• Christine Ingleton, John Chatwin, Jane Seymour, and Sheila Payne.
• Centre for Health and Social Care Studies, University of Sheffield, Northern General Hospital, Sheffield, UK. c.ingleton@sheffield.ac.uk
• J Clin Nurs. 2011 Jul 1; 20 (13-14): 2043-52.

Aims And ObjectivesTo examine the role of trained health and personal care assistants in supporting district nurses and family carers in providing palliative and end of life care in the community.BackgroundIn the UK, there is a policy directive to improve end of life care and to enable greater numbers of people to die at home. This places considerable demands on community nursing services and family carers. In response to this, the Complex and Palliative Continuing Care Service employing generic health and personal care assistants was developed as part of the Marie Curie Delivering Choice Programme in one city in the UK. This paper draws on findings from an independent evaluation of the scheme.DesignThe wider evaluation used a formative evaluation methodology.MethodThis paper draws on in-depth interviews with a range of stakeholders (n = 17), in-depth interviews with bereaved carers (n = 6) and an analysis of documentation.ResultsStakeholders and bereaved carers perceived that the health and personal care assistants made a vital contribution to community palliative care. Careful recruitment, specific training, case management by district nursing with allocation of specific tasks and close ongoing communication were key features which stakeholders indentified. Family carers welcomed the way assistants developed relationships and became familiar and able to meet the care needs of patients. There were some problems reported which related to capacity, work flow and the need for extensive written care plans.ConclusionEmploying health care assistants under the supervision of district nurses appears to support patients and family at home during end of life care and contribute to good quality nursing care.Relevance To Clinical PracticeThe needs for community-based palliative and end of life care will increase rapidly over the course of the next 20 years, placing pressure on community nursing services and family carers.© 2011 Blackwell Publishing Ltd.

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