A Special Mass is held in St. John’s Church annually to celebrate the memory of all patients who died in the UL Hospitals Nenagh Hospital in the previous year. Families of the deceased are invited. A candle in memory of the deceased is lit during the ceremony.

A remembrance tree bearing the names of the people who died in Nenagh Hospital in the previous year is on display. Refreshments are served after the mass. Silvermines Choir participate at this mass.

Remembrance Mass

During the critical times of bad news, dying, death and bereavement, the quality of interactions between end of life patients, their families and hospital staff has a long-term impact on all concerned. Many studies have also shown that hospital staff experience frustration and stress in effectively supporting patients and families at these difficult and emotional times because of a lack of adequate training

Final Journeys is a development initiative targeted at addressing some of these issues with the wider hospital staff group. �e purpose of Final Journeys is to improve end-of-life care through promoting a culture of awareness and personal empowerment among all hospital staff, and to support the development of good communication skills in those hospital staff that have direct contact with patients at the end of life, and their families. To date, over 70 staff (across all grades) at Nenagh Hospital have attended this training day.

Some feedback comments from attendees of Final Journeys:

“From now on I’m going to take time to actively listen and I’ve more awareness that End of Life

care affects everyone working in a hospital.”

“�e course really met my expectations and more”

“Excellent course. It should be made compulsory for all hospital staff”

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End of Life Care Resources Used at Nenagh Hospital

Framed End of Life Symbol

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Ward Altar

�is symbol appears on many of the resources developed by the Hospice Friendly Hospitals Programme to respectfully identify items connected with the end of life in hospitals. In conjunction with good practice in hospitals and care facilities, the symbol aims to add a rightful degree of respect and solemnity to items used following the death of a person and to make resources relating to the end of life instantly identifiable.

�e symbol will appear on a number of resources including: a bed drape for use on a ward following the death of a person, a mortuary trolley drape for transporting the deceased person’s body, a family handover bag used to respectfully return the belongings of a deceased person to their family and a display sign to notify staff and visitors that a person has died within a ward or unit.

Items bearing the symbol should be stored, used and treated with respect as they serve a ‘sacred’ function in marking the death of a person. �e symbol is inspired by ancient Irish history and is not associated with any one religion or denomination. �e 3-stranded white spiral represents the interconnected cycle of life – birth, life and death. �e white outer circle represents continuity, infinity and completion. Purple was chosen as the background colour as it is associated with nobility, solemnity and spirituality.

�e symbol and guideline on how and when to use it are available to download from www.hospicefriendlyhospitals.

End-of-Life Symbol

�is symbol is displayed in Nenagh Hospital at the nurses’ station or on the ward door to notify staff and visitors that a person has died or is dying within our wards. �e use of the symbol helps to promote an atmosphere of calm and respect and also ensures that

grieving relatives will not be disturbed unnecessarily.

�e oak ward altar is used in this hospital when a patient is dying or following their death. �e top of the altar features the end of life spiral. Religious and cultural items relevant to end-of-life care are

stored inside.

We use a high quality family handover bag to promote a dignified and sensitive way of returning the deceased patient’s personal belongings to the

family. We no longer use plastic bags.

A purple drape is placed over our mortuary trolleys when transporting the body of a deceased

person through the hospital.

In recent years our practice at Nenagh Hospital to send a sympathy card to the next-of-kin of those who have died in the hospital. �e sympathy card is handwritten by a person who was involved in the

care of the patient.

Handover bag Mortuary Trolley Drape Sympathy Cards

�e overall purpose of the Hospice Friendly Hospitals (HFH) Programme is to ensure that end-of-life care is central to the mission and everyday business of hospitals. It promotes high quality care for all people at the end of life regardless of diagnosis and whether the death is expected or sudden, and it acknowledges the role of clinical, administrative and support staff in improving the patient’s and family’s experience.

�e Hospice Friendly Hospitals Programme was launched in 2007, to develop and promote a culture of care for those facing death in hospitals that would draw on the principles of hospice care.

