Please read the latest coronavirus advice before visiting any of the hospice sites.

The Lantern Model

Prompted by the prospect of the Year of the Nurse and Midwife in 2020, St Christopher’s Hospice nurses Heather Richardson and Marie Cooper, set out almost two years ago to devise the first new model for palliative and end of life care nursing in three decades.

The Lantern Model, made possible with the support of the Florence Nightingale Foundation and the Burdett Trust for Nursing, articulates the unique, vital and skilled role of nurses caring for people who are dying or bereaved and, by highlighting their contribution, makes the case for increased investment in their recruitment, development and retention.

The model is underpinned by a variety of evidence – patient and family views, subjective experience of nurses and a review of the academic literature. It has been generated through extended discussion and engagement with senior nurses with a broad range of nursing experience at the end of life.

lantern model pdf

The different components of the Lantern Model 

The proposed model borrows its design from work on a person centred practice framework created by two nurses, McCormack and McCance. Their model comprises a number of domains, that are interrelated and contribute to person centred outcomes.

The Lantern Model comprises seven similar components, also interrelated. These are described below:

Outcomes

Outcomes

  1. Knowledge
  2. Comfort
  3. Dignity and respect
  4. Safety
  5. Opportunity to participate
  6. New skills and confidence.

Context

Context of care

  1. Society’s fear of death 
  2. Individuals’ desire for agency, independence and self-determination 
  3. The uncertainties of contemporary dying
  4. A health system under pressure. 

Processes

Processes of nursing care

  1. Connecting
  2. Future planning 
  3. Coaching and caring
  4. Accompanying
  5. Saying goodbye.
MDT support

Support by the wider MDT

  1. Recognising dying
  2. Inviting important conversations about today and the future
  3. Providing enhanced symptom management, psychosocial care and rehabilitation
  4. Supporting continuity of care
  5. Caring for colleagues. 
Personal prerequisites

Personal prerequisites

  1. Compassion
  2. Self-knowledge
  3. Confidence 
  4. Generosity 
  5. Courage. 
Organisational prerequisites

Organisational conditions

  1. Space to care 
  2. Access to a multi-professional team and other sources of help
  3. Commitment to a happy cohesive workforce
  4. Availability of personal and professional development opportunities
  5. Risk-confident and supportive culture.
Key tenets

Key tenets that shape and guide the care provided

  1. A contemporary philosophy of palliative and end of life care
  2. Finding ‘the person in the patient’.

Outcomes

Outcomes

  1. Knowledge 
  2. Comfort 
  3. Dignity and respect 
  4. Safety 
  5. Opportunity to participate 
  6. New skills and confidence.

Outcomes

High-quality nursing seeks to make a difference to people’s health and lives. At the heart of our model are the outcomes nurses working to this model can expect to achieve on behalf of those for whom they provide care.

1. Knowledge

“I understand what is happening”

Everyone involved understands the situation and has insight about the future. They discover this at a speed and with a degree of detail with which they feel comfortable and feel able to ask for more information when they are unclear. The dying person and those around them gain focus from a shared knowledge of what is happening and feel more in control as a result.

2. Comfort

“I can still enjoy life”

The dying person experiences as little distress, whether physical, emotional, social or spiritual in nature, as possible. Their pain and other symptoms are managed, enabling them to continue living well despite advancing illness. Their families and carers observe their comfort and are reassured accordingly.

3. Dignity and respect

“You see me as a person and I know I matter”

The dying person is recognised as the individual they are. They are confident that their wishes/preferences are understood and respected and so they maintain hope, a sense of identity and positive self-regard despite the progress of their illness. Their families and carers are witness to their ongoing sense of personhood and find relief and comfort in that knowledge.

4. Safety

“I feel safe”

The dying person feels safe despite their increasing vulnerability. They feel connected to others, and part of a network of people concerned for them. They know that their families are safe also – cared for before and following their death. Those around them feel held and supported at this difficult time and are confident of the safety of the person who is dying.

5. Opportunity to participate

“I feel involved and know I have a valuable part to play in shaping the future”

People living with a life-shortening condition are enabled to be active participants involved in the design and the delivery of their care as they wish.

6. New skills and confidence

“I feel confident to participate in care”

Everyone involved (the person who is dying, their carers, families, friends, community and other professionals) feels able to participate in supporting the dying person and those around them if this is what they want to do.

‘From the acute onset of illness or the moment of diagnosis, individuals look to nurses for reassurance and understanding, as a human connection in the overwhelming reality of healthcare.’

