bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue viability in the hospice setting: joint working and blended learning to develop and demonstrate competent practice
Authors: Myers Laura , Hailer Valerie
Published: September 2011

Evidence suggests that 35% of people with life-limiting disease develop wounds towards the end of life and managing wounds in this population can be complex and challenging. The majority of the wounds, 50%, are decubitus ulcers and this is attributed to the “failure” of the skin and underlying tissues in the last days of life; acknowledgement of this enables better wound management, leading to enhanced patient comfort. A knowledge questionnaire on wound care demonstrated poor understanding among many of the nurses.

Recently adopted hospice palliative care competencies require that healthcare assistants (HCAs) have knowledge of basic wound care and the ability to carry out simple dressings, while registered nurses (RNs) must be able to assess and manage complex wounds. With a team of over 50 nurses, our goal is to ensure consistency in the standard of wound care as well as a measure of that consistency.

A 2-h classroom session has been delivered by hospice link nurses and a lecturer practitioner and includes tissue viability theory, holistic impact of wounds in palliative care and wound management, including aseptic non-touch technique (ANTT). All members of the inpatient unit nursing team are expected to attend a session as part of a compulsory training day. Additionally, they must complete a workbook on wound management that includes competency assessment, undertaken by an RN trained in teaching and assessing. In addition, all RNs must complete an online wound care management course and provide verification of the results.

The outcome of this project is that wound management in the hospice is delivered to a consistent evidence-based standard, demonstrated by competent practice. Further, the link nurses have been supported to source appropriate evidence and share their tissue viability knowledge with the wider team.
Knowing yourself – understanding others – how an awareness of personality type can help with change
Authors: Pearce Sarah , Nash Sue
Published: September 2011

Introduction

As an intrinsic part of a major service redesign and implementation project, members of St Catherine's Community Team undertook a planned development programme focusing on personal and team development.

The driver for this development programme was the implementation of a new Community Care Model to meet the Department of Health's End of Care Strategy that a ‘palliative care service should be available 24 h a day and 7 days a week in order to make it possible for those who want to die at home to do so.’

The context of the development programme was, therefore, one of high change and challenge that saw 31 new members of staff joining the Community Nursing Teams including 2 new community team leaders.

Part of this programme was a workshop on the theory of Personality Type. Extensive research over many years into personality types has shown that there are many personality related indicators that can impact upon the way in which people interact with one another.

Discussion

This presentation will highlight how the programme impacted on the teams who undertook the programme. By focusing on personality type with a reference to change we were able to explore why some people find change exhilarating while others find it overwhelming. These differences may be the cause of misunderstanding and miscommunication.

Some of the things participants fed back were:-

▶

‘appreciating individual approaches to the same situation, neither being right or wrong – learning from each other’,

▶

‘Looking at personality type and how I modify approach to patients, also how I try to support colleagues’.

Attention in the presentation will be given to how the programme impacted on the teams who undertook the programme and the impact this in turn had on patient care during a time of change.
Developing competencies for end of life care in care homes
Authors: Lansdell John , Mahoney Mary
Published: September 2011

Introduction

End of life care is provided by generalists, often in the care home sector. Inadequate training and support can lead to suboptimal end of life care in care homes. The development of measureable competencies supported by education is essential to improve care delivery. This relies on working together as hospice competencies are not directly transferrable to the care home environment.

Aim

To improve end of life care in care homes in a sustainable way through the development of core competencies supported by education.

Method

This pilot project involved hospice staff working collaboratively with four local care homes. Year one developed a competency framework within each individual home informed by focus groups. Year two analysed competencies and identified key issues for inclusion in a 5-day training programme, tailored to address these issues in the broader context of palliative care. 15 care home staff attended the course, feeding back learning in their respective homes. The impact of the course on end of life care delivery was considered. Year three incorporated the competencies into existing staff appraisal systems. Senior care home staff were trained to assess competence, promoting sustainability of the competency work.

Results

Engaging care home staff in the development of competencies and identification of educational need is essential to ensure a tailored, relevant programme. Effective measurement of competence is achieved through appropriate assessment linked to staff appraisal. Opportunities for sharing learning throughout the process should be identified at an early stage.

