bluuebunny/crossref_metadata_2025_split huggingface dataset:
To explore the factors influencing whether GPs sign the DNAR order as part of the LCP
Authors: Chew Robert , Forbes Karen 
Published: September 2011

BackgroundEnd of life care is currently a government and national priority. The Liverpool Care Pathway for the Dying Patient (LCP) is an evidence-based multiprofessional document which aims to optimise end of life care. In May 2006 the LCP was introduced into a primary care locality within a London PCT. An audit carried out on the first 20 patients to be placed on the LCP noted that the ‘do not attempt resuscitation’ (DNAR) order had been signed by their general practitioner (GP) in only seven out of the 20 patients.Aims and objectivesTo explore the factors influencing whether GPs sign the DNAR order of the LCP. To explore what helps or hinders GPs to sign DNAR orders and to propose actions facilitating completion of such orders.MethodSemi-structured interviews with seven GPs and four nurses were carried out between April 2008 and September 2008. Grounded theory analysis was used.ResultsThe LCP is a nurse led process in the primary care setting that was studied. Facilitatory factors for obtaining a signed DNAR order were a multiprofessional approach to the care of palliative care patients, a good working relationship between GP and district nurse, the GP and district nurse working from the same premises and district nurse confidence in commencing the LCP. Inhibitory factors were initial GP ambivalence towards the LCP, ambivalence of the district nurse to completing the LCP process, difficulties with accessing a GP to sign the DNAR order and commencing the LCP out of hours.ConclusionsThe study demonstrates the importance of a co-ordinated multi-professional approach to achieve a signed DNAR order of the LCP. It highlights the need for the on-going education of healthcare professionals on end of life issues.
Privacy and dignity in a hospice environment – the development of a clinical audit
Authors: Gerry Edwina 
Published: September 2011

IntroductionPrivacy and dignity are important aspects of the patient experience and are central to the philosophy of hospice care.AimTo provide evidence of the standards of privacy and dignity afforded to patients in the wards and Day Hospice.MethodA review of key currents documents and an internet search of appropriate audits was undertaken to identify best practice for delivering care that provides privacy and dignity. Following discussion with clinical colleagues and with patients and carers in their respective forums, the following standards were developed.All patients admitted to the In-Patient Unit and Day Hospice should receive care that▶Respects their personal space▶Respects their modesty▶Protects their self- respect▶Maintains good communication▶Protects their confidentiality.Questionnaires, using Likert scales, were devised for patients and different groups of staff – medical, nursing, allied health professionals, spiritual care team, catering and housekeeping teams. These were given to 30 patients and 130 members of the multi-disciplinary team.ResultsThe response rates were 91% (patients) and 78% (staff). Evaluation of the questionnaires showed that 70% of patients rated their satisfaction with privacy and dignity as “excellent” with the remaining 30% rating it “very good”. For the most part, the ratings of staff and patients were in agreement and indicated achievement of the expected standard.DiscussionDespite the good results there were some areas of concern identified. These included ensuring that hand washing was available for dependent patients prior to meals, closer monitoring of visitor numbers, avoiding interruptions to staff when with patients and maintaining privacy during conversations with staff. Important discussion took place within the teams regarding issues raised in the audit.ConclusionAn action plan was formulated to address the concerns and re-audit is planned for later in the year.
A new model for breaking bad news to people with learning disabilities
Authors: Tuffrey-Wijne Irene , Giatras Nikoletta , Butler Gary , Cresswell Amanda 
Published: September 2011

BackgroundCurrent models for breaking bad news are inadequate in meeting the needs of people with learning disabilities (LD). People with LD are often not told of a life-limiting diagnosis. The task of breaking bad news is often left to carers who are poorly prepared and supported to cope with this. Healthcare professionals don't know how to communicate adequately with people with LD.A new model for breaking bad news to people with LDThe model was developed following a focus group/interview study involving 96 participants, including people with LD, family carers, LD professionals and healthcare professionals (see related abstract for oral presentation). The findings were combined with the literature. A preliminary model was developed; 60 stakeholders gave feedback on this, including a wide range of family carers, professionals and academics. The preliminary model was modified following this feedback.The poster will present the model in a visual format. The model has four components.BUILDING A FOUNDATION OF KNOWLEDGE is central to the model. Gradually and over time, the person with learning disabilities builds his/her understanding of the way his/her situation is changing because of the bad news. The people around him/her help with this, by giving small, singular chunks of information that make sense to the person. This does not have to done by talking: much of the information will be understood through experience.The other three components must be considered throughout:CAPACITY AND UNDERSTANDING, taking account of the Mental Capacity ActPEOPLE INVOLVED, including family, partners, friends, paid carers and professionalsSUPPORT NEEDED by everyone involved, including information, emotional, social, practical and spiritual support.The model now needs to be tested in practice.
Development of an integrated model for earlier identification and provision of palliative care for patients of all diagnoses
Authors: Daniels Charles , Dancy Mark , Donovan Temo , Alimo Audrey , Smith David , Berry Lauren 
Published: September 2011

