The SWAN model of care
Sign – making sure staff know that sadly your loved one is dying and that this is a difficult time for you
Words – keeping you informed
Actions – facilitating what is important to you and your loved one
Needs – making sure we are continually meeting your needs
The aim of this short film is to raise awareness of the SWAN symbol and the resources available to support compassionate end of life care across NUH.
If you have been affected by anything in this film and have a family member in the hospital, please contact the ward team to discuss.
We have additional support from the hospital palliative care and chaplaincy team, they can be contacted via the hospital main switchboard.
Care in the last hours or days of life
Keeping you informed
The ward team will have talked to you about the changes in your loved one’s condition. They will have explained that although all appropriate treatment has been given, sadly your relative or friend is dying. Everything possible will be done to keep them comfortable and to support you. This section gives information about what to expect and how we care for someone in the last hours or days of life.
People can feel numb after hearing that someone is dying and find it hard to take in information. Doctors, nurses and others will update you regularly. We welcome your questions, so please don’t hesitate to approach us for anything you need. Please feel free to contact the ward by phone at any time of day or night.
Visiting hours, accommodation and special wishes during COVID 19
To access the latest visiting arrangements and information please click the link below:
Every effort will be made to accommodate the wishes of your relative or friend at this time. If you are a family member and do not have coronavirus symptoms or are isolating you may wish to bring in comforting things from home such as photographs, music or a duvet. It may be possible for a pet to visit so please discuss this with us. You will be free to visit at an agreed time any time and have access to free car parking. If you want to stay overnight we will make you feel as comfortable as possible, offering you a camp bed, toiletries, food and drinks. It is important to look after yourself.
You may notice a SWAN sign by your loved one’s bed space. This symbol is to communicate to the wider team that you are in a difficult and stressful situation and require support.
Focus on comfort, care and changes to medication
All our care will be focused on comfort. We will not disturb your relative or friend with unnecessary tests or observations but we will regularly assess them for any signs of pain, nausea, breathlessness or agitation. Medicines to relieve these and add to comfort will be given as needed, sometimes through a syringe driver. It might be appropriate to stop giving other medicines that are no longer of benefit.
If you are present- changes you may notice at the end of a person’s life
- Reduced desire to eat and drink – This is part of the normal process of dying. Your relative or friend will be supported to eat and drink for as long as possible. We will provide regular mouth care and may ask if you would like to help give this care.
- Changes in breathing pattern – Breathing may become shallower as life approaches its end. There may be long pauses between breaths for a period of time, especially the nearer to death someone is. This varies greatly from person to person and is usually unnoticed by them.
- Noisy breathing - Some people may make a noise as they are breathing. This is often because they are no longer able to swallow or cough up the normal fluids in their mouth, throat or chest and it can cause a rattling sound. Your relative or friend will usually not be aware of the sound. Sometimes a change in their position can help, and medication can be given too.
- Becoming sleepier – Many people become drowsy and eventually completely unconscious. They may still be able to hear so do continue to talk to them if you would like to.
- Restlessness or agitation – This can be caused by physical problems such as constipation or by emotional or spiritual distress. The presence of loved ones and a quiet environment can help alleviate restlessness.
- The person’s skin may feel cooler and become very pale in colour - We will ensure they have sufficient bed covers.
Spiritual and Pastoral Care
This is a very emotional time and you may want to talk with someone about your feelings, anxieties or beliefs. Our Spiritual and Pastoral Care Team is always available to listen and share with you. You do not have to have be religious to benefit from their support.
Within the hospital, we have representatives from most faiths available by request. Please let the ward team know if you wish to contact them.
Meeting the needs of children
Children are welcome to visit your loved one with you. On request, we can provide information booklets and resources to support children when someone close to them is dying. Leaflets are available from the ward staff and the Hospital Palliative Care Team.
Both children and adults can find it helpful at a time like this to create positive memories for the future. If time permits this could involve putting together a ‘memory box’ containing photos, letters, jewellery and mementos of special times shared together. Hand prints or hair locks of the person you wish to remember will be offered. If you would like more information about this, please speak to us.
Your relative or friend may previously have spoken to you about body, organ or tissue donation. Although it may not be feasible to donate organs such as the heart or kidneys it is often feasible to donate other parts of the body. If this is something that you know is important to them or you would like more information, please tell us so we can guide you to our specialist team.
Tissue donation is not an option in the event of a COVID 19 diagnosis.