bluuebunny/crossref_metadata_2025_split huggingface dataset:
Those who can, do. Those who can do more, volunteer.
Authors: Turnbull Ian , Doran Dawn 
Published: September 2011

Motivations, Challenges and RewardsIntroductionHospice volunteers have been credited with bringing a unique human dimension to an otherwise clinical setting and are considered to be core members of interdisciplinary palliative care teams.This study looks at volunteers who have a mainly patient contact role within the Hospice.Over 100 000 volunteers are currently within the hospice movement – contributing more than 18 million hours of work to their services each year yet they remain a largely under-researched group.Aims▶This study hopes to give this under researched group the opportunity to share their experiences with the Hospice and prospective volunteers▶To understand the motivating factors for patient contact volunteers▶To explore the experiences of those volunteers▶To understand the profile of the volunteers, to aid future recruitment of new volunteers and target training and support.Methods▶Qualitative study of the experiences of patient contact volunteers using semi structured interviews▶Ethics approval granted from Edge Hill University Ethics committee and the Integrated Hospice Governance Group▶Interpretative Phenomenological Analysis was used.Results▶8 semi structured interviews conducted▶Volunteers are drawn to hospice work to make a difference▶Primary motivation is to discover more about themselves and others▶Relatively few negative challenges encountered▶Any negatives are cancelled out by the positive benefits gained▶Capacity for personal growth is strengthened▶Generic knowledge of symptoms would benefit the support they give.Conclusions▶Volunteering is a two way process▶The ‘Psychological Contract’ between the Hospice and its volunteers is very healthy▶The organisation has good role deployment, shared values and good level's of communication.Further developments▶Volunteer inductions adapted to meet the training needs of individuals (eg, boundaries of care, consideration of first aid training for drivers)▶Development of individual ‘Psychological Contracts’ between the hospice and volunteers.
Souls and shadows live
Authors: Heath Bob 
Published: September 2011

Souls and Shadows is a charitable foundation inspired and founded by Caspar Olsen through his songwriting work with Bob Heath, a music therapist based at Sir Michael Sobell House Hospice in Oxford.Caspar died in 2006 and the Foundation began work shortly afterwards. Since its inception the foundation has supported many music therapists who work in palliative care by funding training in creative songwriting, the acquisition of recording equipment and in some cases the direct funding to hospices to pay for therapists services. As a result it has had an extremely positive impact on the creative output of many patients at the end of their lives.It is now proposed that some of this work created by patients is to be presented as a live musical work entitled Souls and Shadows Live. The first concert will be held at The North Wall Theatre in Oxford on April 19th 2011. All of the proceeds will be donated to the Sobell House Hospice Charity.The production programme takes each writer's work and express its unique emotional message using both live and pre recorded audio-visual musical performance. Simple choreographed scenes from each song are staged to re-enforce the emotion and narrative of each piece with a recurring musical theme linking the song cycle to each individual patients journey and story.It is hoped that Souls and Shadows Live will not only promote the use of creative music interventions in palliative and bereavement care but will also create opportunities for networking and skills development in the wider musical arena.This will be an oral presentation which will include pre-recorded and live music from the planned programme.
Closed bereavement therapy group: a new way forward?
Authors: Sutcliffe Olwen , Procter Sally , Holden Anne , Seed Jessica 
Published: September 2011

IntroductionThe End of Life Care Strategy recognises that care does not stop at the point of death but continues through to bereavement. A Closed Bereavement Therapy Group (CBTG) was developed by a hospice and a charity supporting people with cancer.Aims and methodsThe aim of the project was to provide an alternative choice to traditional bereavement support by offering a therapy group that nobody else could join once the programme had started. It offered a safe sharing environment to enable people to understand and explore their grief. Bereaved carers known to the specialist palliative care team (SPCT) were invited to attend over 5 months, of the 142 people contacted, 62 responded and 27 of those expressed a wish to take part. 2 groups were set up and the carers attended for 7 sessions. Feedback was collected at the end of each session.ResultsIt was found that a time and number limited CBTG appears to be an effective way of working with bereaved people. The fall out rate from the programme was low and the evaluations showed that it had met the groups' expectations. One of the most important aspects was their sharing of experiences, as this assisted in normalising the grief process and enabled them to develop coping strategies and increase their resilience which reduced dependency on other professionals. Using expressive arts was particularly effective in that it facilitated access to deeper emotions in an unthreatening way with requests for further sessions. This new innovative project provided an inclusive equitable service across the region for families known to the SPCT. The closed group provides a different type of environment enabling deeper therapeutic work to take place compared to traditional bereavement support groups. It is user led and cost effective and its template can be replicated and adapted to suit other services needs.
Does an inpatient hospice have a role in medical student CP1 training?
Authors: Glascott Rachel , Gray Mandy-Jayne , Swanwick Maelie 
Published: September 2011