IntroductionThe National EOLC Strategy seeks to improve access to high quality palliation for patients of all diagnoses. One such group for which this is difficult is advanced heart failure.AimTo use auspices of NHS Improvement to develop cross organisational integrated pathway for advanced heart failure (HF) to ensure better end of life care (EOL).ResultsA. Retrospective audit identified 26 deceased patients known to the heart failure nurses. The majority had no EOL discussions or specialist palliative care and died in hospital. Most had multiple admissions with average length of stay of 31 days in last year of life.B. Key stakeholders were brought together to develop a new pathway and tools which facilitated patient choice, addressed symptom management and anticipatory care planning.C. Tools include▶Tools for HF nurses▶Patient and Carer assessment tool▶‘Trigger Tool’ to identify patients who are a ‘cause for concern’. Creates gateway for appropriate joint management between cardiology and SPC services.▶Aide memoire for action following identification of patients▶Home management folder.D. Key features of pathway▶Monthly advanced heart failure forum. Enables hospital /community heart failure nurses to discuss patients identified as ‘cause for concern’ with cardiologists and agree CLEAR action plan. Palliative care input to forum is planned▶Bi-monthly meetings between palliative care nurses and community HF nurses▶Joint Heart Failure clinic.E. Re-audit revealed▶Increased use of specialist palliative care services, for example, homecare, day care, hospice and hospice at home▶Increased EoL discussions with HF nurses▶Increase in documented preferred place of care and achievement of death in PPC▶Reduced hospital deaths.ConclusionCross organisational work can develop shared pathways, tools and training which improve care for end stage HF and improve skills of HF nurses.
Supporting end of life care delivery: an inclusive approach
Authors: Lawley Liz , Talbot Judith , Franke Deirdre 
Published: September 2011

In line with the Hospice movement's key role in promoting the Liverpool Care Pathway (LCP) across health and social care settings, quarterly link nurse meetings involving care home, community nursing and hospital staff were developed by the Hospice LCP team in 2008. These have been successful in engaging staff from a range of settings, with a current membership of approximately 60.The benefits of the LCP are well documented. However, the challenges of delivering any aspect of end of life (EOL) care requiring co-operation across social and healthcare settings has also been recognised, particularly in terms of the support needed by care home staff. Assumptions can be made about the impact of the group in meeting these support needs. However, as the Hospice education team look to deliver a more comprehensive EOL programme and to expand the remit of the group to reflect this, understanding representatives' perceptions of the group and its future direction seemed important to ensure ongoing engagement.Questionnaires, using Likert scale and open questions to capture participants' perspectives on different aspects of the group's activities and on expanding the its remit, were e mailed to all representatives.A response rate of 63% (n=38) was achieved. Responses are still being analysed but there is emerging evidence of the value placed, particularly by care home staff, on the opportunity to meet with those working in other settings and of perceived educational needs if taking on a wider EOL role.Both the ongoing commitment of the group and the early results of this survey support previous work highlighting the importance of strong cross sector relationships (3,4).When finalised, the Hospice education team will feedback to the link and EOL steering groups to inform the future direction of the link group and education initiatives.
Doing the right thing at the right time
Authors: Dee Joan 
Published: September 2011

IntroductionIn order to improve the care of patients and their families when the patient is dying it is helpful to implement the Liverpool Care Pathway for the Dying. It therefore is necessary to identified them in a timely fashion. Previous studies suggest that physicians tend to be overly optimistic when attempting to predict survival.ObjectiveTo identify factors that clinicians consider when a patient is dying,enabling implementation of the Liverpool Care Pathway.MethodA phenomenological study using semi-structured interviews (n = five nurses and five doctors) conducted on a hospice inpatient unit.ResultsThere was a prominent theme of anxiety about getting the timing of diagnosing dying right and how the dying patient and their families would cope if this were the case. The factors that influenced the clinician's decision to implement the LCP were: support for decision making, understanding the patient's journey and concern that the care given is appropriate. It also appears that most of the factors that help are the mirror images of those that hinder the process of deciding when the pathway should be implemented. The theme remains the same but the meaning as to whether it helps the clinician to decide if a patient is dying or not changes.ConclusionsAll clinicians interviewed for this study had concerns about increasing the patient's or carers' distress if LCP implementation was mistimed; there is a risk that clinicians are avoiding difficult conversations with family members and there may be a lack of understanding around the reasons for it's use. Specific communications training may help to prepare clinicians for this role.
Hospice neighbours
Authors: Page Emma 
Published: September 2011

