bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fundraising matters: communication skills training for non-clinical hospice staff
Authors: Russell Sarah , Jo Fernandes , Doughty Jess 
Published: September 2011

IntroductionCommunication skills training is traditionally directed towards clinicians. At St Francis we identified a need to support our fundraising staff in their confidence in their daily conversations. These conversations often included distressed bereaved relatives.AimsTo increase the communication skills and confidence of fundraising staff in the community and public setting.MethodsA ½ day interactive workshop using videoed role play with a Connected actor, facilitator and communication skills trainer. The role play was based upon scenarios provided by the fundraisers prior to the workshop. They completed a pre and post workshop confidence questionnaire and a follow-up one 3 months later.Results11 fundraising staff attended.Scenarios revolved around distressed relatives (expected and unexpected), and questions about care and dying in the context of fundraising for the hospice. Pre and post course questionnaires showed an increase in confidence in challenging conversations. The workshop was highly evaluated.Discussion▶Fundraising staff do not necessarily have the day to day experience of clinical conversations to draw upon, but bereaved families have the same expectations of them as clinical staff in terms of conveying empathy and compassion.▶There is a parallel agenda of empathy versus receiving a donation, eliciting a “story” or discussing a fundraising event.▶The communication challenges are similar to clinicians and the power of silence is a similar take home message.▶The advantages of using videoed role play include giving participants the chance to see and discuss things they might have missed first time around.ConclusionFundraising staff have similar communication training motivation as clinical staff. The workshop was a worthwhile education event, albeit seeming too short – in the future it would be beneficial to mix more non-clinical staff to give a wider breadth of discussion and experience – this is planned for later in 2011.
Ultrasound scanning in a hospice setting – does it really alter patient pathways?
Authors: Nemeth Erzsi , Cate Woodwark , Sharon Chadwick 
Published: September 2011

IntroductionBedside ultrasound scanning in a hospice setting is a new initiative. Historically, the hospice has referred patients to the local hospital, requiring a 20 min journey accompanied by relatives or nurse and ambulance crew.A review of patient experience, revealed that this transfer was often distressing and futile.A donation allowed an Ultrasound Scanner to be purchased. Three hospice doctors attended accredited training with specific tuition in ascites detection and diagnostic bladder scanning.Now all patients with possible ascites are scanned prior to drainage.Patients with bladder problems such as anuria, oliguria, haematuria and bladder pain are also scanned.AimsTo assess the clinical benefits of ultrasound scanning within our hospice. To aid clinical diagnosis, enhance experience and improve outcomes.MethodsA retrospective case note study of all ultrasound procedures carried out within the inpatient unit and day hospice at St Francis. The clinical indication for each scan is noted. Scan findings and the clinical outcome is noted.OutcomesPatients were scanned for the following clinical indications:Possible ascites.Bladder problems.Cholestatic jaundiceTraining purposes.Ascites scan assessmentPositive ascites scan= 7Negative ascites scan= 11Number of resulting paracentesis= 7Bladder scan = 8Abnormal finding noted= 2Normal bladder noted= 6Complications= 0DiscussionBedside scans prevent distressing transfer to hospital and unnecessary procedures when time is short. Patients feel this imaging is neither intrusive nor distressing. Future developments include video linking for instant radiological opinion, a new probe to assess for deep vein thrombosis and scans at home.ConclusionWe have limitations with our brief training and have therefore developed links with the radiology team for feedback and support. Bedside ultrasounds are non-invasive and well tolerated, aiding diagnosis, safety and outcomes for patients with suspected ascites or bladder problems.
Psychological contracts of hospice nurses
Authors: Jones Audrey , Sambrook Sally 
Published: September 2011

AimThe aim of this research was to examine the context of psychological contracts of hospice nurses, to explore what they might contain, and also to establish how the contracts might be influenced, with a specific exploration of what may breach the contracts.BackgroundThe psychological contract is a cognitive perceptual model, that is, the contract is in the minds of the employees, and consists of the reciprocated obligations, expectations and contributions that exist between the employer and employee.MethodologyThe study involved in-depth interviews following a modified constructivist grounded theory approach, using the model proposed by Charmaz (2006). Using a purposeful sample, 10 nurses from four hospices across North Wales and the North West participated in the study.FindingsFour main categories emerged within this study: type of psychological contract, how the contracts are formed, the contents and the breaches. The Psychological contracts held by hospice nurses appear to be complex, and analysis found potential multidimensional, multi-level and multi-agent contracting. The contents contained generic items, that is, items that may be seen with any employee in any organisation, however, there were idiosyncratic elements, these included detail of care, relieving distressing symptoms, recognising individual employees in the workplace, quality of care, time to care, and acceptance of reduced terms and conditions. Some of the more serious breaches/violations perceived by the nurses included: lack of access to education, inequitable treatment among staff, and some nurses felt undervalued with very little recognition of their contribution. Hospices should take these findings into account when considering the employer–employee relationship; failure to do so may lead to negative consequences for the organisation, for example reduced loyalty to the organisation, a desire to leave or a negative changes in the attitude or behaviour of staff.
An innovative approach to creating a hospice at home team
Authors: Whitmore Sally 
Published: September 2011