BackgroundThe GMC document ‘Tomorrows Doctors’ recognises that End of Life care is an important skill for all doctors to learn. Evidence shows that newly qualified doctors feel unprepared to care for patients at the end of life. The Palliative Medicine Department at Derby Hospitals NHS Foundation Trust has long been involved in CP2 training with a focus on holistic care, interdisciplinary learning and symptom management. It became part of the CP1 course in 2004. The CP1 placements aim to give a good grounding in clinical skills and team working. Reservations have been expressed about the impact on patients and the appropriateness of exposing 3rd year medical students to end of life care so early in their training.AimTo ascertain whether a CP1 Placement in an in-patient palliative care unit: Has a role in medical student education preparing ‘Tomorrows Doctors’as a scholar/scientist, practitioner and professional. Is an appropriate environment for junior medical students. Is acceptable to our patients.MethodsA questionnaire is given to each medical student on CP1 placement in Palliative Medicine during 2011 to complete at the end of their week. In addition we are giving patients who have been seen by a medical student a short questionnaire to ascertain their views on medical student interactions.ResultsIn a previous departmental audit and in other research, patients have reported favourably about their experience of being involved with medical student teaching. We hope that analysis of the 2011 responses will add to the evidence that the hospice setting is an important learning opportunity for students but also a positive experience for patients. A more detailed evaluation of results will be presented.
Development of national audit tools for hospice community services
Authors: Newton Claire , Fisher Simon , Flanagan Pauline 
Published: September 2011

IntroductionThe remit of the National Audit Tools Group (NATG) is to produce a set of core audit tools to enable hospices to evidence compliance with national standards of care, irrespective of their processes or documentation systems. Quality impact analysis, feedback from workshops, training days and consultation with hospices identified a need for audit tools specific to community services.AimsDevelopment of a comprehensive family of audit tools to measure quality of hospice care in the community against validated standards.MethodsA NATG subgroup was formed drawing on expertise from different community areas, in particular Community Nurse Specialist and Hospice at Home. To inform the development and structure of the tools, it critically reviewed: statutory and regulatory requirements, relevant national standards and guidelines, range and scope of community services provided by hospices. Because of the size and complexity of the project, topics were grouped to reflect different community areas, each requiring specialist input and ensuring multi professional collaboration.ResultsFive audit tools under development are: Referral Management, Initial Assessment, Follow-up Assessment, Assessment Domains, Cooperation with Other Providers. Further tools are planned to include: Advance Care Planning, Communication, Confidentiality, Education and Training, Rapid Response, Documentation and Recording.DiscussionThe diversity of community service provision and the different work patterns across hospices presented a number of challenges in ensuring that the tools under development are fit for purpose and meet local needs.ConclusionFollowing testing and critical review, the first tool will be available by the end of 2011 and will be published on Help the Hospices website as a free download. Other tools will follow during 2012.
The ACT children's palliative care handbook for GPs
Authors: McNamara Katrina 
Published: September 2011

ACT recognises that as long term family practitioners, GPs are ideally placed to facilitate good communication in and between multi-disciplinary and multi-agency teams. The GP has a major role to play in children's palliative care, in understanding its complexities, and the network of service providers involved. The GP remains the constant practitioner for the family, irrespective of the outcome of the child's condition.The project aimed to promote reflective practice and learning, encouraging GP's to build their knowledge and develop case studies.The handbook provides a practical guide for GPs across the UK who face the challenge of working with a child requiring palliative or end of life care, and their family. It addresses the following issues:▶How do I communicate with children and their families?▶How do I break significant news to children and their families?▶How do I handle strong emotions and difficult questions?▶How do I deal with ethical dilemmas in children's palliative care?▶How do I assess and manage all the needs of children and their families?▶How do I assess pain in children?▶How do I manage physical pain in children?▶How can I offer spiritual care to children and families?▶How do I provide good end of life care to children and their families?▶How do I manage acute, distressing terminal symptoms at the end of life?▶How do I deal with the practicalities arising after the death of a child?▶How do I help the family with grief and bereavement?▶How do I survive and thrive in children's palliative care?
Managing fluctuations in legacy income
Authors: Jackson Jane 
Published: September 2011

