bluuebunny/crossref_metadata_2025_split huggingface dataset:
Needs of the Charedi Orthodox Jewish Community in Stamford Hill for specialist palliative care
Authors: Jennings Rebecca 
Published: September 2011

IntroductionThe Charedi Community located in Stamford Hill represent the third largest concentration of strictly Orthodox Jews in the world, with a total population of over 18 000 members. To date the Charedi Community have had little involvement with Hospice. Little is known about the needs of Charedi people with advanced, progressive illness and what factors underpin their lack of uptake of specialist palliative care services.MethodA multi-dimensional Needs Assessment was undertaken, drawing upon Epidemiological, Corporate and Comparative approaches to consider the need as widely as possible. This included a number of focus groups within the Charedi community.ResultsThere is a small but significant need for specialist palliative care services within the Charedi community (up to 44 new patient referrals per year), with specific areas of need identified in relation to specialist nursing and medical input, therapies rehabilitation and bereavement support. These needs would be best met by the Community Palliative Care Team to fulfil the Charedi community's preference to receive care at home.DiscussionThe Charedi community have a need for greater awareness of palliative care services and support available to patients with advanced disease. Charedi care providers are receptive to engage with joint working and training opportunities offered by the Hospice.Additionally, there is a need for Hospices to better understand core Jewish values to ensure culturally sensitive and appropriate care for Jewish patients. Attention to the great value Judaism places on life, implications for provision and withdrawal of interventions and methods of conveying information to allow for maintenance of hope is needed.ConclusionThe Charedi Jewish community in Stamford Hill have an unmet need for Specialist Palliative care. The community is open to work in closer partnership with the Hospice to support Charedi patients with advanced, progressive illness.
A redesign of hospice social care services
Authors: Thomas Martin , Widlake Jutta 
Published: September 2011

IntroductionThe social care resource of the typical hospice has developed in steps over a period of time, as and when funding becomes available. As a consequence of this the structures of different teams and departments are varied and often follow no clear model. This was the situation faced at the hospice of this study team, who identified that this carried with it certain risks, both to service users and to the organisation. In order to address those risks, changes were needed, and a stronger structure developed for the social care provision of the hospice.AimsTo carry out a systematic review and design of a hospice social care service.MethodsA focus group carried out a literature search and multidisciplinary planning sessions. A business plan was developed and put into place.ResultsSocial care was restructured around a 4 level model. The qualified social worker to social care assistant ratio was altered to reflect the need for clear assessment and delegation, in order thet the risks were addressed.DiscussionHospice social care brings with it a high level of risk. This risk can be lessened if the appropriate structure is in place ensuring that patient's needs are at the focus of care. The 4 level model provides a structure to rebuild the service, and a clarity to ensure that the appropriate competencies, knowledge and skills are in place to deliver care safely.ConclusionThe use of the 4 level model to restructure and redesign the hospice's social care service ensured a patient needs focus. The structure also allowed clear identification of the knowledge and skills needed across the health and social care workforce for safe patient assessment and care.
Promoting end of life care across care homes: the role of the specialist palliative care nurse
Authors: Bird Elaine 
Published: September 2011

In 2008 the NAO undertook a retrospective study for all deaths in Sheffield during October 2007. 58% of these deaths occurred in hospital despite 40% having no medical reason to be there. 19% of deaths occurred in care homes.Using the Gold Standard diagnostic framework 42% died from frailty, 30% from cancer, 20% chronic disease and 8% were unexpected. The study supported that best practice palliative care, advanced care planning and preferred priorities of care had not been identified or achieved.The benefits of having a clinical specialist palliative care nurse specifically designated to care homes is to understand the working environment of individual care homes. The role enhances the delivery of palliative care education that reflects the requirements of individual homes and promotes informal education through discussing face to face findings following the specialist assessment of individual residents.The poster provides evidence for encouraging best practice palliative care for all care home residents, irrespective of diagnosis. It identifies changing patterns in referral and discharges from specialist palliative care services as robust supportive end of life care plans are instigated through discussion with individual residents, their families, care home staff and the wider MDT team. Proposed future developments will also be identified.
Therapeutic hand massage: empowering carers to care
Authors: Talbot Judith , Evans Val 
Published: September 2011