IntroductionThis project uses an innovative approach to creating a new Hospice at Home team. The team aims to deliver a service that can respond quickly with a flexible and adaptable approach to meeting the needs of people who are in the last week of their lives and who wish to remain at, or return, home. It also incorporates the needs of families and carers. The service does not offer aspects of care which require a Registered Nurse and therefore works very closely with Primary Healthcare teams.The team comprises of a Registered Nurse Team Co-ordinator, Staff Nurse and 14 whole time equivalent Healthcare Assistants.AimsTo keep decision making as close to the patient's situation as possible in order to deliver a fast, flexible and appropriate response to rapidly changing needs and situations.To create a service that delivers not just personal care but which uses a creative approach to supporting people who wish to remain at home at the end of their lives.MethodDeveloping the assessment and decision making skills of the Healthcare Assistants who deliver the care. This empowers them to assess, plan, deliver and evaluate patient's care needs directly.Flexible approach to needs assessment looking at all aspects of patient's, and their families', requirements. Not just focusing on personal care of the patient but what the whole family situation requires in order for the person to remain at home. For example, house work, shopping, meal preparation, etc.Utilising the Hospice volunteer base to meet needs that cannot be delivered by the Heath Care Assistants. For example, garden maintenance and simple household maintenance.EvaluationProject will be evaluated through the use of families and carer's satisfaction surveys and audit of the number of patient's who achieve their preferred place of death.
Introducing an end of life education programme in a mental health unit for the elderly
Authors: Cooke Caroline , Dixon Rachael , Broadhurst Deborah 
Published: September 2011

IntroductionMore people are dying with dementia. In recognition of this the National Dementia Strategy (2009) focuses on the provision of care for their end of life needs. Following an audit of patients referred from a mental health unit for the elderly to a hospital palliative care team, an end of life education programme was developed.AimsThe aims of the programme were to help staff recognise impending death, promote competence and confidence in symptom management and communication around death and dying. Funding was obtained for 1 year from April 2010 through end of life care monies, and existing resources pooled to supplement the proposal.MethodsThe main elements of the programme were the introduction of the Gold Standards Framework (GSF), the Liverpool Care Pathway (LCP), 3-day communication courses and specialist palliative care placements at the local hospice. There was a lead for each element. A programme of ‘bite- sized teaching sessions’ and workshops was designed and coordinated by the Practice Development Team which incorporated the ‘wants and needs’ of the unit. Teaching was adapted for all staff and multiple teaching styles used. The LCP was modified as syringe drivers were not used on the unit. 14 staff were nominated from the centre to become End of Life Care Advisors with varying levels of expertise and representation from all the wards. The advisors received priority teaching and their role was to disseminate information, support others, maintain and update resource folders on the wards.ResultsEvaluations of every aspect of the project are showing positive increases in confidence and competence.ConclusionThe project has been a catalyst for multi-disciplinary learning. The flexibility of teaching styles is innovative and potentially transferable to other settings.
Understanding life-threatening illness – exploring individual experiences of living with cancer
Authors: Taplin Sue 
Published: September 2011

“A few decades ago, cancer was a topic shrouded in social silence. Today…stories of cancer illness have found a place in our culture. The emergence of this discourse means that those who become ill with cancer can expect some degree of acceptance and understanding. The same cannot be said, however, about all those who survive cancer. Despite the interest that is often generated by stories of survival…there still remain unresolved tensions for those who have lived beyond the acute phase of extreme experience.”This study, which originates from my practice as a social worker in the field of palliative care and formed part of my doctoral studies, sought to uncover and explore some of these ‘unresolved tensions’ in the lives of those who are experiencing cancer as a long-term condition.I aimed in this study to give individuals who were living ‘with and beyond cancer’ the opportunity to talk about their experiences, both during the treatment phase and beyond, in order to explore the meaning of this experience, and therefore to increase the body of public and professional knowledge in this field.I conducted semi-structured interviews with 18 people who were living with cancer as a long-term condition, simultaneously analysing these narratives using a grounded theory approach.My findings from this study were that, overwhelmingly, individuals experienced cancer as life-changing, not only in terms of their own personal development and attitudes to life, but also in how they related to the people around them, including health and social care professionals.While recognising the individual nature of each person's experience, the findings of my study have provided an invaluable insight into the psychosocial needs of people living with cancer, which I aim to disseminate to professionals and policymakers, to increase understanding and enhance aftercare in cancer ‘survivorship’.
A service development to educate healthcare assistants about physical rehabilitation in an in-patient hospice unit
Authors: Atkinson Rachel , Jennings Sally 
Published: September 2011