Discussion and conclusions

Developing a competency framework demonstrates an ongoing commitment to the development of staff and ultimately care home services, when supported by a tailored package of education. Working together is fundamental to success.
The butterfly project
Authors: Brownlee Debbie , Cook Audra , Bunce Alison , Rae Elaine , McEnhill Linda
Published: September 2011

A new and innovative 5 year lottery funded service which involves collaborative working and shared policies across three independent Hospices in NHS Greater Glasgow and Clyde. It offers information, support and help to families with children and young people aged 2–18 years who are facing challenging times in coping with life limiting illness and bereavement, recognising that dealing with grief at an early age can prevent worsening emotional and mental health issues in later life. (Every Child Matters 2004).

In the first year we successfully ran 2 groups; 5 teenagers then 5 children and worked individually with 47 others. They were offered a choice of counselling, play therapy or a mixture of both, at school, home or Hospice and were seen one to one using adapted models of established intervention (Winston's Wish and Solution Focused Care) or within a small age appropriate group. They were encouraged to talk about their feelings through interaction, play or arts and crafts.

We have established training, trained volunteers and plan to train teachers to assist in setting up groups supporting bereaved young people.

Results

Initial evaluation of our teenage group identified that the young people appreciated being treated as equals, and the programme was adapted to extend the sessions following their feedback. We identified that getting children and young people together helped reduce the sense of isolation and helped them talk and learn about the grief process. The hospices have also agreed to extend bereavement support to other family members.

Future plans

A third group has just been completed and a fourth planned. We have also begun researching the needs of very young bereaved children aged 2–5 years highlighting the needs of this age group and the lack of awareness and training within nurseries. A website is to be established.
Support for coping with issues of loss in schools (SCILS)
Authors: Archer Nikki , Walker Jo
Published: September 2011

Working in collaboration with local schools we developed an innovative programme of support to enable staff and pupils to cope with issues around loss and bereavement.

We aimed to use our experience of working with young people living with grief to enable schools to be better prepared for a death in the school community and to normalise death and dying.

Working in partnership with the schools we proposed a four tier triangle of service provision. The services were funded jointly by community money earmarked for ‘vulnerable children’ and investment from the hospice.

We provided opportunities for staff, pupils and parents to learn about loss as part of life, through a varied programme of workshops and assemblies.

We delivered training and resources which introduced staff to the bereavement pathway for schools, this equipped staff to respond appropriately to pupils experiencing loss and explored how they could offer proactive bereavement support.

A strategy for identifying vulnerable children who required specialist bereavement support when grief became more complex was developed.

The project was rolled out to 37 schools, representing over 11 000 pupils. Evaluations were received from 316 staff. 100% understood the aims of the bereavement pathway and felt they had the necessary skills to follow the policy, 80% felt they might require support to work with a bereaved pupil but all understood how to access this. 10 young people were referred for further bereavement support.

This programme, not only met the needs which schools had identified but widened access to hospice care and facilitated community engagement opening a dialogue around death and dying in line with the government's EOLC strategy.

We have been approached by numerous schools who were not part of the original project, and are currently working with them to develop a plan to roll the project throughout our catchment.
Pooling resources to drive quality; the evolution of the National Audit Tools Group (NATG)
Authors: Rodgers Carol , Flanagan Pauline , Thompson Andrew
Published: September 2011

Introduction

Recognising the importance of audit in improving quality and the limited resources available in many hospices, Help the Hospices formed the NATG in 2004.

Aim

To pool expertise from across the hospice movement to develop a core range of hospice-specific audit tools that are available to all.

Method

Initial membership comprised a small multi-professional team of hospice personnel with a specific interest in audit and quality. To establish an effective methodology, they started by developing audit tools relating to core areas of treatment and care.

As more professionals volunteered to participate, the group expanded and subgroups were formed to develop new ranges of tools. The active involvement of experts from particular fields was sought to inform and strengthen this process.

To encourage their widespread use, tools are designed to be user-friendly, and are trialled rigorously before release. Feedback from trials and subsequent usage has led to progressive improvements in design.

Results

Representatives from 29 hospices are members of the group/subgroups, and over 50 hospices have trialled new tools. 22 audit tools have been released to date and downloads from Help the Hospices website have averaged over 400 per month.

Evolution of the group is ongoing with seven subgroups currently developing another 13 audit tools, including new families of tools for community services and children's hospices.

Discussion

The commitment of a broad range of personnel from different backgrounds, supported by their local hospices, has been key to the successful evolution of the NATG.

Membership of subgroups or attendance at workshops provides excellent training opportunities.

Possible future projects include e-learning, benchmarking and validation of locally-generated tools.

