Nutrition and Remember the Ethical questions Cultural and Key messages RCN online resources References

Further information on Royal College of Nursing

hydration seven Ps spiritual needs all these topics can be
found at:
(2014) RCN End of life
survey 2014, London:
www.rcnendoflife.org.uk RCN. Available at:
www.rcn.org.uk
Key points to remember:
• regular individual assessment of nutrition and
When the desire or ability to eat and drink is reduced
these Ps will help you in delivering care.
Difficult questions about nutrition and hydration can
sometimes arise when providing end of life care. This
Each person will have cultural, spiritual and religious
beliefs that will shape the care you give. Be mindful that:
• Dying is a natural process.
• One size fits all decision making is morally
www.rcneolnutrition
hydration.org.uk Nursing and Midwifery Getting it right
every time
framework may help you with decision making. Always: wrong. Council (2015) The Code,
hydration needs is essential • Preference - establish likes and dislikes. • for some people spirituality may be linked to a Further resources professional standards of
• food and drink has physical, social, cultural and belief system and for others it may be about finding • Respond to each person compassionately even practice and behaviour

Getting it right every time

Getting it right every time

spiritual meaning in a person’s life • Palatable - food should be what the person. 1. 2. meaning in what is happening if they are not your direct responsibility. Further resources relating for nurses and midwives.
fancies, perhaps with cream/ Establish the relevant Assess the wishes of • having a conversation and listening to people will • Check that each person’s understanding reflects to end of life care and London: NMC. Available at: Fundamentals of nursing
• desire for food and drink may naturally decrease butter to add calories. clinical facts of the the patient and those nutrition and hydration can
towards the end of life help you understand and meet their needs what they have been told. www.nmc-uk.org care at the end of life
case important to them be found online:
• additional support may be needed with some • Presentation - food should be visually appealing • you don’t need to share a person’s values to respect • Establish a person’s wishes and avoid assuming
conditions where the ability to eat and drink is lost and appetising. them a lack of capacity without careful assessment. www.rcnendoflife.org.
• inability to eat and drink and loss of appetite can • Portions - smaller plates for smaller portions. • a person may have rituals that they may need you to • Nutrition/hydration are regarded in law as a uk/resources
be distressing for everyone involved 3. 4. support them with before or after death medical treatment.
• Position - ensure you and the person being Consider www.rcneolnutrition
• preparing people for this loss of appetite can help Consider the • you won’t know what is important to people unless • Artificial or clinically assisted nutrition and
assisted are in a comfortable the ethical hydration.org.uk/
them to understand the dying process legal perspective you ask them hydration may need to be discussed.
position for eating. perspective resources
• support a person to eat and drink for as long as • it is not possible to provide all the answers and a • The NMC Code of practice says nurses “must
• Patience - let the person take their own time. person may need further support by referral to a recognise and respond compassionately to the
they wish or are able to do so
• Provide - good mouth care regularly, whether 5. specialist team. needs of those who are in their last few days
• sensitive communication may be required about Be aware of the and hours of life.” (NMC, 2015) The RCN represents nurses and nursing, promotes excellence
why a drip may or may not be needed in the last eating and drinking or not. in practice and shapes health policies.
processes needed
few days of life. to support the RCN Direct 0845 772 6100 RCN Online www.rcn.org.uk
decision making www.rcnendoflife.org.uk www.rcneolnutritionhydration.org.uk

June 2015. Publication code: 004 871


Who is this guide for?
All nursing staff including health
care assistants in all settings
caring for people in the last
RCN End of life care survey which
showed that individuals wanted more
education and information around
How will this What are the What do I National guidance for RCN Principles of
guide help me? fundamentals? need to do? end of life care Nursing Practice
This guide will highlight what is important when caring The NMC describe the fundamentals of care as: • Treat people compassionately. The four UK countries decisions about treatment RCN Key Nursing Examples in end of life
have their own guidance and care to the extent that Principles care
for a person approaching the end of their life. Whilst
there is a focus on care in the last few days, the same
• Listen to people.
documents on end of the dying person wants.
caring principles can be applied throughout the last
“The fundamentals of care include, • Communicate clearly and sensitively. life care. In England, the
A Dignity, equality, diversity
and humanity.
Individualised holistic assessment
of need including culture and
guidance is referred to as the 4. Support
but are not limited to, nutrition, • Identify and meet the communication needs reasonable adjustments made. Also
year of life.
of each individual.
five priorities of care: The needs of families consider the needs of the carer.

year of life and those who are
important to them.
caring for people at the end of life,
an independent review of evidence
relating to nutrition and hydration at
It is designed to complement the RCN online
resources on end of life care and nutrition and
hydration. It could also be used as a tool to
support learning.
hydration, bladder and bowel care,
physical handling and making sure
that those receiving care are kept
• Acknowledge pain and distress and take action. 1. Recognise
• Recognise when someone may be entering The possibility that a
the last few days and hours of life.
person may die within the
next few days or hours
must be actively explored,
respected and met as far as
possible.
5. Plan and do
B Ethical integrity, legal integrity,
accountability, responsibility.
Potential conflict within the family
re management of nutritional needs
when there is a decline in ability to
swallow leading to choking.
C Safety of patients, visitors and
staff, management of risk,
Risk assessment in caring for a
person who is in hospital and wants

