bluuebunny/crossref_metadata_2025 huggingface dataset:
P45 Communicating with care, in an ever increasingly complex world
Authors: Dunphy Janet
Published: October 2013

Background

Within the last decade, numerous white papers have been published to improve care for palliative care patients. The principle of effective communication is at the heart of clinical practice and professional codes. Often communication training programmes are expensive, elitist or inaccessible. It is a challenge to develop a workforce in the current climate and demands of biological and sociological developments.

The more complex healthcare becomes, the more important it becomes to keep it simple.

Aim

To improve the confidence and competence of the workforce who will communicate with palliative care patients.

Approach

Design & delivery of innovative, accessible, multi-professional education. The two day programme includes pre and post training interviews in order to provide meaningful, individual assessment and feedback. The teaching styles are both negotiated and didactic. The programme provides an opportunity for professionals to observe and participate in scenarios which demonstrate key and difficult issues involved in communication. The teaching team consists of ‘Jobbing experts’ who have undergone advanced communication skills training, specialist clinicians who share the many and various scripts that lie in their memories. Formative assessments include a reflective essay, which fits well with portfolio learning/evidence for all professionals including General practitioners.

Outcomes

The evaluations have been excellent from all professionals in all clinical arenas. Funding has been secured for further education and collaboration in education is essential to future delivery. The practical element of ensuring information follows the patient, and how to start, support and close conversations were particularly appreciated.

Application to hospice practice

Exciting innovative education can embrace key contemporary issues and develop and inspire a workforce Clinical education in the 21st Century must be in partnership and make the complex simple. Negotiated learning by ‘telling the story’ is both authentic and inspirational. Our stories are worthwhile, inspiring future practitioners– crucial.
P46 The hospice and adult education - a collaborative approach
Authors: Skilton Carolyn , Stocks Susan , Twomey C
Published: October 2013

Introduction and Aim

An initiative with a further education college, a University and local employers identified a need for formal training within end of life care within the care sector. The hospice collaborated with the college to develop an accredited Foundation degree module worth 10 credits targeted at healthcare assistants with a level 3 qualification. Knowledge and skills development and promotion of working in the care sector were key aims.

Method

Interviews and questionnaires were completed by the college with local nursing homes and care agencies to assess optimum delivery methods and fee structure. The module content was developed by the hospice which included blended learning, work shadowing and written assignments. Delivery and assessment of the module was undertaken at the hospice. The local college provided administration and study support and collaborated with the University for accreditation.

Results

Six students were recruited and successfully completed the programme instigating changes in practice within their organisation. Evaluations were positive from the students, the college and the University. Staff valued the opportunity to study with the hospice and to experience putting theory into practice, whilst gaining an accredited qualification.

Discussion

The strength of the programme was local collaboration with the hospice and college. An unexpected outcome was the recruitment of 2 Registered Nurses who used it as a stepping stone for further study. The low module recruitment numbers were disappointing but reflect issues around funding and study leave for staff working in this sector.

Conclusion

This project demonstrated a closer relationship between the hospice and the local health and social care community and promoted the hospice as resource and support for end of life care.
P47 Inter professional practice placements in a Hospice setting
Authors: Thomas Gill
Published: October 2013

Background

Palliative care patients can have complex multidimensional needs. A cohesive multidisciplinary team is vital in the provision of quality care. To achieve this, healthcare professionals need to work alongside and respect each other’s professional roles. The use of interprofessional practice placement (IPP) for under graduates has been found to increase understanding of their own role and that of their team colleagues1.

Princess Alice Hospice has been supporting IPP placements since 2008. Final year mixed professional students undergo an induction programme and work together on an in-patient palliative care unit.

Aims

To explore

how working together challenges stereotypical views and the impact of this on communication

the influence of IPP on students ability to communicate with patients and carers

if IPP equips healthcare students through reflective practice

observations of team dynamic, confidence and behaviour

Methods

The triangulation of course evaluations facilitator feedback and coordinator reflection.

Results

As professionals setting out on their career, the students acknowledged their need to appreciate and respect what each profession brings and team working. They found a hospice a challenging place in which to learn but equally learned the value of good communication and psychosocial support for their patients. Students also appreciated the need to be able to communicate effectively with other professions in order to provide patient centred multidisciplinary care.

Conclusion

If we are to produce healthcare professionals who will provide a quality health service, they need to speak together and function well as a team. IPP provides the forum for experience and emotional intelligence to be nurtured. Supportive quality healthcare is not just knowing the facts but hinges on effective communication when compassion can be expressed.