Conclusion

The NATG has developed a highly effective model for pooling expertise to drive quality improvement by facilitating audit.
Demonstrate the quality of your bereavement service
Authors: Jane Elliott
Published: September 2011

Introduction

Two bereavement audit tools have been written to enable Hospices to collect crucial data to evidence high quality service provision based on national standards.

Aims

To enable hospices to evidence the standard of their bereavement work using high quality audit tools.

Methods

Two audit tools were written by a collaborative group of bereavement service co-ordinators and audit professionals from different hospices. The tools fit together but look at different aspects of bereavement: the first enables audit of a bereavement service and the second audits bereavement care. It was an interesting challenge/struggle for the authors to understand these two different aspects of bereavement service provision when developing the tools.

Discussion

Within current health policy the tools enable hospices to look at how they might provide evidence to address the QIPP agenda and to be commissioned for services.

In anticipation of GP commissioners looking for good value, having audit data available provides tangible evidence of the work of the bereavement service.

Although bereavement care is acknowledged within Palliative care definitions it is only recently that the Department Of Health have recognised this – publication of ‘When A Patient Dies’ and the End Of Life Care Strategy, but there are no quality markers published within initial EOLC quality markers.

The tools are referenced to all available National standards, have been piloted and reviewed assuring users of their quality. This quality has been recognised by other, non-hospice, organisations who have expressed interest in using the tools, as the key principles are transferrable.

Conclusion

We encourage Hospices who do not have a bereavement service, as well as those who do, to use the tools. It will enable them to demonstrate the quality of their bereavement service and may assist them in identifying gaps and plan service developments.
Children's hospices services in Germany – a study on the quality of support
Authors: Schwarzenberg Eileen , Jennessen Sven , Bungenstock Astrid
Published: September 2011

The first Children's Hospice in Germany was founded 1998. At present, there are 10 Children's Hospices which offer short breaks and 73 ambulant Children's Hospice services which provide support at the family's home.

The aim of the first main study in the field of Children's Hospice services in Germany was to find out if Children's Hospices services offer the families the support they need, and how they evaluate the quality of the offers. Another aim was the development of guidelines for “Good Children's Hospice services”.

In a first step in the mixed methods design 10 families who use the offers of Children's Hospice services were interviewed. Based on the results of this survey, a questionnaire was developed, and answered by 172 families.

The findings showed that the offers of Children's Hospice services in Germany match the needs of families. 93% of the parents are ‘very satisfied’ or ‘satisfied’ with the support of their child or adolescent during a short break. 75% of the families are ‘very satisfied’ or ‘satisfied’ with the ambulant Children's Hospice service. However, there need to be made improvements in a number of areas, such as bereavement services, siblings support, cultural diversity, gender care and public relations.

The results of the study illustrate that the aim to offer support for the families already reaches them. The findings may help to establish Children's Hospice services in Germany and thereby help to secure its future funding. The guidelines for “Good Children's Hospice services” are currently being discussed in many Children's Hospices services. They will be evaluated in a follow-up study.
Needs of the Charedi Orthodox Jewish Community in Stamford Hill for specialist palliative care
Authors: Jennings Rebecca
Published: September 2011

Introduction

The Charedi Community located in Stamford Hill represent the third largest concentration of strictly Orthodox Jews in the world, with a total population of over 18 000 members. To date the Charedi Community have had little involvement with Hospice. Little is known about the needs of Charedi people with advanced, progressive illness and what factors underpin their lack of uptake of specialist palliative care services.

Method

A multi-dimensional Needs Assessment was undertaken, drawing upon Epidemiological, Corporate and Comparative approaches to consider the need as widely as possible. This included a number of focus groups within the Charedi community.

Results

There is a small but significant need for specialist palliative care services within the Charedi community (up to 44 new patient referrals per year), with specific areas of need identified in relation to specialist nursing and medical input, therapies rehabilitation and bereavement support. These needs would be best met by the Community Palliative Care Team to fulfil the Charedi community's preference to receive care at home.

Discussion

The Charedi community have a need for greater awareness of palliative care services and support available to patients with advanced disease. Charedi care providers are receptive to engage with joint working and training opportunities offered by the Hospice.

Additionally, there is a need for Hospices to better understand core Jewish values to ensure culturally sensitive and appropriate care for Jewish patients. Attention to the great value Judaism places on life, implications for provision and withdrawal of interventions and methods of conveying information to allow for maintenance of hope is needed.