This guide has been developed
using information from the 2014
the end of life commissioned by the in clean and hygienic conditions… • Involve people in decisions about their care must be recognised and An individual plan of care,
D
clinical safety.
Advocacy, empowerment,
to go home to die and lives alone.
Supporting a person with learning
communicated clearly. which includes food and
RCN, and expert opinion. making sure you provide help to and respect their wishes.
drink, symptom control and
patient-centred care, patient
involvement.
disabilities to die in their preferred
place of care.
You can find these resources at:
www.rcnendoflife.org.uk
those who are not able to • Keep the person who is reaching the end of their life 2. Communicate psychological, social and E Communication, handling Advance care planning.
and those important to them up to Sensitive communication spiritual support, must be feedback, record keeping, Responding to a complaint about

www.rcneolnutritionhydration.org.uk
feed themselves or drink date with any changes in condition. should take place between agreed, co-ordinated and
reporting, monitoring. poor end of life care.
F Evidence-based, practice, The possible introduction of
fluid unaided.” • Document a summary of conversations
staff and the dying person,
and those identified as
delivered with compassion. technical skills, education,
clinical reasoning.
tele-health care in a rural setting.

and decisions. important to them. These themes are reflected G Multi-disciplinary and multi- Co-ordination of care in the
(NMC, 2015) agency working, co-ordination, community setting with a person
in the policy guidance within
• Seek further advice if needed. and continuity of care. with highly complex needs.
3. Involve the other three UK countries.
• Look after yourself and your colleagues and seek H Leadership, contributing to an Nurses and nursing staff lead by
The dying person, and those open and responsive culture. example ensuring end of life care is
support if you need it. identified as important to given in a manner that is responsive
them, should be involved in to individual needs.

Who is this guide for?
All nursing staff including health
care assistants in all settings
caring for people in the last
RCN End of life care survey which
showed that individuals wanted more
education and information around
How will this What are the What do I National guidance for RCN Principles of
guide help me? fundamentals? need to do? end of life care Nursing Practice
This guide will highlight what is important when caring The NMC describe the fundamentals of care as: • Treat people compassionately. The four UK countries decisions about treatment RCN Key Nursing Examples in end of life
have their own guidance and care to the extent that Principles care
for a person approaching the end of their life. Whilst
there is a focus on care in the last few days, the same
• Listen to people.
documents on end of the dying person wants.
caring principles can be applied throughout the last
“The fundamentals of care include, • Communicate clearly and sensitively. life care. In England, the
A Dignity, equality, diversity
and humanity.
Individualised holistic assessment
of need including culture and
guidance is referred to as the 4. Support
but are not limited to, nutrition, • Identify and meet the communication needs reasonable adjustments made. Also
year of life.
of each individual.
five priorities of care: The needs of families consider the needs of the carer.

year of life and those who are
important to them.
caring for people at the end of life,
an independent review of evidence
relating to nutrition and hydration at
It is designed to complement the RCN online
resources on end of life care and nutrition and
hydration. It could also be used as a tool to
support learning.
hydration, bladder and bowel care,
physical handling and making sure
that those receiving care are kept
• Acknowledge pain and distress and take action. 1. Recognise
• Recognise when someone may be entering The possibility that a
the last few days and hours of life.
person may die within the
next few days or hours
must be actively explored,
respected and met as far as
possible.
5. Plan and do
B Ethical integrity, legal integrity,
accountability, responsibility.
Potential conflict within the family
re management of nutritional needs
when there is a decline in ability to
swallow leading to choking.
C Safety of patients, visitors and
staff, management of risk,
Risk assessment in caring for a
person who is in hospital and wants

This guide has been developed
using information from the 2014
the end of life commissioned by the in clean and hygienic conditions… • Involve people in decisions about their care must be recognised and An individual plan of care,
D
clinical safety.
Advocacy, empowerment,
to go home to die and lives alone.
Supporting a person with learning
communicated clearly. which includes food and
RCN, and expert opinion. making sure you provide help to and respect their wishes.
drink, symptom control and
patient-centred care, patient
involvement.
disabilities to die in their preferred
place of care.
You can find these resources at:
www.rcnendoflife.org.uk
those who are not able to • Keep the person who is reaching the end of their life 2. Communicate psychological, social and E Communication, handling Advance care planning.
and those important to them up to Sensitive communication spiritual support, must be feedback, record keeping, Responding to a complaint about

www.rcneolnutritionhydration.org.uk
feed themselves or drink date with any changes in condition. should take place between agreed, co-ordinated and
reporting, monitoring. poor end of life care.
F Evidence-based, practice, The possible introduction of
fluid unaided.” • Document a summary of conversations
staff and the dying person,
and those identified as
delivered with compassion. technical skills, education,
clinical reasoning.
tele-health care in a rural setting.

and decisions. important to them. These themes are reflected G Multi-disciplinary and multi- Co-ordination of care in the
(NMC, 2015) agency working, co-ordination, community setting with a person
in the policy guidance within
• Seek further advice if needed. and continuity of care. with highly complex needs.
3. Involve the other three UK countries.
• Look after yourself and your colleagues and seek H Leadership, contributing to an Nurses and nursing staff lead by
The dying person, and those open and responsive culture. example ensuring end of life care is
support if you need it. identified as important to given in a manner that is responsive
them, should be involved in to individual needs.