Application to hospice practice

IPP in a hospice setting is an appropriate place to support novice healthcare professionals in multidisciplinary working and quality care.
07 Right Care, Right Time, Right Place: the evolution of Hospice without Walls, from vision to reality
Authors: Milliken Joy , Lee Ann , O’Callaghan Suzy , McKegney Hilary
Published: October 2013

Background

This project charts a move from traditional inpatient hospice services, with week day specialist community services, towards the creation of a flexible, integrated ‘hospice without walls’ strategy. The steps that were taken to improve care over a five year period, including challenges faced, stepped approach taken and collaboration with other organisations to ensure the establishment of patient focused, integrated and proactive services are outlined.

Aims

Hospice without walls aimed to understand and meet the needs of patients, carers and referring health care professionals, shaping finite resources most effectively to meet changing demographic needs and provide responsive multi-disciplinary care in all settings.

Approaches used

Developments in a phased manner, incorporating staff and patient vision, improvement and change theory, with evaluation at each implemented stage. This included multi-user feedback, benchmarking service access and formal evaluation through the Marie Curie Delivering Choice Programme.

Outcomes

IT and clerical support platforms were developed to remodel services which have included a central referral centre, patient, carer and health professional advice line, seven day a week community service, staff contractual changes, redeployment of consultant staffing into wider community service and extended MDT.

Evaluation has shown improved patient experience, increased inpatient acuity levels, increased and improved community caseload management, more patients remaining in their preferred place of care, strong linkage between the extended hospice and other end of life service providers with reduced hospital admissions at end of life.

Discussion

The vision is becoming reality and staff can now see the benefits for patients and carers having a more flexible and responsive service model. Engagement with external agencies has been challenging but CCG revenue funding has now secured sustainable income streams and services.
P48 But what happens in a Hospice? Interprofessional learning in the workplace
Authors: Taplin Sue
Published: October 2013

Building on established links between the University of Leicester Medical School, the School of Social Work and LOROS the Leicestershire Hospice, an interprofessional learning module has been developed which enables social work students on the MA programme at the University of Leicester to experience two days in the life of a Hospice.

This programme, which has now been running for five years, gives social work students the opportunity to meet and learn from different members of the hospice mutidisciplinary team, through a variety of means, including group work, question and answer sessions, meeting informal carers who talk about their experiences of looking after someone at the end of life and a guided tour of the hospice. Although the programme can vary from year to year according to the availability of different members of staff, there is always a session on the role of the social worker in end-of-life care, with teaching on handling difficult situations, exploring the meaning to individuals of loss and change and managing your own emotions in this sensitive and emotional area of practice.

The sessions are generally very well evaluated: feedback comments from recent sessions include the following: “the carer was very inspiring and it was helpful to hear first-hand experience”...“very upsetting at times but have taken a lot from the experience nonetheless”...“especially enjoyed the talk regarding spirituality”

It has always proved important to discuss the sessions with the Interprofessional Learning Co-ordinator in the School of Social Work at the University to see if there have been any changes to the core teaching programme, in order that we can ensure that the sessions are covering new ground for the students and enhancing their learning about hospice care, which we believe is a life lesson for all.
P49 Willen hospice - Changing the face of mandatory training through blended learning
Authors: David Marilyn , Hart Annette
Published: October 2013

Title

Changing the face of mandatory training through blended learning.

Background

New medical director observed that staff did not demonstrate an understanding of Mental Capacity Act (MCA).

MCA provides protection for both patients and staff.

Evidence of training required for CQINS.

Aims and objectives

By linking theory to practice, enhances staff knowledge.

By using mental capacity we were promoting patient choice as central to specialist palliative care.

Key functional skills embedded into mandatory training.

Approach used

Practice Development Lead Nurse formed a multi-professional group to review how MCA training could be facilitated. The group decided to train staff who were in daily contact with patients. This included clinical and non-clinical staff from reception, housekeeping and catering.

Training was divided into two parts:

Part 1; included key facts related to the act. Staff completed an online training session. Online quiz was used to assess staffs understanding of the theory of the MCA.

Part two; Staff attended a workshop and small groups worked through different scenarios exploring how key points of the MCA works in day-to-day practice. Workshop facilitators were from different disciplines to provide breadth of insight.

Outcomes

Learning was measurable. An 80% pass mark was required to progress to part two of the training. Feedback was obtained from the workshops.

A competent hospice workforce with the MCA embedded into practice.

Staff demonstrating how to empower patients to make choices.

Innovative approach to hospice learning.