Conclusion

The Charedi Jewish community in Stamford Hill have an unmet need for Specialist Palliative care. The community is open to work in closer partnership with the Hospice to support Charedi patients with advanced, progressive illness.
A redesign of hospice social care services
Authors: Thomas Martin , Widlake Jutta
Published: September 2011

Introduction

The social care resource of the typical hospice has developed in steps over a period of time, as and when funding becomes available. As a consequence of this the structures of different teams and departments are varied and often follow no clear model. This was the situation faced at the hospice of this study team, who identified that this carried with it certain risks, both to service users and to the organisation. In order to address those risks, changes were needed, and a stronger structure developed for the social care provision of the hospice.

Aims

To carry out a systematic review and design of a hospice social care service.

Methods

A focus group carried out a literature search and multidisciplinary planning sessions. A business plan was developed and put into place.

Results

Social care was restructured around a 4 level model. The qualified social worker to social care assistant ratio was altered to reflect the need for clear assessment and delegation, in order thet the risks were addressed.

Discussion

Hospice social care brings with it a high level of risk. This risk can be lessened if the appropriate structure is in place ensuring that patient's needs are at the focus of care. The 4 level model provides a structure to rebuild the service, and a clarity to ensure that the appropriate competencies, knowledge and skills are in place to deliver care safely.

Conclusion

The use of the 4 level model to restructure and redesign the hospice's social care service ensured a patient needs focus. The structure also allowed clear identification of the knowledge and skills needed across the health and social care workforce for safe patient assessment and care.
Promoting end of life care across care homes: the role of the specialist palliative care nurse
Authors: Bird Elaine
Published: September 2011

In 2008 the NAO undertook a retrospective study for all deaths in Sheffield during October 2007. 58% of these deaths occurred in hospital despite 40% having no medical reason to be there. 19% of deaths occurred in care homes.

Using the Gold Standard diagnostic framework 42% died from frailty, 30% from cancer, 20% chronic disease and 8% were unexpected. The study supported that best practice palliative care, advanced care planning and preferred priorities of care had not been identified or achieved.

The benefits of having a clinical specialist palliative care nurse specifically designated to care homes is to understand the working environment of individual care homes. The role enhances the delivery of palliative care education that reflects the requirements of individual homes and promotes informal education through discussing face to face findings following the specialist assessment of individual residents.

The poster provides evidence for encouraging best practice palliative care for all care home residents, irrespective of diagnosis. It identifies changing patterns in referral and discharges from specialist palliative care services as robust supportive end of life care plans are instigated through discussion with individual residents, their families, care home staff and the wider MDT team. Proposed future developments will also be identified.
Therapeutic hand massage: empowering carers to care
Authors: Talbot Judith , Evans Val
Published: September 2011

Evidence suggests there is a great need to support social care home staff in End of Life Care (EOL). Staff may lack confidence in their ability to provide EOL care. The Local Hospice has worked with social care homes, running a successful Liverpool Care Pathway training programme. Participants identified other EOL training needs and the focus was directed to the use of therapeutic hand massage, a recognised effective method of providing pain control and comfort for those clients with dementia and distress.

Aim

To enable care home staff to use therapeutic touch and non-pharmacological management for end of life symptoms and aid communication with the residents in their care.

Methodology

20 care homes and 23 staff were involved in the pilot. Places were free and staff were recruited at NVQ 3 level and above. The programme was delivered in two workshops, held a month apart. The first day focused on practical hand massage techniques, the theory of therapeutic touch and some guidance on how to run workshops in their own care setting. The second workshop required a case study presentation demonstrating what impact hand massage has had on EOL clients.

Evaluation

Participant evaluation of this ‘train the trainer’ approach demonstrated an increased confidence to provide the training to other care home staff and positive effects on the residents were also reported, in terms of reduced agitation and more engagement in communication. There were also reported benefits for relatives of the residents, as they could perform hand massage when visiting. This made them feel that they were ‘doing something’ for their loved ones.

Due to the positive outcome of the pilot programme this workshop is now offered as a regular educational programme. The next programme is already oversubscribed and there is a growing demand for the programme.
Developing in house clinical supervision for all
Authors: Rushton David
Published: September 2011

Introduction

Senior Hospice Clinicians used to receive clinical supervision externally. This meant that learning from external sessions wasn't always shared. And more importantly most other staff didn't receive any clinical supervision or even knew what is was.

Aims

To address this, a group of in-house staff were trained and supported to facilitate small groups of nurses and rehabilitation staff.