AIMS OF THE HOSPICE FRIENDLY HOSPITALS PROGRAMME

• To develop the capacity of hospitals to meet the Quality Standards for End-of-Life Care in Hospitals

• To improve the culture of dying, death and bereavement in hospitals

University Hospitals- Nenagh Hospital is linked to the national Hospice Friendly Acute Hospitals Network. Leaders in end-of-life care from over 35 hospitals linked to the Hospice Friendly Hospitals Programmed are members of this network.

Every 3 months we send a progress report to the HFH in �e Irish Hospice Foundation Dublin and Nenagh Hospital representatives attend 3 HFH network meetings during the year.

University Hospital Nenagh is committed to improving end of life care to our patients and their families. One initiative taken by the End –of – Life Care Committee at University Hospital Nenagh was to develop a family room for relatives who had patients in our hospital nearing the end of their life and for relatives who were bereaved. Previously, we had no such facility at our hospital. Our aim was to create a space that was private and tranquil allowing relatives to use this facility in their moments of sadness and grief and stay both day and night if they so wished while their loved one is dying in our hospital.

With support from the Irish Hospice Foundation - Design and Dignity Grant Scheme we now have a family room ( located in the front hall near reception) which provides a calm, peaceful private environment which hopefully will lessen the stress and loneliness and make the unbearable as full of grace as possible. We are very pleased to have this Family room as an exemplar project for all hospitals in our region.

It is the wish of most of us to be able to die peacefully, conscious and capable of communicating with our loved ones to the very end. Unfortunately, death does not always occur in this way.

�inking about dying is challenging, and talking meaningfully with those who are close to us about matters such as serious illness, dying and death can be difficult. �ink Ahead as a tool to help you start this process at an early stage, beginning with helping you to reflect on your personal values, beliefs and understanding about end of life.

�ink Ahead is a public awareness initiative aimed at guiding people in discussing and recording their care preferences in the event of an accident or other emergency, serious illness or death – when they may well be unable to speak for themselves. It comprises a detailed form divided into six sections:

(1) Key Information; (2) Care Preferences; (3) Legal Matters; (4) Financial Matters; (5) When I Die; and (6) Sharing Information.Visit www.thinkahead.ie for more information or to download a form.

�ink Ahead Information Evening UHL Nenagh Hospital - April 2015

“Excellent day - Excellent course, great speakers, great discussions, very interactive and educational,

great mix of staff.”

Family Room University Hospital Nenagh

Final JourneysImproving how we care for people at end of life.

�ink Ahead -Planning for Death & Dying

“�ank you for organising the remembrance mass...I found it very healing. �e staff at Nenagh

Hospital have certainly helped me through this difficult time”

Feedback from the remembrance mass:

“I’m proud to bring the family of my patients to this room.”

“Fantastic facility.”

“�anks to your passion, vision and commitment the family room will allow so

many families the privacy to mourn and grieve for their loved ones.”

Staff Feedback

“Also, having the privacy of the family room was wonderful in helping us come to terms with the loss of our 90 year old mother who

we thought would live forever.”

Letter from relative

“How people die remains in the memory of those who live on” Dame Cicely Saunders (1918 - 2005) founder of the modern hospice movement.

�e End of Life Care Committee Nenagh Hospital was established to promote and guide good practice in end of life care. �e presence of a committee is required as best practice as per the Hospice Friendly Hospitals Quality Standards for End of Life Care in Hospitals (2010)

End of Life Care is a core part of our hospital work and in our implementation of �e Quality Standards for End of Life Care in hospitals (2010); we strive to ensure that the essential elements of a consistent quality approach to end of life care are in place in all parts of the hospital.

In recent years we have undertaken many initiatives to improve End of Life Care at this hospital including:the introduction of Hospice Friendly Hospitals initiatives such as

�e End of Life Symbol,

�e ward altars,

�e hand over bags,

�e purple drape for the mortuary trolley

Sympathy cards.

Annual remembrance mass

‘Final Journeys’ training for all staff.

‘�ink Ahead’ information evening.

�ree monthly progress report to the Hospice Friendly Hospitals (HFH)

Attend HFH network meetings.

�e family room.

If you have any feedback, suggestions, ideas, or comment regarding End of Life Care at Nenagh Hospital or you would like further information please contact

Carmel Sheehy CNS Palliative Care (067) 42388 or email carmel.sheehy@hse.ie

End Of Life Care, Ul Hospitals, Nenagh Hospital