Evidence suggests there is a great need to support social care home staff in End of Life Care (EOL). Staff may lack confidence in their ability to provide EOL care. The Local Hospice has worked with social care homes, running a successful Liverpool Care Pathway training programme. Participants identified other EOL training needs and the focus was directed to the use of therapeutic hand massage, a recognised effective method of providing pain control and comfort for those clients with dementia and distress.AimTo enable care home staff to use therapeutic touch and non-pharmacological management for end of life symptoms and aid communication with the residents in their care.Methodology20 care homes and 23 staff were involved in the pilot. Places were free and staff were recruited at NVQ 3 level and above. The programme was delivered in two workshops, held a month apart. The first day focused on practical hand massage techniques, the theory of therapeutic touch and some guidance on how to run workshops in their own care setting. The second workshop required a case study presentation demonstrating what impact hand massage has had on EOL clients.EvaluationParticipant evaluation of this ‘train the trainer’ approach demonstrated an increased confidence to provide the training to other care home staff and positive effects on the residents were also reported, in terms of reduced agitation and more engagement in communication. There were also reported benefits for relatives of the residents, as they could perform hand massage when visiting. This made them feel that they were ‘doing something’ for their loved ones.Due to the positive outcome of the pilot programme this workshop is now offered as a regular educational programme. The next programme is already oversubscribed and there is a growing demand for the programme.
Developing in house clinical supervision for all
Authors: Rushton David 
Published: September 2011

IntroductionSenior Hospice Clinicians used to receive clinical supervision externally. This meant that learning from external sessions wasn't always shared. And more importantly most other staff didn't receive any clinical supervision or even knew what is was.AimsTo address this, a group of in-house staff were trained and supported to facilitate small groups of nurses and rehabilitation staff.MethodsExternally provided training looked at:▶Understanding what was clinical supervision▶Functions of supervision▶The process model▶Negotiating a group supervision contract▶Challenges, benefits and common dilemmas▶Practice facilitating groups▶Identifying transferrable skills▶Back-up literature.ResultsAttendance at groups could be difficult. Some staff took more responsibility for attending; others had not previously encountered the concept in their professional lives and therefore saw it as an extra unwanted duty.Two annual surveys were undertaken. These elicited a range of responses, from the highly committed and favourable to those who had not found it easy to incorporate this mode of learning and support into their work.By the second survey responses were still varied but supervision was definitely now valued and there was no wish to make further changes.DiscussionThe experience highlighted:▶The need to overcome cultural obstacles where staff had no prior experience of clinical supervision▶The importance of terminology – the groups are now called ‘reflective practice’, expressing the greater professional curiosity supervisees can bring to their work▶The importance of now extending supervision systems to volunteers who have direct roles with patients and families.
The end of life care strategy: where next?
Authors: Gale Barbara 
Published: September 2011

IntroductionThis research used discourse analysis to examine the End of Life Care Strategy (EOLCS).AimTo uncover dominant, marginal and missing discourses and discuss the implications of these. This research was based on the concept that language does not provide a neutral description of the world.ResultsThe analysis identified dominant medical discourses that included ‘not talking’ and defining a time called ‘end of life’. Professional involvement was seen to be crucial in all aspects of end of life care, which seemed to be in line with a government's approach to influence all life processes from pregnancy, birth and death. There were no discourses identified that related to user involvement, compassion or health promotion.Although there was great emphasis on encouraging people to state their preferences and choices it was purely in relation to their care preferences and place of death. People were described passively and there was no mention of people being encouraged to be in control of the own conditions as there is in other long term conditions. By positioning people in this way the discourses in the EOLCS may be perpetuating the idea that those at the end of their lives are different to everyone else and need to be treated differently.Discussion and conclusionThe research concludes and suggests that there are already alternatives to a medical discourse by using a health promotion model of palliative care. Dying happens to everyone and does not mean they need to be treated differently. Hospice should consider whether the EOLCS is truly the document that guides the way forward or not. The Demos report offers an alternative to the EOLCS and new challenges for hospices.
Triage
Authors: Wythe Jane 
Published: September 2011