Staff feedback

“It affects everyone and all staff has a responsibility”

“Mental capacity is part of everyday care”

“We should accept people’s decisions even if we don’t agree”

“Eccentric or odd decisions are okay”

Application to Hospice Practice

Our education reflects the broadening horizons of palliative care. Developing, equipping and preparing staff for the new challenges ahead.
P50 End Of Life Care (EOLC) training for Social Care Providers in Devon
Authors: Rainbow David , Gibbons Liz , Pryor Michelle
Published: October 2013

This two year Community Pilot in end of life care training for social care providers is a collaborative venture between Devon local authority and Hospiscare.

Aims

To identify the EOLC training needs of domiciliary care workers.

To identify obstacles and inequalities in the provision of domiciliary EOLC in Devon.

Our Approach

Three towns were identified as pilot sites. Twenty-four domiciliary care agencies’s were approached and asked for information relating to:

Staff numbers/turnover

Hours of contracted EOL/palliative care

Their training needs

Barriers in accessing training

Hospiscare community teams, the Hospiscare education team, and primary care nurse managers were also interviewed.

Findings

We received a 92% response rate from Domiciliary Care Agency’s employing just over a 1000 staff.

Analysis of results indicated a need for an introductory level one day programme, In improving the carer’s knowledge, skills and confidence in EOLC.

In addition managers identified gaps in their knowledge relating to their role in EOLC. A manager level one day programme was designed around, the “6 Steps” National Programme.

To date:

Between 05/03/12 and 27/03/13, 400 care workers have attended the Introductory programme 100 senior staff have attended the Managers Programme.

97% of attendees rated the programme as very good or excellent.

The programme has been extended to the whole of Devon, and those working in residential care.

A train the trainer programme is set for release in June. Enabling senior staff to deliver the introductory programme.

Challenges:

In times of substantial service redesign building good relationships and effective communication links with social care providers is key. It is important to make a non-statutory programme attractive through course timing, content and pricing. Sustainability is dependent on facilitating others to deliver the Programme (s), and by connecting with the real concerns and systems of work in grass roots social care.
P51 Six steps + widening the access to good EOL care
Authors: Wilson Gail , Hine Paula , Talbot Judith
Published: October 2013

The Six Steps + project aimed to create a local hospice accredited EOL quality kite mark to support local health and social care providers build their knowledge, skills and confidence in delivering EOL care. The project built on previous work by the North West and includes additional assessments and workshops on dementia and learning disabilities. The project was supported by Burdett Nursing Trust and local commissioners who wanted to see improved standards of EOL care.

The Six Steps + programme has been running for the last 12 months and currently has 66 organisations and 131 individuals registered. The programme has been very successful and has delivered real service improvements eg the last post death audit (412 deaths), demonstrated that 42% of individuals who died had an Advance Care Plan in place and the number of inappropriate hospitals admissions fell from 40% to 23%.

The project truly promotes integrated working. The hospice equality mark is now published in the local authority’s online public directory. Organisations stated they wanted to have a local quality mark linked to the local hospice which families recognise. The EOL Link Forum is pivotal to service integration as well as being a vehicle for ongoing audit and monitoring end of life outcomes.

The programme does not provide any educational credit therefore Skills for Care was approached to accredit the programme. This resulted in a national mapping tool being created to map the Six Steps to the new Quality Credit Framework EOL qualifications.

The next step for the project is to create a train the trainer programme to help others implement Six Steps + in their area. Hospices cannot provide all EOL care and they have an important role in enabling providers in their communities to deliver good quality equitable EOL care for all.
P52 Quality End of Life Care for All (QELCA©)
Authors: Bryan Liz , Cooper Marie , Hayes Anita
Published: October 2013

The Department of Health has concluded that the non-specialist workforce needs to develop the necessary attitudes and skills in order to deliver consistently high quality care for people approaching the end of life and is looking for beacons of best practice in relation to practice development initiatives (DoH, 2008).

St Christopher’s Hospice has designed a training programme which not only role-models end of life care to the participants but equips and empowers them to deliver better care to patients on their return to practice. QELCA© was designed to be delivered by hospice nurses to nurses working in hospitals. Teams of acute nurse clinical managers from the same department spend 5 days based at the hospice in small groups of three or four. Using the hospice setting as a learning resource, nurses are offered a first-hand experience of observing and being alongside specialist nurses as they care for patients at the end of life. In addition to this practice experience the 5-day programme combines classroom discussion and reflection facilitated by experienced specialist palliative care nurses. The programme then continues with six months facilitated Action Learning Sets (ALS) so that action plans for self, team and organisation, formulated by the participants on the final day of their hospice experience, can be supported in practice and learning from the programme consolidated.