Methods

Externally provided training looked at:

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Understanding what was clinical supervision

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Functions of supervision

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The process model

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Negotiating a group supervision contract

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Challenges, benefits and common dilemmas

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Practice facilitating groups

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Identifying transferrable skills

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Back-up literature.

Results

Attendance at groups could be difficult. Some staff took more responsibility for attending; others had not previously encountered the concept in their professional lives and therefore saw it as an extra unwanted duty.

Two annual surveys were undertaken. These elicited a range of responses, from the highly committed and favourable to those who had not found it easy to incorporate this mode of learning and support into their work.

By the second survey responses were still varied but supervision was definitely now valued and there was no wish to make further changes.

Discussion

The experience highlighted:

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The need to overcome cultural obstacles where staff had no prior experience of clinical supervision

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The importance of terminology – the groups are now called ‘reflective practice’, expressing the greater professional curiosity supervisees can bring to their work

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The importance of now extending supervision systems to volunteers who have direct roles with patients and families.
The end of life care strategy: where next?
Authors: Gale Barbara
Published: September 2011

Introduction

This research used discourse analysis to examine the End of Life Care Strategy (EOLCS).

Aim

To uncover dominant, marginal and missing discourses and discuss the implications of these. This research was based on the concept that language does not provide a neutral description of the world.

Results

The analysis identified dominant medical discourses that included ‘not talking’ and defining a time called ‘end of life’. Professional involvement was seen to be crucial in all aspects of end of life care, which seemed to be in line with a government's approach to influence all life processes from pregnancy, birth and death. There were no discourses identified that related to user involvement, compassion or health promotion.

Although there was great emphasis on encouraging people to state their preferences and choices it was purely in relation to their care preferences and place of death. People were described passively and there was no mention of people being encouraged to be in control of the own conditions as there is in other long term conditions. By positioning people in this way the discourses in the EOLCS may be perpetuating the idea that those at the end of their lives are different to everyone else and need to be treated differently.

Discussion and conclusion

The research concludes and suggests that there are already alternatives to a medical discourse by using a health promotion model of palliative care. Dying happens to everyone and does not mean they need to be treated differently. Hospice should consider whether the EOLCS is truly the document that guides the way forward or not. The Demos report offers an alternative to the EOLCS and new challenges for hospices.
Triage
Authors: Wythe Jane
Published: September 2011

A hospice first response

Introduction

The project focused on introducing a clinical nurse specialist as the triage lead for a hospice service offering day care, inpatient and community care. Referrals had previously been managed by an administrator with clinical support.

Aims

To ensure timely responses to patient and family needs and ensure the organisation's response to referrals was appropriate

Provide meaningful support to professional and lay referrers with a consistent response.

Methods

The triage specialist led a rigorous evaluation of the referral process while supportively challenging local referral culture; funding for the triage post was secured from a Big Lottery Fund grant.

▶

Clinical Nurse Specialist and administrative support developed robust systems and processes

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Education strategies were employed with local referrers using team and one to one approaches

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Professional and lay carer opinion was actively sought through the use of questionnaires.

Results

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The triage approach became a catalyst for a new organisational strategy 2011, because of the identified unmet need

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Local regional professionals reported a consistency and transparency in clinical decision-making by the hospice

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Hospice staff expressed an increased confidence in first assessment allocation which has indirectly upheld the distinct contributions of each discipline

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Average response time to referral reduced to from 1 to 2 days to under 1 day.

Discussion and conclusion

An experienced practitioner as triage lead has enabled further exploration of allocation of first assessment to skill mix within disciplines including healthcare assistants. Examination of triage identified that it was more of a first response with a telephone assessment.

The processes established has quickly become embedded in the Hospice's practice culture and remains a source of pride and comfort during periods of rising public and professional expectation of hospice services.
Brief encounters: the scope of a single music therapy session in adult hospice work
Authors: Lings Jane
Published: September 2011

Music therapy provision in adult palliative care is still relatively uncommon in the UK, and the scope of music therapy practice is often unfamiliar to the multi-professional team. Although longer-term work is viable with many hospice patients, it is not always possible. A single music therapy session might be all that is achievable before a patient leaves the hospice, or deteriorates and dies. This paper is based on my clinical experience of 10 years working as music therapist in a hospice. It aims to illuminate the value and potential for music therapy within the constraints of very short-term work.