Who is this guide for?
All nursing staff including health
care assistants in all settings
caring for people in the last
RCN End of life care survey which
showed that individuals wanted more
education and information around
How will this What are the What do I National guidance for RCN Principles of
guide help me? fundamentals? need to do? end of life care Nursing Practice
This guide will highlight what is important when caring The NMC describe the fundamentals of care as: • Treat people compassionately. The four UK countries decisions about treatment RCN Key Nursing Examples in end of life
have their own guidance and care to the extent that Principles care
for a person approaching the end of their life. Whilst
there is a focus on care in the last few days, the same
• Listen to people.
documents on end of the dying person wants.
caring principles can be applied throughout the last
“The fundamentals of care include, • Communicate clearly and sensitively. life care. In England, the
A Dignity, equality, diversity
and humanity.
Individualised holistic assessment
of need including culture and
guidance is referred to as the 4. Support
but are not limited to, nutrition, • Identify and meet the communication needs reasonable adjustments made. Also
year of life.
of each individual.
five priorities of care: The needs of families consider the needs of the carer.

year of life and those who are
important to them.
caring for people at the end of life,
an independent review of evidence
relating to nutrition and hydration at
It is designed to complement the RCN online
resources on end of life care and nutrition and
hydration. It could also be used as a tool to
support learning.
hydration, bladder and bowel care,
physical handling and making sure
that those receiving care are kept
• Acknowledge pain and distress and take action. 1. Recognise
• Recognise when someone may be entering The possibility that a
the last few days and hours of life.
person may die within the
next few days or hours
must be actively explored,
respected and met as far as
possible.
5. Plan and do
B Ethical integrity, legal integrity,
accountability, responsibility.
Potential conflict within the family
re management of nutritional needs
when there is a decline in ability to
swallow leading to choking.
C Safety of patients, visitors and
staff, management of risk,
Risk assessment in caring for a
person who is in hospital and wants

This guide has been developed
using information from the 2014
the end of life commissioned by the in clean and hygienic conditions… • Involve people in decisions about their care must be recognised and An individual plan of care,
D
clinical safety.
Advocacy, empowerment,
to go home to die and lives alone.
Supporting a person with learning
communicated clearly. which includes food and
RCN, and expert opinion. making sure you provide help to and respect their wishes.
drink, symptom control and
patient-centred care, patient
involvement.
disabilities to die in their preferred
place of care.
You can find these resources at:
www.rcnendoflife.org.uk
those who are not able to • Keep the person who is reaching the end of their life 2. Communicate psychological, social and E Communication, handling Advance care planning.
and those important to them up to Sensitive communication spiritual support, must be feedback, record keeping, Responding to a complaint about

www.rcneolnutritionhydration.org.uk
feed themselves or drink date with any changes in condition. should take place between agreed, co-ordinated and
reporting, monitoring. poor end of life care.
F Evidence-based, practice, The possible introduction of
fluid unaided.” • Document a summary of conversations
staff and the dying person,
and those identified as
delivered with compassion. technical skills, education,
clinical reasoning.
tele-health care in a rural setting.

and decisions. important to them. These themes are reflected G Multi-disciplinary and multi- Co-ordination of care in the
(NMC, 2015) agency working, co-ordination, community setting with a person
in the policy guidance within
• Seek further advice if needed. and continuity of care. with highly complex needs.
3. Involve the other three UK countries.
• Look after yourself and your colleagues and seek H Leadership, contributing to an Nurses and nursing staff lead by
The dying person, and those open and responsive culture. example ensuring end of life care is
support if you need it. identified as important to given in a manner that is responsive
them, should be involved in to individual needs.

Who is this guide for?
All nursing staff including health
care assistants in all settings
caring for people in the last
RCN End of life care survey which
showed that individuals wanted more
education and information around
How will this What are the What do I National guidance for RCN Principles of
guide help me? fundamentals? need to do? end of life care Nursing Practice
This guide will highlight what is important when caring The NMC describe the fundamentals of care as: • Treat people compassionately. The four UK countries decisions about treatment RCN Key Nursing Examples in end of life
have their own guidance and care to the extent that Principles care
for a person approaching the end of their life. Whilst
there is a focus on care in the last few days, the same
• Listen to people.
documents on end of the dying person wants.
caring principles can be applied throughout the last
“The fundamentals of care include, • Communicate clearly and sensitively. life care. In England, the
A Dignity, equality, diversity
and humanity.
Individualised holistic assessment
of need including culture and
guidance is referred to as the 4. Support
but are not limited to, nutrition, • Identify and meet the communication needs reasonable adjustments made. Also
year of life.
of each individual.
five priorities of care: The needs of families consider the needs of the carer.

year of life and those who are
important to them.
caring for people at the end of life,
an independent review of evidence
relating to nutrition and hydration at
It is designed to complement the RCN online
resources on end of life care and nutrition and
hydration. It could also be used as a tool to
support learning.
hydration, bladder and bowel care,
physical handling and making sure
that those receiving care are kept
• Acknowledge pain and distress and take action. 1. Recognise
• Recognise when someone may be entering The possibility that a
the last few days and hours of life.
person may die within the
next few days or hours
must be actively explored,
respected and met as far as
possible.
5. Plan and do
B Ethical integrity, legal integrity,
accountability, responsibility.
Potential conflict within the family
re management of nutritional needs
when there is a decline in ability to
swallow leading to choking.
C Safety of patients, visitors and
staff, management of risk,
Risk assessment in caring for a
person who is in hospital and wants

This guide has been developed
using information from the 2014
the end of life commissioned by the in clean and hygienic conditions… • Involve people in decisions about their care must be recognised and An individual plan of care,
D
clinical safety.
Advocacy, empowerment,
to go home to die and lives alone.
Supporting a person with learning
communicated clearly. which includes food and
RCN, and expert opinion. making sure you provide help to and respect their wishes.
drink, symptom control and
patient-centred care, patient
involvement.
disabilities to die in their preferred
place of care.
You can find these resources at:
www.rcnendoflife.org.uk
those who are not able to • Keep the person who is reaching the end of their life 2. Communicate psychological, social and E Communication, handling Advance care planning.
and those important to them up to Sensitive communication spiritual support, must be feedback, record keeping, Responding to a complaint about

www.rcneolnutritionhydration.org.uk
feed themselves or drink date with any changes in condition. should take place between agreed, co-ordinated and
reporting, monitoring. poor end of life care.
F Evidence-based, practice, The possible introduction of
fluid unaided.” • Document a summary of conversations
staff and the dying person,
and those identified as
delivered with compassion. technical skills, education,
clinical reasoning.
tele-health care in a rural setting.

and decisions. important to them. These themes are reflected G Multi-disciplinary and multi- Co-ordination of care in the
(NMC, 2015) agency working, co-ordination, community setting with a person
in the policy guidance within
• Seek further advice if needed. and continuity of care. with highly complex needs.
3. Involve the other three UK countries.
• Look after yourself and your colleagues and seek H Leadership, contributing to an Nurses and nursing staff lead by
The dying person, and those open and responsive culture. example ensuring end of life care is
support if you need it. identified as important to given in a manner that is responsive
them, should be involved in to individual needs.