Rehabilitation is a specialty in its own right, with a powerful emphasis on inter-professional working to help patients improve their independence. Due to medical advances people with life limiting illnesses are living longer and even though they will not be cured rehabilitation has a vital role in improving their lives over the time they have ahead. This concept may seem strange in the context of palliative care but the goals of rehabilitation and palliative care are the same in helping a person to become as active and independent as possible.The aim of this service development is to educate Healthcare Assistants (HCAs) to promote a physical rehabilitation approach in a 31 bedded in-patient hospice unit that focuses on independence.A series of education and practice interventions were developed. They were implemented through group tutorials, display boards and clinical facilitation, with an evaluation of all of these strategies.It has shown that the HCAs who participated found that their knowledge and confidence around the techniques increased. The impact of this service development however was difficult to measure due to poor uptake and evaluation of the educative strategies employed.This service development has demonstrated that the education of HCAs has the potential to improve the rehabilitation of palliative care patients but that this needs to be delivered in a way that ‘fits around’ the daily work of HCAs and has to be recognised as an important part in the culture of the hospice.Those who participated in the service development evaluated it positively, feeling that they were in the position to carry out the techniques and practice with the patients. A further outcome of the development is to consider different ways to provide the classroom teaching and clinical facilitation within the organisation to allow greater participation from staff
Advanced liver disease in a homeless population
Authors: Davis Sarah , Greenish Wendy , Kennedy Peter , Jones Louise 
Published: September 2011

IntroductionResidents at St Mungo's with alcohol related liver disease frequently experience sudden deaths. There were no prognostic indicators to alert staff that a resident may be nearing the end of life and thus opportunities for possible interventions were not being recognised.AimTo identify whether residents who have advanced alcohol related liver disease show any clinical symptoms or behaviours as they are approaching the end of life.Method(s)Examined the summaries of all reported deaths at St Mungo's (Jan 2009>April 2010).Reviewed 27 sets of case notes of residents with a history of alcohol abuse and possible liver diseaseHeld three focus group meetings with staffResultsA combination of physical, psychological and behavioural symptoms occurred in residents with liver disease as they approached the end of life. Staff did not plan with residents for end of life care and palliative care interventions were minimal. Deaths were often sudden and the majority of end of life care was provided by secondary care.DiscussionStaff need training to alert them to key changes in residents' condition, so they can anticipate deterioration and death and offer earlier support. This would provide staff with opportunities to discuss preferences for care and palliative interventions with residents. Bereavement support would benefit both staff and residents particularly following a sudden death and encourage discussions on care at the end of life.ConclusionDifficult to predict when a person with liver failure is in the dying phase. However there are increasing physical, psychological and behavioural symptoms which indicate that a resident is in the advanced stages of liver disease. Earlier interventions by staff would enhance the dying experience of residents.
Advanced care planning for children
Authors: Miller Michael 
Published: September 2011

IntroductionAdvanced care plans form many functions from acting as a vehicle for discussions to acting as a guide for provision of care in emergencies. Is it possible to satisfy these different demands?MethodWith the support of a grant from the DH as part of the £30 million funding, a full day meeting was held to develop a Care Plan for children in Yorkshire and Humber. Parent's views were considered in the morning and provider views in the afternoon. Examples of existing care plans were shown to participants and parents spoke about the difficulty in making decisions. The relationship between PICU and palliative care was discussed.ResultsThe following outcomes were agreed:▶Care plans should be written for and held by parents▶Parents do not need to sign the care plans▶Care plans should include a guide to management of predicted symptoms▶There should be an agreed format of:▶Brief description of present condition▶List of contacts;▶Brief description of management of symptoms, fits, chest infections etc▶Management of slow decline▶Management of sudden decline▶Back page containing ‘tick box’ details of levels of resuscitation levels felt▶To be appropriate for the child.▶The meeting recognised that as the future is never known precisely, care plans need a degree of flexibility to be acceptable to all.▶Ideally there should be a mechanism to ensure care plans are reviewed and up to date.▶It was recognised that the initiation of such discussions is difficult and training would be helpful.▶A small leaflet for parents explaining what care plans are is to be developed.ConclusionThe development of recognisable care plans for child will help end of life care for children as well as supporting their families.
Establishing a sustainable children's palliative care network in Yorkshire and Humber
Authors: Miller Michael , Box Debbie 
Published: September 2011

