Table 6.

Night time nursing roles of Hospice at Home team

Role	Examples
Liaison with community-based staff at night	Liaising with out of hours nurses and GPs in order to obtain appropriate symptom relief during the night (repositioning, prescription of medications, administration of medications)
Pharmacological symptom management	Administering ‘as required’ and ‘just in case medicines’ such as midazolam, diamorphine, lorazepam, glycopyrronium (qualified nurses only)
Specialist assessment	‘Going in cold’ to homes of new patients with very little prior knowledge in order to assess end-of-life care needs and report back to all concerned. Difficult as environment usually not suited to end-of-life care.
After death care	Liaising with family, GPs and funeral homes to initiate post death proceedings Remaining with and comforting carers until body removed from home
Advocacy	Safeguarding, passing on to higher authorities any abuse of patients and carers detected during night time conversations Acting as buffers between large families and patients who needed to rest Challenging ineffective drug regimes
Fundamental nursing care	Pressure area care, general hygiene, comfort and reassurance
Psychological support for patient and family	Offering counselling to distressed patients and family members