Ferrell BR and Coyle N (2008). The nature of suffering and the goals of nursing. Oncology Nursing Forum. 35(2): 241-247 

Context

Context of care

  • Society’s fear of death 
  • Individuals’ desire for agency, independence and self-determination 
  • The uncertainties of contemporary dying
  • A health system under pressure. 

Context of care

The Lantern Model is set within a contemporary context of end of life. This will, of course, vary according to whereabouts in the world the application of this model is being considered and we encourage those interested to use the Lantern Model to refine this section and the detail of the desired outcomes to reflect local preferences and priorities.

1. Society’s fear of death

Most people are very frightened about dying and the impact on their families in the event of their demise. Those around them are often frightened too – what will deterioration on the part of the dying person look like? Do they have the skills to support them? Are they allowed to help or is that the role of the professional? Will they survive beyond the death?

2. Individuals’ desire for agency, independence and self-determination

Many people including those that are dying want greater control in relation to their lives and its enactment than they have done historically.

3. The uncertainties of contemporary dying

The model is set in a context in which dying is often a prolonged and uncertain process, in which people commonly live with multiple conditions (accompanied by growing disability), any one of which could result in their death.

4. A healthcare system under pressure

Regardless of the intentions of the nurse, their very best efforts are at risk of being thwarted by a healthcare system under sustained pressure.

‘In increasingly secular and atomised societies, people are unfamiliar with the processes, realities and rituals associated with dying and grieving, there has been a progressive loss of language and opportunity to discuss death. The loss of norms, rituals and the social role of the dying person has cut death loose from historic cultural practices. This means even when health care services operate at the margins, families and communities may feel unable to manage a dying process, feeling it should be managed by professionals, and relegating control to them’

Lancet Commission on the Value of Death. Unpublished to date. 2020 

Processes

Processes of nursing care

  1. Connecting
  2. Future planning 
  3. Coaching and caring
  4. Accompanying
  5. Saying goodbye.

Processes of nursing care

The outcomes of care described previously are only possible when nurses engage in particular processes of nursing described below. The nuance of the enactment of each of these processes will vary depending on the context of care and the degree of experience and expertise of the nurse.

1. Connecting

“Hello, I would like to get to know you and find out what is important to you”

The nurse always seeks to create a meaningful relationship with the person to whom they offer care, regardless of whether it is likely to be short or long term in nature.

2. Future planning

“Tell me what you would like your future to look like and let me suggest how I can help you achieve it”

The nurse recognises the value of holistic assessment of someone’s needs, concerns and goals. This assessment is individualised and repeated to accommodate changing views and priorities on the part of the dying person and those close to them.

3. Coaching and caring

“I have skills and knowledge to share, encouragement to offer and care available when you can no longer care for your self yourself”

The nurse’s offer of care moves confidently between the two polar positions of supporting self-care and providing intimate hands-on care for someone, reflective of their strengths and capabilities as well as their needs.

4. Accompanying

“I am here to help as and when you need me”

Nurses respond to suffering primarily through their presence – witness to the changes in someone’s life and the pain that such change may bring.

5. Saying goodbye

“I have valued being part of your life. Farewell”

Once someone’s care comes to an end, the nurse seeks to disengage emotionally from that relationship.

‘Authentic engagement refers to a relationship between human beings that is deeper than what can be captured by traditional notions of professionalism. When a nurse is authentically engaged with a patient and/or the patient’s family, this means that the nurse enacts a relational practice that is characterised by curiosity and humility, concern and commitment, investment and action’

Singer P et al (1999) Quality End-of-Life Care: Patients’ Perspectives. Journal of the American Medical Association 13. 281(2): 163-168

MDT support

Support by the wider MDT

  1. Recognising dying
  2. Inviting important conversations about today and the future 
  3. Providing enhanced symptom management, psychosocial care and rehabilitation 
  4. Supporting continuity of care 
  5. Caring for colleagues. 

Support by the

wider MDT

Whilst the Lantern Model is, without apology, a model of nursing, we believe it remiss if we were not to consider the essential contribution of other members of the multi-disciplinary team to the care required by the person who is dying and their family.

1. Recognising dying

“My care is at its best when others help identify when someone is coming to the end of their life and would benefit from additional/different support”

The nurse invites help from medical and other colleagues to recognise the point in someone’s life trajectory when death is the most likely outcome of their condition.

2. Inviting important conversations about today and the future

“My care is at its best when others contribute to important conversations that people want to have about their future”

The nurse invites input from medical, social work and other colleagues to initiate and support crucial conversations with the person who is dying and those close to them about the future and what they can expect.