IntroductionRecognising the unpredictability of legacy income, and as a result of a risk assessment of the hospice's financial structure and framework, the Trustees and Chief Executive of the hospice introduced a Designated Reserve - the Legacy Equalisation Fund.AimThe aim of this Fund is to enable the hospice to dampen the effect of annual fluctuations in the flow of legacy income and forms part of the hospice reserves. The Fund is used at the discretion of the Trustees for revenue or capital expenditure in future years when a shortfall in income from other sources occurs.MethodThe annual budget for legacy income is calculated on the basis of the average received in the previous 5 years. Management accounts and reporting reflect this figure while the Financial Accounts, in line with SORP, reflect the actual amount receivable in the SOFA. A Balance Sheet transfer between Funds reflects the surplus/deficit legacy monies receivable compared to budget.ResultsThe level of legacies received over the last 5 years has enabled the Hospice to budget and plan with confidence in the knowledge that there are adequate reserve resources available to cover any shortfall in other sources of income.DiscussionDuring an unprecedented period of economic turbulence, the hospice has continued to manage its finances with a view to long term viability, while retaining the flexibility to take advantage of opportunities for new service development which meets its core objectives.ConclusionThe value of having the Legacy Equalisation Fund is particularly apparent in current financial circumstances as it will allow the hospice to continue to support capital and revenue service development projects in a period when traditional sources of finance may not be available due to likely cuts in government expenditure and the general economic climate.
Productive ward at Earl Mountbatten Hospice
Authors: Plummer Brigid , Parkes Lena 
Published: September 2011

BackgroundThe Productive Ward is a National Initiative developed by the NHS Institute of Innovation & Improvement (NHS). Promoting proactive change that concentrates on innovation in practice and on staff having the control to make changes, as stated by the Boshoff (2005). It is different to reactive change, which comes about as a result of needing to modify practice.The Hospice was invited to be part of the Productive Ward project in order for us to review our systems and processes and enable us to save time that could be used to deliver direct patient care.AimTo complete the three foundation modules, followed by eight process modules.Photographs were taken prior to the de-cluttering/re-organisation on the ward. This resulted in time saving as all the equipment for a procedure is kept in the same place, that is, catheterisation – the dressing pack, catheter, catheter bag, stand etc are now located in the same place.Knowing how you are doing – this provides monthly outcome measures for key performance indicators.Meal Wastage Action was taken to reduce meal wastage which resulted in significant cost savings.Stock/Finance Stock is now kept to a minimum, that is, dressings, drug, etc, making it easier to ascertain exactly how much stock the ward is holding, this has also resulted in a tidier store room.Hand oversMorning handovers were held in the staff room taking up to an hour. The change introduced (with a huge amount of resistance) was to hold the handover in the nurses' office to ensure visibility and swiftness. The intention from my perspective was to speed up and reduce the time/cost of this handover. The handover now takes approx. 15 min.Overall, the Productive Ward initiative has proved successful with positive outcomes.
Prioritising care in a community palliative care setting using a dependency scoring tool
Authors: Dark Dawn , Cardy Claire , Green Sarah 
Published: September 2011

With increasing referral rates to the Specialist Palliative Care community team, it became necessary to analyse the dependency of the caseload. A review showed a lack of available tools that had been used successfully, so an in-house solution was sought to develop one.The starting point was to utilise the experience and instincts of the Nurse Specialists to place the patients on their caseload into four different categories:- Red, Amber, Green and Blue, depending on perceived urgency and complexity of needs (with Red being the highest and Blue the lowest).10 patients from each of the four categories were randomly picked and scored using the modified Support Team Assessment Tool. This identified a lower symptom score for patients assigned to the Blue and Green categories compared to those in Red and Amber.Of the10 Red category patients, 7 died and 3 required admission to the Hospice for symptom control within a 2 week period. This contrasted with the patients in the other categories, who remained well controlled at home.Analysing the scores, pain could be considered the most important indicator. The exercise showed that Nurse Specialists were able to accurately determine patients' dependency.This has influenced the way the team manages their caseload. All patients are now categorised and home visits are carried out by the most appropriate team member, using the different skill mix of roles. Red and Amber patients are assessed by the Nurse Specialist, whereas patients in the Green and Blue category may be assessed by a Staff Nurse, reporting back to the Nurse Specialist who maintains overall responsibility.This ensures that each patient on the caseload has regular contact, and is seen by the most appropriate professional at the appropriate time. Patient evaluation is currently underway, but informal feedback from patients and families has been positive.
Outcome of referrals to a community specialist palliative care service, where do patients die?
Authors: Capel Margred , Vout Lauren , Gazi Terri 
Published: September 2011

