SUPPORTING PALLIATIVE CARE IN CARE HOMES ‘Fife’s

Report
FIFE
SUPPORTING PALLIATIVE CARE IN CARE HOMES
‘Fife’s Educational Care Home Project’
Phase 1 and 2
Jan Aimer
Project Lead
Acting Head of Practice and Professional
Development CHP’S Fife/
Macmillan Cancer and Palliative Care Educator
Aim of the Project
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That General Palliative Care
practice in care homes is
enhanced and developed by an
educational strategy and
consistent programme of
knowledge and skills.
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That acquired and enhanced
skills and knowledge in general
palliative care are implemented
into practice.
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That Care Homes have formal
links to specialist palliative care
resources enabling advice:
support and planning of care
management for residents and
carers.
Why we started the project
• 5% >65years reside in care
homes
• 1 in 5 deaths takes place in
this setting.
• 52% of all care homes are for
older people (908) (Scottish
Care Commission , 2004).
• Forecast population of
elderly will continue to rise
well into the 21st Century.
• Care homes for older people
have the highest incidences
of failing to meet regulations
(Scottish Care Commission,
2004).
• Good quality of end of life
care must be recognised as
a basic human right (WHO,
2002).
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Department of Health Improving
Care Improving Lives (2005).
Supporting People with Long
Term Conditions (2005)
Joined up thinking Joined up
Care (2006)
The Future Care of Older People
in Scotland (Scottish Executive
2006)
Making Good Care Better (2006)
National Practice Statements
for General Palliative Care in
adult Care Homes in Scotland.
Sparra Scottish Patients at Risk
of
Re-Admission
and
Admission (June 2006)
Better Health Better Care (2008).
Living and Dying Well (2008).
Practice Educator’s Role in
the Project
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Education
Clinical
Consultancy
Leadership
Research
Audit
Palliative Care Education Facilitator’s
Role in the Project
‘The facilitators role is
concerned with enabling the
development of reflective
learning by helping to identify
learner needs, guide group
processes, encourage critical
thinking, and assess the
achievement of learning goals’
Harvey et al, 2002 )
Libby and Heather’s Role is to Enable
cultural changes & challenging current ways
of working, utilizing reflection as a learning
tool.
What is it about…….
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Role model / Effective relationships
Supportive learning environment
Ownership / Realistic Outcomes
Professionalism / Trust / Respect
Good Communication / Clear direction
Innovation / Motivation
Up-to-date knowledge
Team building/ People / Friendship
Recognition of others skills & abilities
Having vision, enthusiasm & commitment
Receptive to new ideas
Projects Strategic Objectives
Appraisals
TNA
Service
Development
Critical
Incidents
Patients
expectations
feedback
complaints
Education
External
HCI Provided
Identify care homes interested in Project.
Roles people play
Competencies
Changes to take place
Identification of Training/
Development Needs
Clearly articulated and expressed in
measurable terms and
objectives/outcomes
Training Plans Agreed
Education=
Trust/in-House
programmes
Tool Used in Project
Preferred Method Of
Delivery
• Train the Trainers
Model
• ‘Key Champions’ in
Palliative Care from
each care home
Macmillan Foundations in
Palliative Care
A programme of Facilitated
Learning for Care-home Staff
Challenges
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C
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Collaboration/Communication
Healthcare Professionals
Achieving our project goals
Leadership
Learning Environment
Educational Opportunities
Nursing practice/clinical focus
Government Issues
Evaluation
Challenges in Practice
Resources Staffing Levels
/financial implications
Annual Leave
Sickness
Mandatory Training
overwhelming
Shift Patterns
Family Commitments
Attendance in own time
Recruitment and retention
problems
Resistance to change
Low motivation/low morale
Undervalued
Recommendations from First Cohort to
resolve some of the barriers faced
• Involve the Manager more in tightening the
Inclusion criteria for key champion so that
we do not loose them initially
• Deliver the programme over 3.5.days
Participants Comments
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Registered Nurse
Understanding models of grief and
bereavement have given me a better
view of how the client and those related
to the client and also those who care for
the client may feel or react. The models
of pain and the breakthrough of pain
were most helpful and I will integrate
these into my work as a nurse as a more
effective strategy of dealing with pain.
Also discussing the nature of
relationships between the dying patient,
staff and family has made me think more
on the emotional side of my job which is
something I think most nurses tend to
become quite clinical about. This course
has made me think more about how
much more comfortable we can make
the final months, hours, days or years
for the dying client and how effective a
more structured team orientated
approach can be.”
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Support Worker
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“Since doing the palliative care
course it has opened my eyes to
many things. It has made me
understand the needs of the elderly
a lot better, also levels of pain and
how you can help them in many
ways medically and emotionally.
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Helping relatives through their grief
and sometimes a cuddle say’s
much more than words. Helping
each other as well, as grief can
affect people in many different
ways.”
ADVANTAGES OF HAVING INPUT
FROM THE EDUCATION TEAM
• Offers opportunities to gain knowledge and skills to both
registered and non-registered staff with the aim to influence
clinical practice and improve patient care.
• Palliative care needs tailored to each individual care homes
• Professional development and continuing learning opportunities
• Consultancy basis
• Educational remit
• Key Link person for Care Homes for practice development
opportunities in NHS Fife
Benefits for the Care Home
and the Older Person
VISION FOR THE FUTURE
Living and Dying Well (2008)
Phase 2
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Improve People’s Quality of Life with end of life issues.
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Address the inequality of care of the older person
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Adopt an innovative approach to education and develop good
communication channels across the boundaries of NHS and the
Private Sector.
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Empower staff to become competent, reliable and trustworthy people
in dealing with palliative care and end of life issues.
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Collaborative and shared working.
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Continued evaluation

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