3. Providing enhanced symptom management, psychosocial care and rehabilitation

“My care is at its best when other members of the team identify and deliver a range of interventions alongside nursing, which helps people maintain their quality of life and their functionality”

Depending on their skills, the nurse will want to draw on additional expertise of other colleagues to attend to distressing symptoms that they notice in the person for whom they are caring.

4. Supporting continuity of care

“My care is at its best when colleagues work collaboratively with me and across organisational and other boundaries to enable continuity of care”

The nurse recognises the importance of an experience of continuity of care on the part of the person who is dying and those close to them.

5. Caring for colleagues

“My care is at its best when I know other colleagues look out for me and my wellbeing, mindful of the stress we all experience”

The engagement and disengagement of the nurse with those in their care, particularly at the point of death, can be stressful, particularly when it happens regularly and in a sustained way. Other stresses, related to organisational life, also take their toll.

‘Integrating the spectrum of expertise of different individuals into the palliative care plan increases the likelihood that patients are managed in a holistic manner. Working in a team can positively influence individual members through reinforcing interpersonal relationships, providing opportunities for professional appraisal and sharing of experiences, responsibilities and worries’

Fernando GVMC and Hughes S (2019). Team approaches in palliative care: a review of the literature. International Journal of Palliative Nursing. 25(9) 

Personal prerequisites

Personal prerequisites

  1. Compassion
  2. Self-knowledge
  3. Confidence 
  4. Generosity 
  5. Courage 

Personal

prerequisites

In our introduction to the Lantern Model we describe a close relationship between the character of the nurse, how they enact processes of nursing care and the outcomes they achieve on the part of the dying person and those close to them. By ‘character’ we mean the way that the nurse thinks, feels and behaves in relation to their job and their relationships.

1. Compassion

“My care is at its best when I can demonstrate the concern and care I feel for the people I work with”

Nurses who embody compassion bring extraordinary kindness to their work, underpinned by a strong empathy for the person/people for whom they care.

2. Self-knowledge

“My care is at its best when I know my strengths and my weaknesses and work with them in mind”

This nurse has insight into themselves as a person and as a professional. Being conscious of their own response to death, dying and loss enables them to be authentic in their response to other people’s concerns and fears.

3. Confidence

“My care is at its best when I am confident I know what I am doing”

Confident nurses are poised to anticipate and respond to the needs and goals of individuals in their care drawing on clinical competency, tacit knowledge, other personal strengths and a sense of agency.

4. Generosity

“My care is at its best when I go ‘over and above’ in my work to really make a difference”

Nurses who embody this will go the extra mile. They recognise the opportunities they afford themselves and others when they choose to give more than could reasonably be expected, including very personal aspects of themselves.

5. Courage

“My care is at its best when I am brave in my practice”

Once someone’s care comes to an end, the nurse seeks to disengage emotionally from that relationship.

‘Suffering is only intolerable when nobody cares’

Saunders C (1960). The management of patients in the terminal stage. Editor: Raven R. First published in Cancer. 6: 403-17   

Organisational prerequisites

Organisational conditions

  1. Space to care 
  2. Access to a multi-professional team and other sources of help
  3. Commitment to a happy cohesive workforce
  4. Availability of personal and professional development opportunities
  5. Risk-confident and supportive culture.

Organisational

conditions

Even with strong personal characteristics, the impact of the nurse will by limited without sustained organisational commitment to end of life care and the particular contribution of the nurse within it.

1. Space to care

“My care is at its best when others help identify when someone is coming to the end of their life and would benefit from additional/different support”

The supportive organisation provides space to care in a number of different ways. It recognises the importance of time to care, of a healing physical environment and opportunities for reflection on the part of caregivers and the value afforded the dying person and their family when a nurse can spend time with those in their care, exploring what is important to them, progress made towards their goals and any unmet needs thus far.

2. Access to a multi-professional team and other sources of help

“My care is at its best when others contribute to important conversations that people want to have about their future”

This organisation recognises the value of holistic care for the person who is dying and their family/carers,and acknowledges that this is best achieved when strong nursing is supported by multi-professional expertise and input by other significant players – like friends, neighbours, and community/religious leaders.

3. Commitment to a happy cohesive workforce

“My care is at its best when other members of the team identify and deliver a range of interventions alongside nursing, which helps people maintain their quality of life and their functionality”

This organisation knows that happiness at work and resilience on the part of its workforce contributes to high-quality care. It recognises the different stressors for the nurse – arising from organisational issues as well a those related to prolonged care for people who are dying and/or who face loss. It acknowledges the value of strong connections between nurses and other team members as part of a positive experience of team work.