Using case vignettes, three different approaches will be introduced and discussed: receptive work, improvisation and songwriting. Receptive approaches focus on active listening using live or recorded music. This can facilitate reminiscence, relaxation and /or visualisation. Improvisation offers interaction, a musical dialogue. Using simple instruments and supported by the therapist's music, there is the possibility for creativity, new and transformative experience, and the expression of feelings. Songwriting brings together words and music with the potential to create something lasting. It provides the opportunity to articulate and to understand feelings, and often patients report unexpected pleasure and pride in their achievement. A recorded song might have a purpose and life of its own, such as being given or left as a gift, placed in a memory box or played at the funeral.

In my experience music's unique qualities help establish an atmosphere where a trusting therapeutic relationship can develop very quickly. Its flexibility and adaptability enables work at depth even in very short-term work, which can meet the both holistic needs of the patient and their loved ones.

Recorded patient songs will be used to illustrate this presentation.
Dynamic review and development of an orientation and mentorship program for hospice CNSs
Authors: Attwood Elizabeth
Published: September 2011

Aims

To improve the orientation and mentorship of Hospice Community Nurse Specialists.

To accelerate skills development and delivery of quality specialist palliative care.

Background

Rosseret al(2004) describe role transition from Generalist to Specialist Nurse as complex and stressful. McCreaddie (2001) using grounded theory approach showed that orientation and mentorship are helpful when adopting the Nurse Specialist role.

Methods

Literature review

Focus group. CNSs made suggestions for future orientation and mentorship programs

Audit. 18 CNSs reviewed the current Hospice CNS orientation and mentorship program

Formative evaluation through semi informal interviews and summative evaluation by questionnaire at 6/12 post recruitment, after changes to program.

Results

The audit findings were categorised according to % of positive statements:

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≥75% supernumerary period and available learning resources

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40–75% clinical visits and personal objectives

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≤ 40% formal mentorship and role expectations.

The suggestions from the focus group and research evidence were concordant with the audit findings and were used as evidence for change.

Implementation of a competency-based orientation and mentorship guide.

The guide includes competences reflecting National Occupational Standards for end of life care. It includes self and peer assessment, caseload management, guidance for mentors and local information. The guide serves as a teaching tool and benchmark for standards of practice.

Ongoing evaluation

In the summative evaluation post the change, CNSs positively rate mentorship and are clear about their role. The formative evaluation shows they feel supported and are more confident in their role.

Conclusion

Changes to the program are dynamic in response to ongoing evaluation and change which will be followed by re-audit in the future. In time, it is hoped that a well prepared work force will promote innovation in specialist palliative care.
Evaluating the impact of nurse independent prescribing within a weekend CNS service
Authors: Webb Wendy
Published: September 2011

Introduction

Nurse independent prescribing (NIP) is a development of the nursing role that has been long awaited by both the Royal College of Nursing and the Nursing and Midwifery Council and is now widely celebrated. However, it has been met with varied responses among cancer and palliative care CNSs. In fact, while the Department of Health's End of Life Care Strategy encourages nurses to pioneer new ways of working in order to provide rapid access to specialist palliative care advice and assessment, the literature reveals a reluctance within CNS teams to embrace this development of the role, to undertake prescribing training and, once qualified, to practice as prescribers.

Aims

This study evaluates the impact of nurse independent prescribing within a weekend CNS service at one hospice.

Methods

A 6 month audit of prescribing activity data is presented in this study. In addition to this, specific case studies are used to highlight the benefits of CNS nurse prescribing in the out of hours (OOH) period.

Results

This study demonstrates that the skills of nurse prescribing offer an effective way for the CNS to be more responsive to the changing and unpredictable needs of palliative patients, especially in the OOH period, enabling timely and appropriate symptom control in a single, seamless consultation.

Discussion

Discussion surrounds the challenges of OOH access to drugs, off-label prescribing, CPD, mentorship, professional support and communication.

Conclusion

This paper celebrates role expansion and innovations in practice, demonstrates the value of NIP in the OOH period, challenges and encourages other CNS teams to consider OOH NIP initiatives, and offers specific guidance and recommendations for developing and sustaining such a service.
Debating forum – what do you think?
Authors: Nuckhir Charlotte , Stocks Susan
Published: September 2011

Introduction

Those working with dying people have described feeling like they are ‘walking a legal and ethical tightrope’. This is largely due to the fact that decision making is often complex and emotive. Considering decisions from an ethical viewpoint can help make sense of dilemmas often faced within palliative care. Evidence also shows that individuals are more motivated and gain more job satisfaction when they feel appreciated and valued and listened to.