Everyone needs good neighbours – developing a Hospice Neighbours SchemeIntroductionThis is an innovative, volunteer-led scheme created to help people (and their families) who are coming to the end of their lives with practical everyday tasks as well as support in the last days of life.AimsTo provide practical support to these people, this can include collecting prescriptions, taking the dog for a walk or simply providing companionship.Hospice Neighbours will enable support earlier in diagnosis, no matter what this is. It will be more proactive way of working, relieving pressure in the earlier stages of illness which will help make later stages easier. This will ease demands on both hospice services and other care agencies.Methodsemployed so far have been to:▶Recruit, train and develop teams of neighbours▶Recruit a volunteer coordinator responsible for assessing patient's needs and matching them to a neighbour.▶Record all neighbour activity and obtain feedback from the service users.Results so farSome requests for someone to help with:Walking, to help regain their confidence post chemotherapy treatment. A Hospice Neighbour now visits fortnightly to provide companionship.Gardening, which due to illness he is no longer able to tend. A Hospice Neighbour visited regularly to help with shopping and to keep the garden tidy.Daily tasks as cancer affected his right arm. A Hospice Neighbour visited weekly to help with cleaning and writing letters.Discussion and conclusionEarly indication from the pilot areas is that the scheme has potential to make a significant difference to patients and families in local communities. As it became an integral part of hospice community service it will helped to extend choice for those who would prefer to stay at home.
Beyond talking therapy: diverse bereavement support
Authors: Prrot Catherine 
Published: September 2011

IntroductionThe purpose of this project was to provide a more comprehensive, inclusive bereavement service to the local community.Aims were to▶Empower and enable resilience in diverse ways▶Offer less threatening support to those not choosing one to one counselling▶Offer a social / activity-based alternative for people who develop attachment to hospice-based services▶Explore partnerships with other providers, reducing duplication and giving clarification▶Integrate Bereavement Needs Assessment (BNA) research findings.MethodsThe bereavement service, in its routine evaluation and consultation from our Service User advisory group, confirmed a need for greater diversity in its methods. This led to the ‘traditional’ bereavement groups being supplemented by cookery, home maintenance classes, walking and creative activity, as well as with drop-in facilities.ResultsThe new groups started successfully, with interest and satisfaction from those using it.Agreement has been reached with other providers to explore the potential for collaboration and partnership in providing a one stop bereavement service: a joint event is now at the planning stage.DiscussionIt is often more vulnerable people who find it harder to use traditional bereavement services and this project will continue to broaden those accessing it. Success also needs to be measured by evidence that people are accessing the right kind of support for themselves.ConclusionEarly signs are that individual need is being appropriately met through the offer of more diverse forms of support and that potential partners are interested in exploring the benefits of collaboration.
Collaboration online
Authors: Gale Barbara 
Published: September 2011

Hospices face the challenge of managing small and large projects, from developing a new service to a refurbishment or new build. An online system enables people to collaborate and share ideas and documents, quickly and easily.Without an online system, people rely on meetings, minutes and email; often sending or printing large files with the difficulty of managing different versions.This hospice has successfully used an online project collaboration product called Basecamp. There are now many similar products: Zoho, Glasscubes, Huddle and Manymoon; some offer charitable pricing and can integrate with Google Apps.Features include:▶Storage of documents, spreadsheets, pictures, PDFs▶Message threads▶Action lists with allocated tasks▶Calendar and milestones▶Timesheets and Gantt charts▶Access by external contractors▶Collaborate on writing a document.The systems are easy to use and often have video tutorials for new users. The Hospice found that their refurbishment project was completed on time and within budget, decisions and discussions with the architect could happen easily and quickly, without the need for extra meetings.Other collaboration tools include Google Apps, where documents and spreadsheets can be shared and even worked on at the same time. Applications include email, calendar, sites (intranet), all hosted by Google, held securely accessed from anywhere with internet access including mobile.Many companies are converting to Google Apps – Jaguar Land Rover, Rentokil, Sue Ryder. Google Apps is provided free to non-profit in the USA and plans to offer the same in the UK, but the date for this has not yet been confirmed.With increasing numbers of staff needing remote access to documents, online applications can offer greater storage space, effective collaboration, better reliability and improved efficiency.
Hearing voices: sounds great!
Authors: Saunders Jacqueline 
Published: September 2011