In partnership with St Christopher’s and Help the Hospices, the National End of Life Care Programme (NEoLCP), through the Transform Programme (NEoLCP, 2013), piloted QELCA©across 17 sites. 21 hospices were involved and a total of 137 acute nurses attended the QELCA©programme. Evaluation data were collected at four stages across the pilot timeline using mixed methods comprising, survey questionnaires, semi-structured questionnaires and focus groups. A report outlined the findings and made recommendations for the further development of the programme.
P53 Quality End of Life Care for All [QELCA] Leeds
Authors: Speight Laura , Lawman Steve
Published: October 2013

Introduction

St Gemma’s Hospice and Leeds teaching hospitals trust are involved in a national end of life care programme’s pilot. This is an education initiative called ‘Quality End of Life Care for All’ [QELCA] developed by St Christopher’s hospice.

Aims

Share expertise of Hospice care with nurses working in a variety of settings where End Of Life Care [EOLC] was being provided.

Empowerment of generalist nurses to make a difference in practice, providing EOLC.

Address with nurses issues of anxiety, fear, and lack of insight/self-awareness when providing EOLC.

Equip nurses to remain in meaningful emotional contact with patients/relatives whilst preserving professional integrity.

Prevention of emotional exhaustion and risk of ‘burn out’.

Methods

5 days placement at St Gemma’s Hospice.

Combination of facilitated classroom learning and practical experience. [IPU, Community, Day services.]

Reflect on learning and formulate action plan for priorities for change.

Action plan is supported by facilitated action learning [AL] over six sessions.

Results

Positive relationships/ networks between acute and hospice staff.

Constructive comments made regarding EOLC provision in different clinical areas.

Each QELCA candidate focusses on something to change/ implement within clinical practice based on Hospice experience.

During AL sessions, progress discussed/ action plans made. Changes occurred, with management support.

Discussion

Attendance and feedback from the course is so far very positive, candidates enjoyed being in the different environment. AL sets not well attended therefore criteria could be changed for future courses. Results from AL are positive showing that changes had been implemented and worked in practice.

Conclusion/ Future recommendations

Since the introduction of the DoH’s End of life care strategy 2008, there has been a focus on patients’ wishes at end of life especially on Preferred Place of Care, [PPC]. Courses such as QELCA, enable healthcare professionals to expand their knowledge in such a specialist area and provide such care through a process of innovation and change.
P54 Improving domiciliary end of life care through the development and evaluation of a specialised programme for domiciliary care organisations
Authors: Partington Lynne
Published: October 2013

Background/Context

Within the UK, there is a drive to reduce the number of hospital deaths thus potentially increasing end of life care in the community. However, there has not been a corresponding increase in the numbers of professional health care workers, so organisations such as domiciliary care agencies are providing more complex care and support for very ill patients in their own homes. This is an emerging role for these organisations so they need development, education and support to provide quality end of life care.

Aim

The ‘Six Steps to Success’ programme was originally developed to enable nursing homes to implement a structured organisational change to enable the delivery of the best end of life care. The programme has been adapted for use with domiciliary care agencies, involving a multi agency approach to developing the programme.

Approach used

A pilot programme with four different organisations was pioneered, with the organisations participating both as learning organisations and evaluation partners. The pilot programme was evaluated both pre and post programme using three tools: Quality Markers, Post Death Information (PDI) and a Knowledge, Skills and Confidence audit.

Outcomes

The results have established an increase in the quality of end of life care through a number of means, ranging from early identification of patients at the end of life through to improved communications with other agencies. Qualitative data has also been captured which demonstrates real life impacts and changes.

Application to Practice

Supporting domiciliary agencies to care for the increasing number of patients requiring end of life care in their own homes has often been provided by hospices and their education departments. However, education alone is often not enough to make the changes required within an organisation and this programme can influence more extensive changes through a structured and systematic approach.
P55 Palliative Care Master Class Series for GP’s
Authors: Debbie Ho , Tredgett Dr Kate , Beckhelling Jill
Published: October 2013

Introduction

A key strategic priority for the Hospice is extending the reach of its influence to more people facing the end of life. Key to this is its collaboration with GPs across its community. Following a needs assessment, an alignment with the local Education Trust (SET) was formed and a bespoke Master Class Series for GP’s developed. SET is the local coordinator and communicator of education for 170 GP members.

Aims

Year 1: 30% GPs to attend at least 1 session and 10% to attend 2 or more.

Over 3 year period for 70% GPs to attend at least 1 session and 40% to attend 2 or more.