Debate is one formal method of interactive discussion which both encourages the exploration of issues from an ethical viewpoint and provides the opportunity for individuals to have their voices heard.

Aim

To provide a structured forum for members of the organisation to:

▶

Debate relevant, current and/or ethical issues

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Encourage understanding and appreciation of each others views in a safe environment

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Reflect on practice in regard to decision making.

Method

Bi monthly hour long forums are held. Topics and speakers are coordinated by the learning and development manager who also chairs the sessions. The forum is open to all staff, volunteers and external healthcare partners.

Results

Topics to date include:

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Assisted suicide –should the law be changed?

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Should we always tell the truth?

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Does having a faith matter in the hospice environment?

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Generalist versus specialist within palliative care.

Up to 35 people have attended including the Chief executive, directors, managers, clinicians, support staff fundraisers and volunteers. Feedback has been overwhelmingly positive.

Conclusion

The results suggest the introduction of structured debate is regarded as an exciting, valuable opportunity to listen, be listened to, reflect and develop. The impact has been positive, thought provoking, unifying and motivating for all who have taken part suggesting that the aims have been achieved.
Developing core competencies for staff and using them in the hospice environment to define behaviour
Authors: Moorey Alison , Bourne Jacqui
Published: September 2011

The development of core competencies to be used across the Hospice was prompted by an identified need to clarify the expectations of everyone working for the organisation.

In 2009 it was identified that competencies used in interviewing were not actively being used or understood and a project plan was developed.

A project lead was identified and seven members of staff from various departments joined the group, along with HR Consultants who volunteered part of their time so the cost was minimised.

The group initially defined and agreed seven competencies along with short descriptors:

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People Care

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Motivation and Initiative

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Change and Adaptability

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Planning and Organisation

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Analysis and Decision Making Ability

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Coaching and Teamwork

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Leadership.

The next task of the group was to agree descriptions of behaviours for all three competencies at three levels. This work involved consulting with staff to ensure that the wording used was meaningful and relevant to the staff.

All job descriptions were reviewed to ensure that they specified the competencies required and at which level. Following this a question bank was developed which provides a range of interview questions for each of the competencies at each level; line managers were trained in interview techniques so they were able to judge the evidence from the answers.

All applicants for employment are sent a copy of the core competencies so that expectations of all employees are made clear from the outset. The final stage of the project is to include the core competencies in performance review documentation and this is currently being tested.

This project has been wide ranging and has enabled the Hospice to clarify expectations of staff at all levels as well as giving line managers the tools to effectively praise good performance as well as managing poor performance.
Food for thought!
Authors: Bacon Ruth
Published: September 2011

Introduction

The hospice recognised the importance of good nutrition for palliative care patients but there was a lack of research in relation to their nutritional needs. As a result, in 2008, it established a nutritional working party.

Aims

▶

Increase the diet and nutritional needs knowledge of clinical staff

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Improve recording of individual dietary needs

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Give patients permission to eat what they choose and develop the food choices available to them

▶

Review of the availability and benefit of nutritional supplements

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Improved the quality of nutritional advice across all departments.

Method

To form a multi professional group who has representation from the nursing and medical teams, community dietician, catering department and volunteers. The group meets at 6 weekly intervals and its purpose is to:

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Educate all staff members on the provision of nutritional care for patients with life limiting illness

▶

Create new initiatives to enhance the provision of nutritional care

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Develop more collaborative working with multi professionals in nutritional care.

Results

The group has initiated:

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Nutritional theme weeks

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Alcoholic drinks menu

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Increased variety of food choices

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Education board and resources folder

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Training sessions in relation to food choices and appropriate nutritional supplements.

Conclusion

There has been positive verbal feedback from staff members and service users. The working group has demonstrated excellent collaborative working leading to a greater understanding of nutritional care and has highlighted the need for future innovations, such as nutritional competencies, and the development of nutritional assessments.

The hospice is participating in the Help the Hospices patient survey the results of which will inform this work. It has also participated in a Help the Hospices pilot to develop a nutritional assessment tool.
Improving psychosocial care: the way forward
Authors: Clarke Karen , Wass Tricia
Published: September 2011

Introduction

A review identified the need to:

▶

Create a strategy for delivering psychosocial care

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Develop psychosocial skills

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Provide counselling.

