effective integration of palliative care in respiratory setting - using action research
DESCRIPTION
Overview of Action Research Project carried out to integrate palliative care into the care of those with respiratory illness. Presented at International Congress on Palliative Care, Montreal, September 2014TRANSCRIPT
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Effective integration of Palliative Care in Respiratory Setting – Using
Action Research
Marie Lynch, Bettina Korn, Patricia White PhD
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Introduction
1. Context 2. Methods of
integration3. Results4. Key learning
No conflict of interest
2010 2013Project
Duration
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SitesBarriers Patients
I always think of palliative care as just cancer.
I remember it frightened me, the mention of it, it also
frightened me more when they said morphine, I think
most people think morphine is for people on the way out.
Patient 1 Patient 4
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Education Needs - Baseline
0%10%20%30%40%50%60%70%80%90%
100%
Currently have a PalliativeCare Qualification
Interested in AttendingPalliative Care Education
yes
no
All health care staff on the respiratory ward (nurses, doctors, care assistants, physiotherapists)42/49 questionnaires returned (86% response rate)
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Action Research
• Recognised method for quality improvement & organisational change
• Approach requires – Collaboration– Empowerment– Reflection
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Demonstrate 2 methods of integration
Collaboration Developing Knowledge
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End of life care review meetings
Facilitating questions:•What went well in the care of this patient and their family at the end of life?•What didn’t go so well?•What would we do differently?•Would the way this person died be acceptable to me?
Developing Knowledge:
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Formal Education Clinical education input: End of life care awareness &
communication skills training:
Developing Knowledge:
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Project steering group
14 Steering group meetings over 18 month
period
Focus group with members – pre and post
project timelines
collaboration
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Working Together: Journey to improve patient centred care
Respiratory Team
Specialist palliative care
teamPatient
collaboration
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Developing the pathway
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RESULTS - quantitative Number of patients accessing palliative care 44
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RESULTS - qualitative
Patients
Staff
“I wouldn’t be afraid to go into it (hospice) if I had to go into it someday where I would have been before.”
Patient 2
‘The greatest achievement is the shared approach that now exists between the hospice and the respiratory unit’. Respiratory Nurse
I do think that it would have been less effective if it had been a traditional research project… you’d be able to stand up… and present the data but that would have no impact on the patient.
Respiratory Physician
It (day hospice) gave you an idea what the future might hold and how you could deal with it and that was comforting in itself. Patient 3
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RESULTS Addressing the barriers
Additional policy and knowledge transfer benefits
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Reflection
More focus on quantitative data
‘ Respiratory and palliative care knowledge based values and world views have come together and we have generated a new practice based knowledge base’.
‘There are effects we can’t measure… [for example with] the MDT meetings, there was so much learning that happened within the Respiratory Assessment Unit and staff on the ward and [all] that does filter through and the relationships that were built’ .
How do we know what makes a difference to patient care?
Respiratory Nurses
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To Conclude The Patient Voice
• Thanks to Eamonn Rooney
– The Meaning of Palliative Care– The Difference it Makes