Method

A rolling programme of three 2 hour educational sessions commenced in 2012:

‘Amitriptyline to Zomorph via Oxycodone and beyond’ - Successful pain management in palliative care

‘Managing your 1%’ - How to optimise care for your patients in the last year of life including advance care planning, DNAR, and services available to support GP’s.

‘Achieving a successful home death’ - The ‘how to’ guide for general practitioners including syringe driver conversions, just in case medications, ethical dilemmas and services available

Sessions were designed to be cumulative with concepts revisited and developed to reinforce learning. Case based and interactive, sessions provided opportunities for sharing experience, questions and reflection. Sessions ran on several occasions, and were free of charge.

Results

Sessions were evaluated using a ‘reaction’ feedback form. Two months after the course GPs were sent a structured impact assessment form on which to provide an account of one occasion when they have applied the knowledge acquired during the course. Completing part 2 of the evaluation extended CPD credits from 2 to 4 per session.

The target attendance for year 1 has been exceeded and evaluation by GPs has been excellent.
P56 Recording voices. Why is oral history important in palliative care and bereavement?
Authors: Winslow Michelle , Smith Sam , Betteley Adrienne , Noble Bill
Published: October 2013

Oral history is the recording of unique life experience; it captures and preserves voices and participants are involved in the process of producing their own life histories. An oral history service for patients has run successfully in the Sheffield Macmillan Unit for Palliative Care since 2007. In 2012, with Macmillan Cancer Support we embarked on a project to develop oral history in pilot sites in the north of England and Northern Ireland. Evaluation of these services will determine whether oral history as a service will be rolled out nationally.

Oral history complements palliative care services, it offers time to reflect, record identity and make a family record in the teller’s voice. A motivation for recording life stories can be the opportunity to create a family record. Oral history interviews are carried out by trained volunteers. Participants receive an audio CD soon after their interview and recordings are securely archived. With consent, interviews are available for research.

To understand the role of oral history in palliative care and bereavement, a further 12 month project is assessing the impact of creating an oral history. We have analysed an existing archive of 200 oral histories and sought views from participants, family and friends via semi structured interviews and a questionnaire. Results are contributing important insights into the meaning of oral history for people who make recordings, and for those who receive them.

Findings from both projects offer vital academic information to support the future shape and direction of Macmillan oral history services. We are establishing that oral history enhances patient experience of palliative care by providing opportunities to reflect and express identity in a non-medical context. Especially valuable is the existence of a voice recording for family and friends in bereavement.
P57 Developing an oral history service in a hospice
Authors: Williams Clare , Park Judith
Published: October 2013

Background/context

This poster describes the development and implementation of an oral history service at St Luke’s Hospice in Sheffield. Oral history involves an interviewer questioning and recording an interviewee. The service was modelled on a successful service at a local palliative care centre.

Aim

Patients using the hospice’s day centre and in-patient unit would be offered the opportunity to make an audio recording of their life story. Patients would receive a copy of their story on CD and extra copies would be available to their family and friends with the patient’s agreement.

Approach used

The service started with a pilot where two patients took part in an interview and then gave feedback. This was positive and so the service was launched. Initially, a member of staff who was a trained oral historian conducted the interviews, but demand for the service led to 20 volunteers being recruited to carry out the interviews. Volunteers were trained in areas such as interview technique, use of recording equipment, ethics, and working with seriously ill patients.

Outcomes

To date, 29 patients have used the service and 48 interviews have been recorded. Some patients have used the service to record final messages for family, and one has made a ‘Desert Island Discs’ style recording complete with music. Others have produced photo books to accompany recordings. The hospice is now able to offer the service to patients looked after at home by our Community nurses. It continues to receive positive feedback from patients and their relatives.

Application to hospice practice

The service’s model could be used by other hospices to set up their own oral history service. The hospice is also participating in a research study which aims to provide empirical evidence as to the benefits of oral history in palliative care.
08 Care, Compassion and Generosity: Building models of hospice care in diverse and resource poor communities
Authors: Robey Simon
Published: October 2013

Background and Content

People with palliative and end of life care needs are dying for change. Therefore “to allow people the deaths they want, end of life caremustbe radically transformed” Garber and Leadbeater (2010).

Aim

Develop models of compassionate communities allowing greater access to social and therapeutic hospice services.

Approach Used

Organisational collaborative working with the inception of a Task & Finish Group.

A questionnaire to find out what satellite services people want and where they want those services delivered.

Discussion groups in GP surgeries, community centres, carers groups and existing support groups.

Analysing the 165 returned questionnaires. The data will inform the direction of the initial pilot project.

Outcomes

Develop a community based service supported by volunteers.