IntroductionA Children's Palliative Care Network was established in Yorkshire in 2005 after the appointment of a Consultant in Paediatric Palliative Medicine. A strategy group helped to share information and created on a local pathway of care. One difficulty was establishing links with the commissioning process. Another was that it was not certain that the network fulfilled the needs of the local providers or supported families effectively. A third was the change to Regional Boundaries so that four more PCT's and two other Children's Hospices were included in the network.The possibility of funding from the DH grant to Children's Palliative Care allowed us to explore these issues.MethodA Doctor with a background in Palliative care was appointed to undertake a review of the network and contact GP's, nursing services and hospital services throughout the region.OutcomeThere was overwhelming support for a network. This should be supportive and informative as well as organising and linking with commissioning. It is recognised that some formal administrative support is necessary for the success of the network. There needs to be rotation of members to enable succession planning.An Action plan of achievable projects has been developed.There need to be better links with other Children's networks, including the PICU, Neonatal and neurology networks.ConclusionA strong network is an important aspect of ensuring equity of palliative care around the region. Implementing the recommendations of this report will help ensure its viability.
Partnerships with young people in palliative care
Authors: Connelly Val 
Published: September 2011

IntroductionThis Project is an attempt to diversify the hospice volunteer base using volunteers from ages 16–25 years in a specifically designed programme. Managed within the constraints of the National Curriculum the programme is an opportunity for volunteers interested in a Health and Social Care career to experience palliative care.AimThe main aim of the project is to promote the principles of palliative care provision to a wider audience within the community. The programme is keen to encourage young people from a variety of diverse backgrounds to volunteer and to create new intergenerational links with patients and their families while enhancing a CV or improving job prospects.MethodA number of new volunteer roles and a Volunteer Induction Programme were developed. Young volunteers were recruited through schools, colleges and various agencies working in the community. Placements have been facilitated using established volunteers as mentors and were monitored and supported on an ongoing basis.ResultsPatients have benefited enormously from the involvement of young people with opportunities to learn new skills from volunteers some with additional needs. The link with a younger generation has offered a forum for sharing stories and experiences.Volunteers have been able to access places at university, gain employment and build their skill base citing their experience of palliative care in a hospice setting.DiscussionThe project has been monitored throughout and evaluated on a yearly basis measuring personal outcomes and benefits to patients, staff and families. It has exceeded expectations in terms of interest in the scheme and commitment of volunteers.ConclusionYoung people from a wide variety of backgrounds have made a worthwhile contribution to the quality of life of patients. They will take their experiences and spread the hospice message in the future.
Biometric access drug cabinets for personal controlled drugs in hospices
Authors: Griffiths Matt , Bunn Ray 
Published: September 2011

The secure storage of controlled drugs (CDs) is defined in the Misuse of Drugs (Safe Custody) Regulations 1973. The 2007 Amendment specified its application to care homes which includes hospices. Compliant storage involves use of receptacles compliant with British Standard 2881.The Home Office has confirmed that there are no exemptions to these safe custody storage requirements in care homes (personal communication 2011) although some approved local discretion is allowed in NHS trusts.Spontaneous breakthrough cancer pain (BCP) is severe with a rapid onset and relatively short duration in most patients requiring prompt treatment with potent opioid analgesics. Treatment is with immediate release oral morphine or oxycodone or the newer faster acting oral transmucosal and nasal fentanyl preparations. Except oral morphine solution 10 mg/5 ml, these preparations must comply with safe custody CD regulations storage.Healthcare professionals frequently cite treatment delay due to central retrieval of CDs, often distant from the patient, key locating, unlocking cupboards and completing administration audit. This results in patients in pain longer.By employing self administration of medicines policies plus the development of a BS2881 compliant near-patient biometric storage cabinet, we have set out to empower patients in their own BCP treatment and reduce treatment delays. There is no legal requirement to witness CD self-administration.Biometric cabinets are keyless with secure access by means of a thumbprint. IT cabinet link provides access authorisation and an audit trail. Lock-out times are programmable to govern frequency of access and repeat access. There are different cabinets for central ward or individual bed side location.Pilot sites are being recruited for a trial and evaluation of the development. Organisationally agreed Standard Operating Procedures will govern the entire process in line with official requirements.The outcomes of the pilot will be evaluated and published.Development in association with Flynn Pharma.