Aim To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence.

Method A two-phase exploratory mixed methods design was used, evaluating the effect of an end of life care toolkit and associated training in care homes, facilitated by a specialist palliative care team. Six care homes in England were recruited to the intervention; 24 staff participated in discussion groups; 54 staff attended at least one training session; and pre- and post-intervention questionnaires were completed by 78 and 103 staff respectively.

Results Staff confidence in receiving emotional and clinical support and managing end of life care symptoms increased post-intervention, but confidence in discussing death and dying with residents and relatives decreased. Audit data indicate greater reduction in the number of residents from participating care homes dying in hospital than those from comparison homes.

Conclusion Collaborative end of life care interventions support care home staff to manage end of life and may enable residents to have choice about their place of death.

Aim To explore caregivers’ perspectives on ethics in older people’s residential and domiciliary social care.

Method Seventeen staff working in domiciliary and residential care were divided into four focus groups and invited to share their perspectives on ‘ethical’ or ‘good’ care, the ethical issues that arise in their care practice, and barriers and enablers for ethical care.

Findings A thematic analysis identified four themes: negotiating relationships, boundaries and the management of emotions, the effects of negative portrayals of care, and becoming a good carer.

Conclusion Providing ethical social care is complex, and involves managing emotional boundaries and relational issues. The authors suggest that caregivers provide skilled companionship to those in their care.

Aims To explore and evaluate the experience of the ‘Arts for Life’ project among patients or residents with terminal illness in nursing homes and the community, their relatives and practitioners.

Method Semi-structured qualitative interviews were conducted with five patients/residents and two relatives. Five practitioners including a music therapist and a digital artist were involved in the study.

Findings The evaluation discusses the perceived benefits and challenges of the Arts for Life project from the perspectives of a small sample of patients/residents, relatives, nurses and arts facilitators. The findings suggested that the Arts for Life project provided opportunities for participants to express their creativity and individuality. A range of benefits was identified. Participants described their involvement in the project as providing a means of escapism, relief from pain and anxiety, and as helping them to engage with loss.

Conclusion The findings should be interpreted with caution as a result of the small sample size. The evaluation suggests that people with different diagnoses benefit in different ways from participation in the arts. An understanding of the role of the arts enables nurses to appreciate different responses to end-of-life care. Larger scale research is required with focused evaluation objectives to explore further the issues raised.

This article discusses ethical aspects of ‘terminal sedation’ in relation to end-of-life care. An examination of the literature reveals there are different definitions and explanations of terminal sedation. Some definitions appear compatible with the values of palliative care and nursing, whereas others could arguably be perceived as deserving of the term ‘euthanasia in disguise’. The authors suggest that ‘palliative sedation’ is a more helpful term and argue that, when defined and understood appropriately, it is a defensible and ethical practice. Nurses should be clear about the purpose of their profession, honest about their intentions and respect the autonomy and dignity of the patients for whom they provide care. The doctrine or principle of ‘double effect’ has been put forward to support the practice of terminal sedation. The authors examine this doctrine and caution that nurses and other professions need to approach it critically in relation to terminal sedation. Vignettes are used to illustrate aspects of the discussion.