Recruit, train and supervise a voluntary Empowered Living Team (ELT) to support hospice professionals in delivering care in the community through initiatives such as hand massage, physiotherapy rehabilitation programmes, supporting people to practice mindfulness techniques in their own homes with the support of a CD of relaxation techniques, guided meditations.

The satellite will also offer a space for bereavement services to establish a community presence and a greater resource for the Community Palliative Care Teams (CPCT) to refer patients and family to.

Application to Hospice care

We will demonstrate how by increasing access to hospice services through a compassionate community model more people will be able to:

Discuss preferred place and type of care they receive

Plan for their preferred place of death

Reduce the fear of accessing hospice services such as planned respite, outpatient services

Through community support decrease the amount of emergency admissions to A&E

Increase the chances of families experiencing a well-planned and a good death.

Access a greater variety of services by more partnership working.
P58 Real world hospice research: challenges and opportunities
Authors: Russell Sarah , Chadwick Sharon , Hodell Kate , Barbara Miller , Nmeth Erzsi , Taylor Ros , McLaughlin Kimberley , Woodwark Cate
Published: October 2013

Compassionate evidence-based practice, collecting data and building evidence is fundamental to hospice care. The Hospice of St Francis research strategy provides areal worldpragmatic effective approach to research evidenced based care in a medium sized hospice.

Challenges

Research governance and credibility as a small organisation

Time to reflect, discuss and put into practice evidenced based care

Being a Researcher Practitioner in the workplace

Realistic research with Universities and other research organisations.

Using research to disseminate and influence care beyond the hospice walls

Solutions and Opportunities

Research strategy, governance and register of all research, audit and service evaluation activity reported to Clinical Governance and Clinical Leads forum.

Collaborative research and governance with Institutes of Higher Education and individual researchers wanting to access our hospice as a research site.

Research Interest Forum: 2 monthly multi professional forum to discuss issues as researchers in practice and evidence based practice clinicians.

Journal Club: Quarterly forum to discuss articles of interest and relevance to practice

Think Tank: Monthly multi professional forum to share feedback from conferences and practice initiatives.

Case and Care Reflections: monthly forums reflecting on clinical care.

Clinical Nurse Specialist Continuous Professional Development Programme: 2 monthly forum delivered by Associate Specialist in palliative care.

Schwartz rounds to stimulating discussion and reflection about care

Publications and dissemination strategy.

A shared passion for real world research.

“Hospices must meet a range of challenges: collecting better data, developing a better understanding of those who needs will dominate future decades, and establishing a robust evidence base for new services” (Calanzani 2013). The Hospice of St Francis whole system approach to real world research makes a difference to care and offers possibilites for other similar sized organisations
P59 ENTER - Enabling nurses to engage in research: developing a culture of enquiry in clinical environments
Authors: Broadhurst Debra , Brown Jayne
Published: October 2013

Background

Identifying the importance of research in end of life care and fostering a culture of enquiry is a key step for healthcare providers if they are to move forward in addressing some of the challenges highlighted by the End of Life Care Strategy (DH, 2008). The ENTER project recognises the need to enhance the ability and confidence of nurses to engage in research activity and view it as an integral part of clinical practice to ensure high quality care at life’s end.

Aims

Empowerment of senior nurses to guide their teams on research processes

Establish a network of support across the region

Develop a web-based resource

Encourage clinical teams to embed a research culture in their working environments

Approach used

Seven senior nurses (band 6 and above) attended a three day workshop which comprised of a mixture of taught sessions on the research process, sharing examples of research practices, introducing the ‘human face’ of teams such as Research and Development and Ethics Committees and reveiwing currently available resources.

Outcomes

The group of nurses quickly established themselves as a support network for each other and although the project was originally time limited, a Community of Practice is being explored with support from Macmillan. Quarterly meetings have been planned for the next year with the aim of keeping the momentum going in each of the nurses clinical environments. A web based resource is being developed that will support nurses to foster a culture of enquiry, develop their own research practices and enable others to engage in research activity.

Application to hospice practice

Two nurses work specifically in hospices and are currently developing ward based projects to enhance the frontline staffs ability to participate in research. Others work in CNS roles and on wards in the acute sector and are looking at how they can further develop and encourage colleagues to become involved in the research process in some way.
P60 The experience of recruiting hospice patients, family members and health care professionals to a qualitative research study
Authors: Perry Rachel , Orlando Rosanna , Coast Joanna , Armour Kathy
Published: October 2013

Background

A single patient recruitment site hospice and local university partnership has been established for a European Research Council funded research study. It aims to assess the validity of a supportive care measure in patients receiving end of life care, people close to them (CPs) and primary healthcare professionals (HCPs). The recruitment targets are 35 patients, 20 CPs and 20 HCPs. A hospice nurse (HN) identifies participants prior to recruitment by university researchers.