Who is this guide for?
All nursing staff including health
care assistants in all settings
caring for people in the last
RCN End of life care survey which
showed that individuals wanted more
education and information around
How will this What are the What do I National guidance for RCN Principles of
guide help me? fundamentals? need to do? end of life care Nursing Practice
This guide will highlight what is important when caring The NMC describe the fundamentals of care as: • Treat people compassionately. The four UK countries decisions about treatment RCN Key Nursing Examples in end of life
have their own guidance and care to the extent that Principles care
for a person approaching the end of their life. Whilst
there is a focus on care in the last few days, the same
• Listen to people.
documents on end of the dying person wants.
caring principles can be applied throughout the last
“The fundamentals of care include, • Communicate clearly and sensitively. life care. In England, the
A Dignity, equality, diversity
and humanity.
Individualised holistic assessment
of need including culture and
guidance is referred to as the 4. Support
but are not limited to, nutrition, • Identify and meet the communication needs reasonable adjustments made. Also
year of life.
of each individual.
five priorities of care: The needs of families consider the needs of the carer.

year of life and those who are
important to them.
caring for people at the end of life,
an independent review of evidence
relating to nutrition and hydration at
It is designed to complement the RCN online
resources on end of life care and nutrition and
hydration. It could also be used as a tool to
support learning.
hydration, bladder and bowel care,
physical handling and making sure
that those receiving care are kept
• Acknowledge pain and distress and take action. 1. Recognise
• Recognise when someone may be entering The possibility that a
the last few days and hours of life.
person may die within the
next few days or hours
must be actively explored,
respected and met as far as
possible.
5. Plan and do
B Ethical integrity, legal integrity,
accountability, responsibility.
Potential conflict within the family
re management of nutritional needs
when there is a decline in ability to
swallow leading to choking.
C Safety of patients, visitors and
staff, management of risk,
Risk assessment in caring for a
person who is in hospital and wants

This guide has been developed
using information from the 2014
the end of life commissioned by the in clean and hygienic conditions… • Involve people in decisions about their care must be recognised and An individual plan of care,
D
clinical safety.
Advocacy, empowerment,
to go home to die and lives alone.
Supporting a person with learning
communicated clearly. which includes food and
RCN, and expert opinion. making sure you provide help to and respect their wishes.
drink, symptom control and
patient-centred care, patient
involvement.
disabilities to die in their preferred
place of care.
You can find these resources at:
www.rcnendoflife.org.uk
those who are not able to • Keep the person who is reaching the end of their life 2. Communicate psychological, social and E Communication, handling Advance care planning.
and those important to them up to Sensitive communication spiritual support, must be feedback, record keeping, Responding to a complaint about

www.rcneolnutritionhydration.org.uk
feed themselves or drink date with any changes in condition. should take place between agreed, co-ordinated and
reporting, monitoring. poor end of life care.
F Evidence-based, practice, The possible introduction of
fluid unaided.” • Document a summary of conversations
staff and the dying person,
and those identified as
delivered with compassion. technical skills, education,
clinical reasoning.
tele-health care in a rural setting.

and decisions. important to them. These themes are reflected G Multi-disciplinary and multi- Co-ordination of care in the
(NMC, 2015) agency working, co-ordination, community setting with a person
in the policy guidance within
• Seek further advice if needed. and continuity of care. with highly complex needs.
3. Involve the other three UK countries.
• Look after yourself and your colleagues and seek H Leadership, contributing to an Nurses and nursing staff lead by
The dying person, and those open and responsive culture. example ensuring end of life care is
support if you need it. identified as important to given in a manner that is responsive
them, should be involved in to individual needs.

Who is this guide for?
All nursing staff including health
care assistants in all settings
caring for people in the last
RCN End of life care survey which
showed that individuals wanted more
education and information around
How will this What are the What do I National guidance for RCN Principles of
guide help me? fundamentals? need to do? end of life care Nursing Practice
This guide will highlight what is important when caring The NMC describe the fundamentals of care as: • Treat people compassionately. The four UK countries decisions about treatment RCN Key Nursing Examples in end of life
have their own guidance and care to the extent that Principles care
for a person approaching the end of their life. Whilst
there is a focus on care in the last few days, the same
• Listen to people.
documents on end of the dying person wants.
caring principles can be applied throughout the last
“The fundamentals of care include, • Communicate clearly and sensitively. life care. In England, the
A Dignity, equality, diversity
and humanity.
Individualised holistic assessment
of need including culture and
guidance is referred to as the 4. Support
but are not limited to, nutrition, • Identify and meet the communication needs reasonable adjustments made. Also
year of life.
of each individual.
five priorities of care: The needs of families consider the needs of the carer.