A hospice first responseIntroductionThe project focused on introducing a clinical nurse specialist as the triage lead for a hospice service offering day care, inpatient and community care. Referrals had previously been managed by an administrator with clinical support.AimsTo ensure timely responses to patient and family needs and ensure the organisation's response to referrals was appropriateProvide meaningful support to professional and lay referrers with a consistent response.MethodsThe triage specialist led a rigorous evaluation of the referral process while supportively challenging local referral culture; funding for the triage post was secured from a Big Lottery Fund grant.▶Clinical Nurse Specialist and administrative support developed robust systems and processes▶Education strategies were employed with local referrers using team and one to one approaches▶Professional and lay carer opinion was actively sought through the use of questionnaires.Results▶The triage approach became a catalyst for a new organisational strategy 2011, because of the identified unmet need▶Local regional professionals reported a consistency and transparency in clinical decision-making by the hospice▶Hospice staff expressed an increased confidence in first assessment allocation which has indirectly upheld the distinct contributions of each discipline▶Average response time to referral reduced to from 1 to 2 days to under 1 day.Discussion and conclusionAn experienced practitioner as triage lead has enabled further exploration of allocation of first assessment to skill mix within disciplines including healthcare assistants. Examination of triage identified that it was more of a first response with a telephone assessment.The processes established has quickly become embedded in the Hospice's practice culture and remains a source of pride and comfort during periods of rising public and professional expectation of hospice services.
Brief encounters: the scope of a single music therapy session in adult hospice work
Authors: Lings Jane 
Published: September 2011

Music therapy provision in adult palliative care is still relatively uncommon in the UK, and the scope of music therapy practice is often unfamiliar to the multi-professional team. Although longer-term work is viable with many hospice patients, it is not always possible. A single music therapy session might be all that is achievable before a patient leaves the hospice, or deteriorates and dies. This paper is based on my clinical experience of 10 years working as music therapist in a hospice. It aims to illuminate the value and potential for music therapy within the constraints of very short-term work.Using case vignettes, three different approaches will be introduced and discussed: receptive work, improvisation and songwriting. Receptive approaches focus on active listening using live or recorded music. This can facilitate reminiscence, relaxation and /or visualisation. Improvisation offers interaction, a musical dialogue. Using simple instruments and supported by the therapist's music, there is the possibility for creativity, new and transformative experience, and the expression of feelings. Songwriting brings together words and music with the potential to create something lasting. It provides the opportunity to articulate and to understand feelings, and often patients report unexpected pleasure and pride in their achievement. A recorded song might have a purpose and life of its own, such as being given or left as a gift, placed in a memory box or played at the funeral.In my experience music's unique qualities help establish an atmosphere where a trusting therapeutic relationship can develop very quickly. Its flexibility and adaptability enables work at depth even in very short-term work, which can meet the both holistic needs of the patient and their loved ones.Recorded patient songs will be used to illustrate this presentation.
Dynamic review and development of an orientation and mentorship program for hospice CNSs
Authors: Attwood Elizabeth 
Published: September 2011

AimsTo improve the orientation and mentorship of Hospice Community Nurse Specialists.To accelerate skills development and delivery of quality specialist palliative care.BackgroundRosseret al(2004) describe role transition from Generalist to Specialist Nurse as complex and stressful. McCreaddie (2001) using grounded theory approach showed that orientation and mentorship are helpful when adopting the Nurse Specialist role.MethodsLiterature reviewFocus group. CNSs made suggestions for future orientation and mentorship programsAudit. 18 CNSs reviewed the current Hospice CNS orientation and mentorship programFormative evaluation through semi informal interviews and summative evaluation by questionnaire at 6/12 post recruitment, after changes to program.ResultsThe audit findings were categorised according to % of positive statements:▶≥75% supernumerary period and available learning resources▶40–75% clinical visits and personal objectives▶≤ 40% formal mentorship and role expectations.The suggestions from the focus group and research evidence were concordant with the audit findings and were used as evidence for change.Implementation of a competency-based orientation and mentorship guide.The guide includes competences reflecting National Occupational Standards for end of life care. It includes self and peer assessment, caseload management, guidance for mentors and local information. The guide serves as a teaching tool and benchmark for standards of practice.Ongoing evaluationIn the summative evaluation post the change, CNSs positively rate mentorship and are clear about their role. The formative evaluation shows they feel supported and are more confident in their role.ConclusionChanges to the program are dynamic in response to ongoing evaluation and change which will be followed by re-audit in the future. In time, it is hoped that a well prepared work force will promote innovation in specialist palliative care.
Evaluating the impact of nurse independent prescribing within a weekend CNS service
Authors: Webb Wendy 
Published: September 2011