IntroductionOver recent years the Hospice has invested significantly in developing a range of means whereby people who use our services and provide the services can influence strategy, change practice and cast opinions into management decision making and clinical practice.AimsTo be an organisation which genuinely listens to its people, enshrining the concept of a community of care and caring for the community of patients, families and carers.Methodsimplemented so far include:The Service User Forum developing into the Advisory Group involved in:▶Senior appointments – Chaplain, CEO, Ward Sister▶Patient client information material▶The organisation's website strategy▶Design, application and interpretation of patient and family Satisfaction Survey (actually undertaken by members of the Service User Forum)▶Fundraising and marketing methodsA Staff Forum being set up:▶Regular meetings with C.E.O. and Directors to express concerns and formulate solutions.Regular Staff Satisfaction Surveys:▶Using the Times methodology generating depth and breadth of data, now used for three consecutive years.Staff briefings:▶CEO gives regular briefings to all staff and volunteers about all aspects of the Hospice.DiscussionIt is now expected practice to integrate peoples' voices (opinions) into planning, delivery and evaluation of all domains of the Hospice.ConclusionThe Hospice feels a better place to work – a ‘listening’ and consultative approach. Patients and bereaved relatives meeting quarterly with an independent facilitator ‘say it as it is’ – real partnership.
How to get 50 positive press stories on your hospice a month
Authors: Jeffery Yasmin 
Published: September 2011

IntroductionWorking effectively with the press can improve local understanding of the work of the hospice and its need for donations.“Market the hospice more” was one of the first things asked of the marketing department; it was felt that many local people did not understand the work of the hospice or its need for donations.AimsThis paper explains how we have maximised the use of newspapers to achieve this. Success also depends on the cooperation of staff and the press.MethodsStaff firstMake sure everyone is aware of the need to access patient/family stories – staff and volunteers are walking newspapers. Explain what a good story is and flag up recent coverage - ‘have you seen our article in the Mercury’ and display it throughout the hospice. Distribute ‘have you a story’ cards for patients, visitors and staff to help break the ice.The mediaImplement a media strategy, monitor all local press; and ensure you have a functional press office. Organise public open events, invite all media, make sure the press see all new publications and always send an invitation to visit.Get to know your editors – understand what they want and send through weekly stories and pictures that are topical, well timed and well written. Supply a mixture of fundraising and clinical stories.Hospice stories can help sell newspapers; the hospice has a huge following which could drive up sales.Offer exclusives and ‘page ready’ copy and negotiate media partnerships for flagship events.ConclusionOur profile has increased significantly. More people know what we do, why we do it and want to support us.Regular and positive newspaper coverage opens the doors to the Hospice, and supports fundraising and patient and family care.
An audit of the advice given to GPs by hospice community nurse specialists regarding step 3 opioids
Authors: Mundy Caroline , Versaci Katie 
Published: September 2011

IntroductionThe Gold Standards Framework state part of the nurse specialist's role is to ensure early and effective symptom control. Opioid advice is commonly given. Advice should be both correct, evidence based and documentation accurate.AimsTo establish the accuracy of advice given about step 3 opiates, noting if documentation was completed, and whether the advice was supported in writing to the prescriber.Methods17 CNS answered a questionnaire for every patient they visited either on or starting on opiates. First visits were excluded. Identification was made of those who had a change recommended. Data was collected retrospectively from the patient's records regarding advice given and its documentation. 49 sets of data were analysed using an interpretive approach.Results100% appropriate interval and route for regular and breakthrough opioid prescribed. 88% (n=43) taking as prescribed. 78% (n=38) on correct breakthrough dose. 93% (n=46) understood breakthrough medication could be repeated after an hour if pain remained poorly controlled. 100% (n=9) opioid switch doses were accurately calculated. 89% (n=27) recorded indication for advice given in patient records. 50% (n=27) communicated written advice to GP. 86% (n=21) ensured timing maintained analgesia. Discussion The results were consistent with the aim of the audit, showing that the advice given is accurate, but that documentation and written communication to GP's is weak. A pro forma letter has been developed to assist in standardising advice.ConclusionThis audit has shown the need for clearly defined standards for documentation of rationale for advice and written communication to GPs. This is hugely relevant for community based specialist nurses who give medication advice on such a regular basis and is noted as a clinical governance issue.