year of life and those who are
important to them.
caring for people at the end of life,
an independent review of evidence
relating to nutrition and hydration at
It is designed to complement the RCN online
resources on end of life care and nutrition and
hydration. It could also be used as a tool to
support learning.
hydration, bladder and bowel care,
physical handling and making sure
that those receiving care are kept
• Acknowledge pain and distress and take action. 1. Recognise
• Recognise when someone may be entering The possibility that a
the last few days and hours of life.
person may die within the
next few days or hours
must be actively explored,
respected and met as far as
possible.
5. Plan and do
B Ethical integrity, legal integrity,
accountability, responsibility.
Potential conflict within the family
re management of nutritional needs
when there is a decline in ability to
swallow leading to choking.
C Safety of patients, visitors and
staff, management of risk,
Risk assessment in caring for a
person who is in hospital and wants

This guide has been developed
using information from the 2014
the end of life commissioned by the in clean and hygienic conditions… • Involve people in decisions about their care must be recognised and An individual plan of care,
D
clinical safety.
Advocacy, empowerment,
to go home to die and lives alone.
Supporting a person with learning
communicated clearly. which includes food and
RCN, and expert opinion. making sure you provide help to and respect their wishes.
drink, symptom control and
patient-centred care, patient
involvement.
disabilities to die in their preferred
place of care.
You can find these resources at:
www.rcnendoflife.org.uk
those who are not able to • Keep the person who is reaching the end of their life 2. Communicate psychological, social and E Communication, handling Advance care planning.
and those important to them up to Sensitive communication spiritual support, must be feedback, record keeping, Responding to a complaint about

www.rcneolnutritionhydration.org.uk
feed themselves or drink date with any changes in condition. should take place between agreed, co-ordinated and
reporting, monitoring. poor end of life care.
F Evidence-based, practice, The possible introduction of
fluid unaided.” • Document a summary of conversations
staff and the dying person,
and those identified as
delivered with compassion. technical skills, education,
clinical reasoning.
tele-health care in a rural setting.

and decisions. important to them. These themes are reflected G Multi-disciplinary and multi- Co-ordination of care in the
(NMC, 2015) agency working, co-ordination, community setting with a person
in the policy guidance within
• Seek further advice if needed. and continuity of care. with highly complex needs.
3. Involve the other three UK countries.
• Look after yourself and your colleagues and seek H Leadership, contributing to an Nurses and nursing staff lead by
The dying person, and those open and responsive culture. example ensuring end of life care is
support if you need it. identified as important to given in a manner that is responsive
them, should be involved in to individual needs.
Nutrition and Remember the Ethical questions Cultural and Key messages RCN online resources References
Further information on Royal College of Nursing
hydration seven Ps spiritual needs all these topics can be
found at:
(2014) RCN End of life
survey 2014, London:
www.rcnendoflife.org.uk RCN. Available at:
www.rcn.org.uk
Key points to remember:
• regular individual assessment of nutrition and
When the desire or ability to eat and drink is reduced
these Ps will help you in delivering care.
Difficult questions about nutrition and hydration can
sometimes arise when providing end of life care. This
Each person will have cultural, spiritual and religious
beliefs that will shape the care you give. Be mindful that:
• Dying is a natural process.
• One size fits all decision making is morally
www.rcneolnutrition
hydration.org.uk Nursing and Midwifery Getting it right
every time
framework may help you with decision making. Always: wrong. Council (2015) The Code,
hydration needs is essential • Preference - establish likes and dislikes. • for some people spirituality may be linked to a Further resources professional standards of
• food and drink has physical, social, cultural and belief system and for others it may be about finding • Respond to each person compassionately even practice and behaviour

Getting it right every time

Getting it right every time

spiritual meaning in a person’s life • Palatable - food should be what the person. 1. 2. meaning in what is happening if they are not your direct responsibility. Further resources relating for nurses and midwives.
fancies, perhaps with cream/ Establish the relevant Assess the wishes of • having a conversation and listening to people will • Check that each person’s understanding reflects to end of life care and London: NMC. Available at: Fundamentals of nursing
• desire for food and drink may naturally decrease butter to add calories. clinical facts of the the patient and those nutrition and hydration can
towards the end of life help you understand and meet their needs what they have been told. www.nmc-uk.org care at the end of life
case important to them be found online:
• additional support may be needed with some • Presentation - food should be visually appealing • you don’t need to share a person’s values to respect • Establish a person’s wishes and avoid assuming
conditions where the ability to eat and drink is lost and appetising. them a lack of capacity without careful assessment. www.rcnendoflife.org.
• inability to eat and drink and loss of appetite can • Portions - smaller plates for smaller portions. • a person may have rituals that they may need you to • Nutrition/hydration are regarded in law as a uk/resources
be distressing for everyone involved 3. 4. support them with before or after death medical treatment.
• Position - ensure you and the person being Consider www.rcneolnutrition
• preparing people for this loss of appetite can help Consider the • you won’t know what is important to people unless • Artificial or clinically assisted nutrition and
assisted are in a comfortable the ethical hydration.org.uk/
them to understand the dying process legal perspective you ask them hydration may need to be discussed.
position for eating. perspective resources
• support a person to eat and drink for as long as • it is not possible to provide all the answers and a • The NMC Code of practice says nurses “must
• Patience - let the person take their own time. person may need further support by referral to a recognise and respond compassionately to the
they wish or are able to do so
• Provide - good mouth care regularly, whether 5. specialist team. needs of those who are in their last few days
• sensitive communication may be required about Be aware of the and hours of life.” (NMC, 2015) The RCN represents nurses and nursing, promotes excellence
why a drip may or may not be needed in the last eating and drinking or not. in practice and shapes health policies.
processes needed
few days of life. to support the RCN Direct 0845 772 6100 RCN Online www.rcn.org.uk
decision making www.rcnendoflife.org.uk www.rcneolnutritionhydration.org.uk