The majority of people would prefer to die at home, yet more than 50% of the UK population die in hospital. NHS policy and specialist palliative care services encourage the individual to choose and expect to experience end-of-life care in their preferred place. Commissioners for specialist services use place of death as a quality marker against funding provided.MethodA proforma was completed upon the death of every patient referred to the service in 2009–10. Information captured included preferred and actual place of death, aspects surrounding end-of-life care including any triggers for admission.Results788 patients known to the hospice died, the median number of days patients were known was 83 and mean 160.7% of deaths were from non-malignant disease.55% of patients specified their preferred place of death was their current place of living (home, residential or nursing home and prison). 67% of patients who expressed this preference achieved this. 14% of patients identified they would prefer to be admitted as an inpatient to the hospice for end-of-life care, 81% achieved this. New conditions and lack of social support were significant triggers for admission.ConclusionThe proportion of patients achieving their preferences for home and inpatient hospice with this community service compares favourably with results reported. Achieving preferences is a reflection of healthy community services as a whole. Despite the more unpredictable time course of non-malignant illnesses, the majority of these patients were able to achieve their preferences for end-of-life care.This audit provided basic information for discussion with our commissioners. Breakdown by primary care team and cause of admission enabled the service to consider targets for future education and activity by looking at triggers for acute admissions as starting points to change health behaviour and target social care.
An audit around preferred place of death: one UK hospice experience
Authors: Walker Susan , Read Susan , Priest Helena 
Published: September 2011

IntroductionAccording to the End of Life Care Strategy, good end of life care includes choosing a place of care for one's death. It is easy to assume that all hospice patients discuss their wishes and that plans for death are recorded. The audit data in this paper, however, suggests that such planning is not universal and asks questions about why this might be so.AimsTo present an audit of 150 hospice case notes to show the documentation of patients' preferred place of death over a 2 year period.MethodsAs phase one of a PhD research study, case notes of deceased patients were accessed from January 2008 (n=50); January 2009 (n=50) and January 2010 (n=50) during September – November 2010. Data collected included actual place of death, whether preferred place of death was documented, whether preferences were achieved, whether patients had conversations about end of life care options; whether wishes were reviewed and which professionals recorded information. The 2 year time frame represented a range of experiences within the hospice context. Descriptive statistics were used for analysis.ResultsResults illustrated that place of death was varied; that preferred place of death was recorded in only 18.7% of cases and of this very small number whose wishes were documented, the majority (89.3%) died in their chosen location. Only 10.6% of the sample recorded conversations about preferences, and reviews were infrequent (21%) with few changes of preference.ConclusionsThis research demonstrates that identification, documentation and review of preferred place of death was achieved for only a small percentage of patients of this hospice during 2008–2010. This prompts further research questions around why this is so.
Lean on us – a clinical kitchen
Authors: Kelby Simon 
Published: September 2011

Recognising the importance of food for patients is central to successfully delivering nutritional care. Our hospice sought to improve the patient experience by bringing kitchen staff into the clinical team. A project using Lean principles run by a volunteer industry expert and a Macmillan palliative dietician is underway to achieve this.Aim▶Improve the patient food experience.▶Integrate kitchen staff into the clinical team▶Develop team working without altering reporting structures▶Use the new team to improve nutritional care.Method▶Utilise Lean (a widely used tool in industry and the care sector) to affect the changes.▶Ward and kitchen staff discuss problems, seek solutions, implement them and take responsibility for their success.▶Launch a full review of nutritional care to find and resolve issues using Lean principles.ResultsThe project is still underway but already we have successfully brought together the kitchen and nursing staff increasing their mutual understanding. The team is developing better systems and have Lean tools to help them continuously improve. This has resulted in more consistent delivery of nutritional care to patients.ConclusionWe have not yet seen the full patient benefit but by bringing together the kitchen and nursing staff makes delivering nutritional care much simpler and more effective. Frustrations caused by lack of processes for communication between kitchen and ward staff led to inefficiencies and lower patient care. These are being overcome and the whole team is now more efficient and reactive to changing patient needs and is more efficient.Recommendations▶Bringing nutrition into clinical care ensures this critical area is more fully delivered.▶Allowing the whole team to develop and implement ideas ensures full staff buy in.