Aim

Undertake a pilot to

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Allow time and give value to the psychological well-being of patients/families

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Enable staff to recognise emotional distress and empower them to act upon it

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Enable difficult conversations to be handled confidently and sensitively.

Method

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Recruited six, part time counsellors

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Reflective sessions to share experiences

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Introduction of 10 Psychosocial Care Champions

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Questionnaire to establish a baseline

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Training in providing psychosocial care

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Clinical supervision – supervisor and supervisee training, developing documentation

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Innovative training of volunteers and non-clinical staff in psychosocial skills.

Results

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Psychosocial Champions – encourage informal, regular conversations about psychosocial needs

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Counsellors provided a safe space to express and explore patients' sense of loss

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“Hospice brand” brought familiarity enabling counsellors to develop therapeutic relationships in short timeframe

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Questionnaire (42% response) revealed:

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Time and capacity – an ongoing challenge

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Respondents were able to:

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Identify psychological/social needs and own limitations

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Develop trusting, non-judgemental relationships with patients/carers.

Discussion

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Insufficient capacity to improve psychosocial data – next phase

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Questionnaire will be repeated to assess the progress made.

Conclusion

This pilot phase has identified the need to have a full time resource driving psychosocial care who will:

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Ensure specialist and general psychosocial support for patients/families is available at all times

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Continue to develop the MDT

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Create a culture where people feel confident to try new skills

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Ongoing training and development

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Develop a tool kit based on the findings from the questionnaire

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Maintain the integration of bereavement services

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Increase external liaison with other services

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Explore the possibility of income generation.
Reaching out to schools: a vocational experience programme for school students
Authors: Stocks Susan
Published: September 2011

Introduction

Traditionally, the hospice has offered vocational placements to students over the age of 16 who are undergoing health and social care training at College or University. There had been many requests from schools for placements for the under 16's who have a ‘work experience’ week as part of their Year 10 studies.

Aim

To work with local secondary schools to enable their students (aged 15) to participate in worthwhile and productive vocational experience within the hospice.

Method

Students who choose vocational experience within the hospice are invited with their parents to discuss the work of the hospice, have a tour and discuss a programme for the week.

Following the meeting an information pack is sent to the student which includes objectives, the programme, and information around confidentiality.

A typical programme would include:

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Working on the In patient unit, and with Hospice @ Home

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Working in Day Therapy, attending breathing clinics and joining in activities, such as art therapy

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Observing the complementary therapists

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Meeting with a Counsellor and the Chaplain.

On day one there is an induction with a Mentor who the student will meet with each day to discuss their learning experience.

On completion of the placement, Evaluation forms are completed by the student and the organisation, and a Certificate of Attendance and Achievement issued.

Results

Very positive feedback has been received from the schools, students and hospice staff and volunteers, with students showing an increased interest in volunteering.

Conclusion

This new programme has:

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Raised the profile of the hospice within the local school community

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Led the hospice to reflect on the lower age limit for volunteering

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Enabled the hospice to make further links with schools in relation to the curriculum.
Nursing workforce modelling in UK hospices – recommendations for future planning
Authors: Roberts Dai , Hurst Keith
Published: September 2011

Context

United Kingdom (UK) hospice ward staffing has remained unchallenged for two decades while specialist palliative care provision has changed markedly, bringing new workforce demands. Yet, there has been little evidence to inform hospice workforce structures, which aspire to deliver the highest quality holistic care to specialist palliative care patients and their carers. Workforce planning and development has been described as ensuring that sufficient (but not over-sufficient) and appropriately qualified staff are available, in the right place and at the right time to match service demand. Key elements that influence nurse staffing levels include ward occupancy, patient dependency, nursing activity, workload and staff mix.

Method

An evaluation method adapted from a UK-wide nursing workforce planning and development study was used to assess nursing activity in a patient (and carer) dependency context within 13 hospices (16 wards).

Findings

A dataset, which profiles and benchmarks hospice ward patient dependency, nursing workload, staff activity, ward establishments, quality and costs in 16 hospice wards has been created. There are marked differences between hospices across the UK within each of the workforce modelling elements. Hospice ward staff face heavier workloads; wards are better staffed and more expensive to run, but deliver higher-quality care than their NHS counterparts. Structural and procedural differences between hospice wards in the study are hard to explain.

Conclusions and recommendations

The hospice dataset provides evidence-based recommendations to inform specialist palliative care nursing workforce modelling, including deciding future nursing workforce size and mix based on rising workloads. The new dataset is suitable for use in all UK hospice wards.