June 2015. Publication code: 004 871

Nutrition and Remember the Ethical questions Cultural and Key messages RCN online resources References
Further information on Royal College of Nursing
hydration seven Ps spiritual needs all these topics can be
found at:
(2014) RCN End of life
survey 2014, London:
www.rcnendoflife.org.uk RCN. Available at:
www.rcn.org.uk
Key points to remember:
• regular individual assessment of nutrition and
When the desire or ability to eat and drink is reduced
these Ps will help you in delivering care.
Difficult questions about nutrition and hydration can
sometimes arise when providing end of life care. This
Each person will have cultural, spiritual and religious
beliefs that will shape the care you give. Be mindful that:
• Dying is a natural process.
• One size fits all decision making is morally
www.rcneolnutrition
hydration.org.uk Nursing and Midwifery Getting it right
every time
framework may help you with decision making. Always: wrong. Council (2015) The Code,
hydration needs is essential • Preference - establish likes and dislikes. • for some people spirituality may be linked to a Further resources professional standards of
• food and drink has physical, social, cultural and belief system and for others it may be about finding • Respond to each person compassionately even practice and behaviour

Getting it right every time

Getting it right every time

spiritual meaning in a person’s life • Palatable - food should be what the person. 1. 2. meaning in what is happening if they are not your direct responsibility. Further resources relating for nurses and midwives.
fancies, perhaps with cream/ Establish the relevant Assess the wishes of • having a conversation and listening to people will • Check that each person’s understanding reflects to end of life care and London: NMC. Available at: Fundamentals of nursing
• desire for food and drink may naturally decrease butter to add calories. clinical facts of the the patient and those nutrition and hydration can
towards the end of life help you understand and meet their needs what they have been told. www.nmc-uk.org care at the end of life
case important to them be found online:
• additional support may be needed with some • Presentation - food should be visually appealing • you don’t need to share a person’s values to respect • Establish a person’s wishes and avoid assuming
conditions where the ability to eat and drink is lost and appetising. them a lack of capacity without careful assessment. www.rcnendoflife.org.
• inability to eat and drink and loss of appetite can • Portions - smaller plates for smaller portions. • a person may have rituals that they may need you to • Nutrition/hydration are regarded in law as a uk/resources
be distressing for everyone involved 3. 4. support them with before or after death medical treatment.
• Position - ensure you and the person being Consider www.rcneolnutrition
• preparing people for this loss of appetite can help Consider the • you won’t know what is important to people unless • Artificial or clinically assisted nutrition and
assisted are in a comfortable the ethical hydration.org.uk/
them to understand the dying process legal perspective you ask them hydration may need to be discussed.
position for eating. perspective resources
• support a person to eat and drink for as long as • it is not possible to provide all the answers and a • The NMC Code of practice says nurses “must
• Patience - let the person take their own time. person may need further support by referral to a recognise and respond compassionately to the
they wish or are able to do so
• Provide - good mouth care regularly, whether 5. specialist team. needs of those who are in their last few days
• sensitive communication may be required about Be aware of the and hours of life.” (NMC, 2015) The RCN represents nurses and nursing, promotes excellence
why a drip may or may not be needed in the last eating and drinking or not. in practice and shapes health policies.
processes needed
few days of life. to support the RCN Direct 0845 772 6100 RCN Online www.rcn.org.uk
decision making www.rcnendoflife.org.uk www.rcneolnutritionhydration.org.uk

June 2015. Publication code: 004 871

Nutrition and Remember the Ethical questions Cultural and Key messages RCN online resources References
Further information on Royal College of Nursing
hydration seven Ps spiritual needs all these topics can be
found at:
(2014) RCN End of life
survey 2014, London:
www.rcnendoflife.org.uk RCN. Available at:
www.rcn.org.uk
Key points to remember:
• regular individual assessment of nutrition and
When the desire or ability to eat and drink is reduced
these Ps will help you in delivering care.
Difficult questions about nutrition and hydration can
sometimes arise when providing end of life care. This
Each person will have cultural, spiritual and religious
beliefs that will shape the care you give. Be mindful that:
• Dying is a natural process.
• One size fits all decision making is morally
www.rcneolnutrition
hydration.org.uk Nursing and Midwifery Getting it right
every time
framework may help you with decision making. Always: wrong. Council (2015) The Code,
hydration needs is essential • Preference - establish likes and dislikes. • for some people spirituality may be linked to a Further resources professional standards of
• food and drink has physical, social, cultural and belief system and for others it may be about finding • Respond to each person compassionately even practice and behaviour

