Toward Care of the Dying Scale - RNAO Appendix G

This scale's purpose is to determine how nurses feel about certain situations in which they are involved with patients. All statements concern nursing care given to the dying person and/or his/her family. Where there is a reference to a dying patient, assume it refers to a person who is considered to be terminally ill, with six months or fewer to live.

Source: Folmelt, K. American Journal Hospice Palliative Care (Vol. 8, Issue 5) pp. 37-43 Copyright 1991 By Sage Publication

Registered Nurses' Association of Ontario. (2011). Appendix G of End-of-Life Care During the last Days and Hours. Toronto, ON: Author pp. 108-109

Retrieved from http://rnao.ca/sites/rnao-ca/files/End-of-Life_Care_During_the_Last_Days_and_Hours_0.pdf

PDF icon Appendix G.pdf

Abbey Pain Scale

The Abbey Pain Scale is an instrument designed to assist in the assessment of pain in patients who are unable to clearly articulate their needs, for example, patients with dementia, cognition or communication issues. The scale does not differentiate between distress and pain, so measuring the effectiveness of pain-relieving interventions is essential.

Abbey, J; De Bellis, A; Piller, N; Esterman, A; Giles, L; Parker, D and Lowcay, B. Funded by the JH & JD Gunn Medical Research Foundation 1998 – 2002. This document may be reproduced with this acknowledgment retained.

https://www.apsoc.org.au/PDF/Publications/Abbey_Pain_Scale.pdf

 

 

 

 

 

 

 

 

 

Abbey Pain Scale
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Care In The Last Days And Hours Of Life - RNAO Fact Sheet

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 www.rnao.ca/bestpractices.

Registered Nurses’ Association of Ontario. (2011).  Care In The Last Days And Hours Of Life.  Toronto, Canada: Author.  Retrieved from https://rnao.ca/sites/rnao-ca/files/Care_in_the_Last_Days_and_Hours_of_Life.pdf

Care In The Last Days And Hours Of Life - RNAO Fact Sheet
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Canadian Health Care Evaluation Project (CANHELP) questionnaire

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: https://www.thecarenet.ca/index.php?option=com_content&view=article&id=806

The CARENET © 2025

Canadian Health Care Evaluation Project (CANHELP) questionnaire
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Palliative Pain and Symptom Management Consultation Program: South Western Ontario

Resource for palliative, pain and symptom management.

Palliative Pain and Symptom Management Consultation Program: South Western Ontario.  (n.d.). Resources.  Retrieved on September 29, 2013.  Website www.palliativecareswo.ca.  © Copyright 2002-2008.

Palliative Pain and Symptom Management Consultation Program
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Strategies for Helping Individuals Engage in Decision Making at the End of Life - RNAO Appendix J

Individuals have a right t know their options and to have their preferences considered. Supporting individuals who are nearing the end of life requires interprofessional collaboration and problem-solving. Shared decision-maing can help individuals participate in the decision-making process in the ways the prefer and can help to meet their needs.

Strategies for health-care providers to help families and individuals with decision making on end-of-care.

Registered Nurses’ Association of Ontario (2011). Appendix J of End-of-Life Care During the Last Days and Hours. Toronto, ON: Author. pp. 112-113.

PDF icon Strategies for Helping Individuals Engage in Decision Making at the End of Life

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