IntroductionNurse independent prescribing (NIP) is a development of the nursing role that has been long awaited by both the Royal College of Nursing and the Nursing and Midwifery Council and is now widely celebrated. However, it has been met with varied responses among cancer and palliative care CNSs. In fact, while the Department of Health's End of Life Care Strategy encourages nurses to pioneer new ways of working in order to provide rapid access to specialist palliative care advice and assessment, the literature reveals a reluctance within CNS teams to embrace this development of the role, to undertake prescribing training and, once qualified, to practice as prescribers.AimsThis study evaluates the impact of nurse independent prescribing within a weekend CNS service at one hospice.MethodsA 6 month audit of prescribing activity data is presented in this study. In addition to this, specific case studies are used to highlight the benefits of CNS nurse prescribing in the out of hours (OOH) period.ResultsThis study demonstrates that the skills of nurse prescribing offer an effective way for the CNS to be more responsive to the changing and unpredictable needs of palliative patients, especially in the OOH period, enabling timely and appropriate symptom control in a single, seamless consultation.DiscussionDiscussion surrounds the challenges of OOH access to drugs, off-label prescribing, CPD, mentorship, professional support and communication.ConclusionThis paper celebrates role expansion and innovations in practice, demonstrates the value of NIP in the OOH period, challenges and encourages other CNS teams to consider OOH NIP initiatives, and offers specific guidance and recommendations for developing and sustaining such a service.
Debating forum – what do you think?
Authors: Nuckhir Charlotte , Stocks Susan 
Published: September 2011

IntroductionThose working with dying people have described feeling like they are ‘walking a legal and ethical tightrope’. This is largely due to the fact that decision making is often complex and emotive. Considering decisions from an ethical viewpoint can help make sense of dilemmas often faced within palliative care. Evidence also shows that individuals are more motivated and gain more job satisfaction when they feel appreciated and valued and listened to.Debate is one formal method of interactive discussion which both encourages the exploration of issues from an ethical viewpoint and provides the opportunity for individuals to have their voices heard.AimTo provide a structured forum for members of the organisation to:▶Debate relevant, current and/or ethical issues▶Encourage understanding and appreciation of each others views in a safe environment▶Reflect on practice in regard to decision making.MethodBi monthly hour long forums are held. Topics and speakers are coordinated by the learning and development manager who also chairs the sessions. The forum is open to all staff, volunteers and external healthcare partners.ResultsTopics to date include:▶Assisted suicide –should the law be changed?▶Should we always tell the truth?▶Does having a faith matter in the hospice environment?▶Generalist versus specialist within palliative care.Up to 35 people have attended including the Chief executive, directors, managers, clinicians, support staff fundraisers and volunteers. Feedback has been overwhelmingly positive.ConclusionThe results suggest the introduction of structured debate is regarded as an exciting, valuable opportunity to listen, be listened to, reflect and develop. The impact has been positive, thought provoking, unifying and motivating for all who have taken part suggesting that the aims have been achieved.
Developing core competencies for staff and using them in the hospice environment to define behaviour
Authors: Moorey Alison , Bourne Jacqui 
Published: September 2011

The development of core competencies to be used across the Hospice was prompted by an identified need to clarify the expectations of everyone working for the organisation.In 2009 it was identified that competencies used in interviewing were not actively being used or understood and a project plan was developed.A project lead was identified and seven members of staff from various departments joined the group, along with HR Consultants who volunteered part of their time so the cost was minimised.The group initially defined and agreed seven competencies along with short descriptors:▶People Care▶Motivation and Initiative▶Change and Adaptability▶Planning and Organisation▶Analysis and Decision Making Ability▶Coaching and Teamwork▶Leadership.The next task of the group was to agree descriptions of behaviours for all three competencies at three levels. This work involved consulting with staff to ensure that the wording used was meaningful and relevant to the staff.All job descriptions were reviewed to ensure that they specified the competencies required and at which level. Following this a question bank was developed which provides a range of interview questions for each of the competencies at each level; line managers were trained in interview techniques so they were able to judge the evidence from the answers.All applicants for employment are sent a copy of the core competencies so that expectations of all employees are made clear from the outset. The final stage of the project is to include the core competencies in performance review documentation and this is currently being tested.This project has been wide ranging and has enabled the Hospice to clarify expectations of staff at all levels as well as giving line managers the tools to effectively praise good performance as well as managing poor performance.