Getting it right every time

Getting it right every time

spiritual meaning in a person’s life • Palatable - food should be what the person. 1. 2. meaning in what is happening if they are not your direct responsibility. Further resources relating for nurses and midwives.
fancies, perhaps with cream/ Establish the relevant Assess the wishes of • having a conversation and listening to people will • Check that each person’s understanding reflects to end of life care and London: NMC. Available at: Fundamentals of nursing
• desire for food and drink may naturally decrease butter to add calories. clinical facts of the the patient and those nutrition and hydration can
towards the end of life help you understand and meet their needs what they have been told. www.nmc-uk.org care at the end of life
case important to them be found online:
• additional support may be needed with some • Presentation - food should be visually appealing • you don’t need to share a person’s values to respect • Establish a person’s wishes and avoid assuming
conditions where the ability to eat and drink is lost and appetising. them a lack of capacity without careful assessment. www.rcnendoflife.org.
• inability to eat and drink and loss of appetite can • Portions - smaller plates for smaller portions. • a person may have rituals that they may need you to • Nutrition/hydration are regarded in law as a uk/resources
be distressing for everyone involved 3. 4. support them with before or after death medical treatment.
• Position - ensure you and the person being Consider www.rcneolnutrition
• preparing people for this loss of appetite can help Consider the • you won’t know what is important to people unless • Artificial or clinically assisted nutrition and
assisted are in a comfortable the ethical hydration.org.uk/
them to understand the dying process legal perspective you ask them hydration may need to be discussed.
position for eating. perspective resources
• support a person to eat and drink for as long as • it is not possible to provide all the answers and a • The NMC Code of practice says nurses “must
• Patience - let the person take their own time. person may need further support by referral to a recognise and respond compassionately to the
they wish or are able to do so
• Provide - good mouth care regularly, whether 5. specialist team. needs of those who are in their last few days
• sensitive communication may be required about Be aware of the and hours of life.” (NMC, 2015) The RCN represents nurses and nursing, promotes excellence
why a drip may or may not be needed in the last eating and drinking or not. in practice and shapes health policies.
processes needed
few days of life. to support the RCN Direct 0845 772 6100 RCN Online www.rcn.org.uk
decision making www.rcnendoflife.org.uk www.rcneolnutritionhydration.org.uk

June 2015. Publication code: 004 871

Nutrition and Remember the Ethical questions Cultural and Key messages RCN online resources References
Further information on Royal College of Nursing
hydration seven Ps spiritual needs all these topics can be
found at:
(2014) RCN End of life
survey 2014, London:
www.rcnendoflife.org.uk RCN. Available at:
www.rcn.org.uk
Key points to remember:
• regular individual assessment of nutrition and
When the desire or ability to eat and drink is reduced
these Ps will help you in delivering care.
Difficult questions about nutrition and hydration can
sometimes arise when providing end of life care. This
Each person will have cultural, spiritual and religious
beliefs that will shape the care you give. Be mindful that:
• Dying is a natural process.
• One size fits all decision making is morally
www.rcneolnutrition
hydration.org.uk Nursing and Midwifery Getting it right
every time
framework may help you with decision making. Always: wrong. Council (2015) The Code,
hydration needs is essential • Preference - establish likes and dislikes. • for some people spirituality may be linked to a Further resources professional standards of
• food and drink has physical, social, cultural and belief system and for others it may be about finding • Respond to each person compassionately even practice and behaviour

Getting it right every time

Getting it right every time

spiritual meaning in a person’s life • Palatable - food should be what the person. 1. 2. meaning in what is happening if they are not your direct responsibility. Further resources relating for nurses and midwives.
fancies, perhaps with cream/ Establish the relevant Assess the wishes of • having a conversation and listening to people will • Check that each person’s understanding reflects to end of life care and London: NMC. Available at: Fundamentals of nursing
• desire for food and drink may naturally decrease butter to add calories. clinical facts of the the patient and those nutrition and hydration can
towards the end of life help you understand and meet their needs what they have been told. www.nmc-uk.org care at the end of life
case important to them be found online:
• additional support may be needed with some • Presentation - food should be visually appealing • you don’t need to share a person’s values to respect • Establish a person’s wishes and avoid assuming
conditions where the ability to eat and drink is lost and appetising. them a lack of capacity without careful assessment. www.rcnendoflife.org.
• inability to eat and drink and loss of appetite can • Portions - smaller plates for smaller portions. • a person may have rituals that they may need you to • Nutrition/hydration are regarded in law as a uk/resources
be distressing for everyone involved 3. 4. support them with before or after death medical treatment.
• Position - ensure you and the person being Consider www.rcneolnutrition
• preparing people for this loss of appetite can help Consider the • you won’t know what is important to people unless • Artificial or clinically assisted nutrition and
assisted are in a comfortable the ethical hydration.org.uk/
them to understand the dying process legal perspective you ask them hydration may need to be discussed.
position for eating. perspective resources
• support a person to eat and drink for as long as • it is not possible to provide all the answers and a • The NMC Code of practice says nurses “must
• Patience - let the person take their own time. person may need further support by referral to a recognise and respond compassionately to the
they wish or are able to do so
• Provide - good mouth care regularly, whether 5. specialist team. needs of those who are in their last few days
• sensitive communication may be required about Be aware of the and hours of life.” (NMC, 2015) The RCN represents nurses and nursing, promotes excellence
why a drip may or may not be needed in the last eating and drinking or not. in practice and shapes health policies.
processes needed
few days of life. to support the RCN Direct 0845 772 6100 RCN Online www.rcn.org.uk
decision making www.rcnendoflife.org.uk www.rcneolnutritionhydration.org.uk

June 2015. Publication code: 004 871

Nutrition and Remember the Ethical questions Cultural and Key messages RCN online resources References
Further information on Royal College of Nursing
hydration seven Ps spiritual needs all these topics can be
found at:
(2014) RCN End of life
survey 2014, London:
www.rcnendoflife.org.uk RCN. Available at:
www.rcn.org.uk
Key points to remember:
• regular individual assessment of nutrition and
When the desire or ability to eat and drink is reduced
these Ps will help you in delivering care.
Difficult questions about nutrition and hydration can
sometimes arise when providing end of life care. This
Each person will have cultural, spiritual and religious
beliefs that will shape the care you give. Be mindful that:
• Dying is a natural process.
• One size fits all decision making is morally
www.rcneolnutrition
hydration.org.uk Nursing and Midwifery Getting it right
every time
framework may help you with decision making. Always: wrong. Council (2015) The Code,
hydration needs is essential • Preference - establish likes and dislikes. • for some people spirituality may be linked to a Further resources professional standards of
• food and drink has physical, social, cultural and belief system and for others it may be about finding • Respond to each person compassionately even practice and behaviour