Aim

To establish successful patient recruitment in a hospice new to research.

Approach Used

The HN liaised with the multidisciplinary team (MDT) to identify eligible patients and provide support; she also approached all eligible patients in her own area of practice, day services. Facilities (e.g. interview rooms) were organised for researchers to recruit and interview participants.

Outcomes

To date, 22 patients have been introduced to the study by the HN and given a patient information leaflet. 6 patient follow-ups are pending and 3 interviews have been booked. 5 patients have been recruited from Day Hospice. With permission from patients, 2 CPs and 4 HCPs have been interviewed.

Challenges affecting recruitment include environmental issues (moving hospice); ethical issues (amendment required); poor health status of patients and their cyclical involvement in daycare.

Remedies include (i) dialogue with patients and staff reducing concerns about the research nurse’s potential conflict in duties; (ii) communication reducing the reluctance of staff to “over-protect” patients and allow recruitment; (iii) extension of participants to community and IPU patients improving recruitment rates; (iv) adaptation of patient management system to administer interactions for research.

Application to Hospice Practice

Our study explored methods of recruitment of patients to research. Improvements include communication of goals with hospice colleagues and university researchers and a growing confidence in approaching patients. Recruitment experience will change practice in this and future studies.
P61 How do Hospices perceive their role in the current Health Care Environment? A View from the Top
Authors: Linehan Gaberielle
Published: October 2013

A qualitative study using a critical review of the literature and semi structured interviews with a small sample of Hospice Chief Executives explored their perceptions of the impact and effect of the national policy agenda on their organisation and hospice care in England.

The findings from the research indicate that hospice services continue to be influenced by their history and legacy. The ‘arrogance’ of hospice organisations viewing themselves as ‘set apart’ and in charge of their own destiny is set to be challenged by the new world of commissioning. Operating outside the National Health Service but dependent on partial funding to provide end of life care services to patients, they are trying to be innovative, challenge existing cultural norms, engage a wider populace and redefine the parameters of what they can offer while maintaining ‘independence’.

The national drive to support care in the community is refocusing hospice care into the community with outreach support and engagement with other provider services, rather than inpatient provision. This integrated approach poses conceptual difficulty for hospice staff.

The balancing of the historic context with external demands of an ever changing health care landscape focused the CEOs interviewed to discuss the change in identity of hospice from a ‘building’, to a community outreach service with access to specialist resources- a significant turning point. Increased visibility impacted on how hospice was viewed by the wider healthcare economy, rather than, ‘do gooding’ little charities, but as part of whole service provision. The struggle between independence and integration is a tension for hospice particularly related to outcomes and demonstrating the unique role of palliative and EoLC.

The study also highlighted how policy has influenced hospice to reframe as small business units taking a commercial view of their service configuration which all CEOs viewed as a challenge.
P62 Managing change in challenging times
Authors: Parkes Nicola
Published: October 2013

Introduction

As hospices face challenges, there is a need to balance the economic cost and the demands placed upon the services we provide, leading to new ways of working and changes within the organisation.

Change can be difficult and can often be seen as being “done to” as opposed to being “part of “the process.

Aims

The aim was to find a simple tool to use within teams to engage them in the change process and to illicit issues that where pertinent to them in the future development of the service, and to identify areas in which efficiencies could be made.

Method

We devised a simple tool which enabled staff to state what they wanted to “Stop, Start and Keep” within the services they provided.

Discussion

This tool was used in an “away day” style environment, the whole team where engaged in the process and the use of the tool elicited themes from the team in relation to the questions asked, and enabled the team to develop a plan for future developments and discuss key areas of concern.

There was an over arching theme related to maintaining quality which underpinned all such developments and a desire to ensure the quality of care patients received was not adversely affected. The use of the tool acted as a bench mark to where we are now and where we wanted to be, and enables the team to review progress, its impact and celebrate success.

Conclusion

The use of this tool enabled the team to feel engaged and contribute to the development of new ideas and ways of working in challenging times. The process is fluid and enables teams the opportunity to revisit and review and address issues and developments.
P63 Fit for the future…. Empowering an organisation through strategy delivery
Authors: Neely Roslyn
Published: October 2013

Background

The organisation has created a visionary strategy to position them as an influential, leading paediatric palliative care provider in Scotland, the UK and beyond. In creating this, there was an opportunity to truly engage with all those involved in the organisation; reflecting visions and hopes for the future through collaboration and consultation. Children, young people and families using the services; trustees, staff and volunteers were consulted through a series of focus groups, externally facilitated to maximise objectivity. This was the starting point for a dynamic ongoing strategic planning process to ensure the organisation is in a strong position to meet the changing needs of babies, children, young people and their families in a changing political and financial landscape.