4. Availability of personal and professional development opportunities

“My care is at its best when colleagues work collaboratively with me and across organisational and other boundaries to enable continuity of care”

This organisation is in no doubt about the value afforded its service by a committed, skilled workforce including its nurses and understands that the offer
of ongoing learning opportunities support retention.

5. Risk-confident and supportive culture

“My care is at its best when I know other colleagues look out for me and my wellbeing, mindful of the stress we all experience”

This organisation acknowledges that high-quality nursing for people facing the end of life will often call for a flexible response to risks encountered by the person who is dying and creative solutions on the part of those who care for them. There is no mindset for ‘one size fits all’.

‘The majority of factors causing stress in the hospice workforce could be alleviated by good management practice. The quality of the work environment has a significant impact on stress levels and most situations could be improved by effective leadership, a participatory culture and good line management of staff and volunteers’

Pryce-Jones J (2010). Happiness at work. Maximising your psychological capital for success. Wiley-Blackwell. West Sussex  

Key tenets

Key tenets that shape and guide the care provided

  1. A contemporary philosophy of palliative and end of life care
  2. Finding ‘the person in the patient’.

Key tenets

Two important principles sit at the base of the Lantern Model that anchor and shape the model in its entirety.

1. A contemporary philosophy of palliative and end of life care

First, the model is situated in a contemporary philosophy of palliative and end of life care. This philosophy acts as the root for the model, providing stability and a point of reference, regardless of the nuance of how the model is enacted or where.

The definition of palliative and end of life care which helps to encapsulate this philosophy is described in the Lantern Model PDF.

2. Finding ‘the person in the patient’

The second tenet is a requirement of the nurse to always seek to find ‘the person in the patient’ in their care or in anyone else who seeks their help. This approach serves to connect the philosophy of palliative care to its practice.

It is fundamental to the quality of care at the end of life and addresses the concept and experience of ‘total pain’ which focuses on the person and their experience of illness be it physical, emotional, spiritual or social
in nature.

‘You matter because you are you, and you matter to the last moment of your life. We will do all that we can not only to help you die peacefully, but also to live until you die’

Saunders C, cited by Twycross R (2006). A tribute to Dame Cicely Saunders. Memorial Service. Westminister Abbey. London UK 

The Lantern Model

Screenshot at ..

About the authors

heather and marie
Dr Heather Richardson and Marie Cooper

Dr Heather Richardson 

Joint Chief Executive, St Christopher’s; Honorary Professor in the International Observatory on End of Life Care, Lancaster University

Heather Richardson works as one of the Joint Chief Executives of St Christopher’s Hospice, London. She has previously held the role of National Clinical Lead for Hospice UK, and worked as Clinical Director, then Strategy Advisor to St. Joseph’s Hospice in east London prior to her move to St Christopher’s.

Heather is a registered general and mental health nurse and has worked in hospice/palliative care since 1988. She has a PhD, her research concerned with users’ experience of day hospice. More recently, she has developed a research interest around public health and end of life care. She currently serves as an honorary professor in palliative care at Lancaster University.

In the past, she has received the International Palliative Nurse of the Year award issued by the International Journal of Palliative Nursing and other awards related to her role in innovation in healthcare.

Marie Cooper 

Project Lead for Celebrating Palliative Care Nursing

Marie is a nurse with 40 years’ experience of clinical leadership with an expertise in practice development across  a range of care settings. Having delivered change in her previous roles, she now supports others to do so. Her particular area of interest is in working with nurse leaders to develop high performance teams and practice. Such opportunities have given her a clarity about the many issues nurse leaders and those engaged in palliative care delivery face today.

From 2014 to June 2019, Marie was Practice Development Lead for Hospice UK, which enabled her to work with hospice clinical leaders and national organisations to champion the delivery of high quality, accessible palliative care.

Since June 2019, Marie works freelance and in addition to her other work she is the Project Lead at St Christopher’s Hospice for the Celebrating Palliative Care Nursing programme. This is an exciting programme which  includes developing a contemporary Model of Nursing and bringing together pioneering nurses who are shaping palliative care across the world into a vibrant community.

Celebrating End of Life and Palliative Nursing

Nursing in palliative and end of life care has a rich history and remains a central element of its delivery.

We want to shine a light on its contribution past and present, and consider its future shape so that it remains pertinent, visible and impactful.

Our pioneering nurses

Pioneering nurses from around the world

Nominations are now closed, but you can still find out how we are identifying and showcasing our pioneering nurses.

Lantern model

Lantern Model webinar series

20 January, 04 February, 24 March and 31 March 2021 – FREE

Focusing on the Lantern Model, the first new model of palliative and end of life care nursing for 20 years.

Find out more about our celebration of nursing