Getting it right every time

Getting it right every time

spiritual meaning in a person’s life • Palatable - food should be what the person. 1. 2. meaning in what is happening if they are not your direct responsibility. Further resources relating for nurses and midwives.
fancies, perhaps with cream/ Establish the relevant Assess the wishes of • having a conversation and listening to people will • Check that each person’s understanding reflects to end of life care and London: NMC. Available at: Fundamentals of nursing
• desire for food and drink may naturally decrease butter to add calories. clinical facts of the the patient and those nutrition and hydration can
towards the end of life help you understand and meet their needs what they have been told. www.nmc-uk.org care at the end of life
case important to them be found online:
• additional support may be needed with some • Presentation - food should be visually appealing • you don’t need to share a person’s values to respect • Establish a person’s wishes and avoid assuming
conditions where the ability to eat and drink is lost and appetising. them a lack of capacity without careful assessment. www.rcnendoflife.org.
• inability to eat and drink and loss of appetite can • Portions - smaller plates for smaller portions. • a person may have rituals that they may need you to • Nutrition/hydration are regarded in law as a uk/resources
be distressing for everyone involved 3. 4. support them with before or after death medical treatment.
• Position - ensure you and the person being Consider www.rcneolnutrition
• preparing people for this loss of appetite can help Consider the • you won’t know what is important to people unless • Artificial or clinically assisted nutrition and
assisted are in a comfortable the ethical hydration.org.uk/
them to understand the dying process legal perspective you ask them hydration may need to be discussed.
position for eating. perspective resources
• support a person to eat and drink for as long as • it is not possible to provide all the answers and a • The NMC Code of practice says nurses “must
• Patience - let the person take their own time. person may need further support by referral to a recognise and respond compassionately to the
they wish or are able to do so
• Provide - good mouth care regularly, whether 5. specialist team. needs of those who are in their last few days
• sensitive communication may be required about Be aware of the and hours of life.” (NMC, 2015) The RCN represents nurses and nursing, promotes excellence
why a drip may or may not be needed in the last eating and drinking or not. in practice and shapes health policies.
processes needed
few days of life. to support the RCN Direct 0845 772 6100 RCN Online www.rcn.org.uk
decision making www.rcnendoflife.org.uk www.rcneolnutritionhydration.org.uk

June 2015. Publication code: 004 871

Nutrition and Remember the Ethical questions Cultural and Key messages RCN online resources References
Further information on Royal College of Nursing
hydration seven Ps spiritual needs all these topics can be
found at:
(2014) RCN End of life
survey 2014, London:
www.rcnendoflife.org.uk RCN. Available at:
www.rcn.org.uk
Key points to remember:
• regular individual assessment of nutrition and
When the desire or ability to eat and drink is reduced
these Ps will help you in delivering care.
Difficult questions about nutrition and hydration can
sometimes arise when providing end of life care. This
Each person will have cultural, spiritual and religious
beliefs that will shape the care you give. Be mindful that:
• Dying is a natural process.
• One size fits all decision making is morally
www.rcneolnutrition
hydration.org.uk Nursing and Midwifery Getting it right
every time
framework may help you with decision making. Always: wrong. Council (2015) The Code,
hydration needs is essential • Preference - establish likes and dislikes. • for some people spirituality may be linked to a Further resources professional standards of
• food and drink has physical, social, cultural and belief system and for others it may be about finding • Respond to each person compassionately even practice and behaviour

Getting it right every time

Getting it right every time

spiritual meaning in a person’s life • Palatable - food should be what the person. 1. 2. meaning in what is happening if they are not your direct responsibility. Further resources relating for nurses and midwives.
fancies, perhaps with cream/ Establish the relevant Assess the wishes of • having a conversation and listening to people will • Check that each person’s understanding reflects to end of life care and London: NMC. Available at: Fundamentals of nursing
• desire for food and drink may naturally decrease butter to add calories. clinical facts of the the patient and those nutrition and hydration can
towards the end of life help you understand and meet their needs what they have been told. www.nmc-uk.org care at the end of life
case important to them be found online:
• additional support may be needed with some • Presentation - food should be visually appealing • you don’t need to share a person’s values to respect • Establish a person’s wishes and avoid assuming
conditions where the ability to eat and drink is lost and appetising. them a lack of capacity without careful assessment. www.rcnendoflife.org.
• inability to eat and drink and loss of appetite can • Portions - smaller plates for smaller portions. • a person may have rituals that they may need you to • Nutrition/hydration are regarded in law as a uk/resources
be distressing for everyone involved 3. 4. support them with before or after death medical treatment.
• Position - ensure you and the person being Consider www.rcneolnutrition
• preparing people for this loss of appetite can help Consider the • you won’t know what is important to people unless • Artificial or clinically assisted nutrition and
assisted are in a comfortable the ethical hydration.org.uk/
them to understand the dying process legal perspective you ask them hydration may need to be discussed.
position for eating. perspective resources
• support a person to eat and drink for as long as • it is not possible to provide all the answers and a • The NMC Code of practice says nurses “must
• Patience - let the person take their own time. person may need further support by referral to a recognise and respond compassionately to the
they wish or are able to do so
• Provide - good mouth care regularly, whether 5. specialist team. needs of those who are in their last few days
• sensitive communication may be required about Be aware of the and hours of life.” (NMC, 2015) The RCN represents nurses and nursing, promotes excellence
why a drip may or may not be needed in the last eating and drinking or not. in practice and shapes health policies.
processes needed
few days of life. to support the RCN Direct 0845 772 6100 RCN Online www.rcn.org.uk
decision making www.rcnendoflife.org.uk www.rcneolnutritionhydration.org.uk

June 2015. Publication code: 004 871