Method

A number of sessions were held to explore what the future might hold for the organisation over the next ten years. This has included exploring the changing needs of the children, young people and families who will use the service; considering new ways of delivering care, skill mix review, the hospice environment, income and expenditure projections, the political landscape, policy and partnership working with statutory and voluntary organisations.

Outcomes

Two years on and the resulting strategic plan is delivering measurable outcomes which are positively impacting on the care and support being given to families. The organisation has also influenced the development of a Framework for the Delivery of Palliative Care for Children and Young People (2013). Staff, volunteers and service-users are motivated, guided and empowered by the plan. The plan has raised awareness of the organisation within health and local authority networks, resulting in increased referrals and funding.
P64 Financial planning for uncertainty
Authors: Ryan Alison , Keep Sheena
Published: October 2013

Introduction

In common with other independent hospices, Weldmar Hospicecare Trust faces considerable uncertainty over the size and nature of future income. This paper describes the financial modelling which allows us to make sound financial plans despite that uncertainty.

Aims

To create an understanding of our complex finances so we can focus on the most impactful income generation, control expenditure and use our Balance Sheet strength to create a future where we are no longer dependent on any one source of income.

Approach used

analysis of expenditure and income steams by type and cost centre (80 + budget lines).

Application of differential growth/cost pressure assumptions to each line on an Excel model which allows assumptions to be changed producing different results.

Outcomes

this command of our finances has allowed us to:

make budget adjustments in the context of securing long term strength,

to manage sudden unforeseen changes (such as 90% failure of legacy income in one year) without making damaging short term cuts,

to distribute resources to staff via pay in a way which is sustainable and transparent and affordable,

to invest in income raising possibilities even while running planned £1million deficits.

Our model shows that in four years’ time we will have generated sufficient surplus to minimise the impact of loss or reduction of NHS income should competitive tendering produce such a result. It provides a clear guide to managers on how service development can, or cannot, be afforded.

Application to hospice practice

Hospices have complex and unpredictable income streams – NHS, trading, legacies, donations, investment and relatively fixed costs – largely staffing. Without a long term view, short term reactions to financial hiatus can lead to unnecessary curtailment of services, loss of opportunity and lowered morale. This model minimises those problems.
P65 Developing a culture of good leadership and management
Authors: Kelly Lynn , Greenhalgh Stephen
Published: October 2013

Background

Little interaction between managers across different directorates

No sense of ‘team’ amongst managers

Lack of consistent approach and varying degrees of management experience

Aim

Set standard for leadership & management amongst middle managers

Raise confidence of managers in dealing with staff performance

Develop team working across departments

Enable managers to contribute to and deliver the Hospice 5 year plan

Approach Used

Researched suitable providers, developed partnership with Lancashire Teaching Hospitals NHS Foundation Trust Leadership and Organisational Development Team

Training Needs Analysis - rated confidence across different leadership and management areas and then prioritised for development.

Key components:

7.5 days of group training

Leadership & Management Situational Judgement Test

Self-assessment against NHS Leadership Framework

1–2-1 with advisor

Group project work / presentation

Impact evaluation (due June 2013)

ILM Level 5 qualification

Outcomes

‘The difference in the first Management Team meeting following the course was tangible and exciting. Colleagues were more confident, open and prepared to actively challenge and contribute. I came away greatly encouraged by the credible difference which entirely justifies the investment that we made into establishing an Education Team that can sharpen our business effectiveness at every level just at a time when we need it most!’–Stephen Greenhalgh, CEO

In my directorate, confidence in their own ability springs to mind, they have been committed to the appraisal scheme and cascading from the business plan to performance plans”–Lorraine Charlesworth, Director of Income Generation

“My attendance on the Management course assisted me to reflect on my Management style and enabled me to increase delegation to my staff. It also improved my working relationship with my line Manager and other Managers on the programme.” -Cheryl Scott, FamilySupportTeam Manager

“One of the most practically useful courses I’ve ever been on - combined theoretical and applied knowledge made the content easily transferable to the workplace. I have already implemented many changes within my team."Katie Russell-Paddison, HeadofAdmin

Key Operating Principles

Developing leadership for a new era

Developing the hospice workforce