Jan AimerProject Lead

Acting Head of Practice and Professional Development CHP’S Fife/

Macmillan Cancer and Palliative Care Educator

SUPPORTING PALLIATIVE CARE IN CARE HOMES

‘Fife’s Educational Care Home Project’Phase 1 and 2

FIFE

Aim of the Project

• That General Palliative Care practice in care homes is enhanced and developed by an educational strategy and consistent programme of knowledge and skills.

• That acquired and enhanced skills and knowledge in general palliative care are implemented into practice.

• That Care Homes have formal links to specialist palliative care resources enabling advice: support and planning of care management for residents and carers.

Why we started the project

• 5% >65years reside in care homes

• 1 in 5 deaths takes place in this setting.

• 52% of all care homes are for older people (908) (Scottish Care Commission , 2004).

• Forecast population of elderly will continue to rise well into the 21st Century.

• Care homes for older people have the highest incidences of failing to meet regulations (Scottish Care Commission, 2004).

• Good quality of end of life care must be recognised as a basic human right (WHO, 2002).

• Department of Health Improving Care Improving Lives (2005).

• Supporting People with Long Term Conditions (2005)

• Joined up thinking Joined up Care (2006)

• The Future Care of Older People in Scotland (Scottish Executive 2006)

• Making Good Care Better (2006) National Practice Statements for General Palliative Care in adult Care Homes in Scotland.

Sparra Scottish Patients at Risk of Re-Admission and Admission (June 2006)

• Better Health Better Care (2008).• Living and Dying Well (2008).

Practice Educator’s Role in the Project

• Education• Clinical• Consultancy• Leadership• Research• Audit

Palliative Care Education Facilitator’s Role in the Project

‘The facilitators role is concerned with enabling the development of reflective learning by helping to identify learner needs, guide group processes, encourage critical thinking, and assess the achievement of learning goals’

Harvey et al, 2002 )

Libby and Heather’s Role is to Enable cultural changes & challenging current ways of working, utilizing reflection as a learning tool.

What is it about…….

• Role model / Effective relationships• Supportive learning environment • Ownership / Realistic Outcomes• Professionalism / Trust / Respect• Good Communication / Clear direction• Innovation / Motivation• Up-to-date knowledge• Team building/ People / Friendship• Recognition of others skills & abilities• Having vision, enthusiasm &

commitment• Receptive to new ideas

Projects Strategic Objectives

Identify care homes interested in Project.Roles people play

CompetenciesChanges to take place

Identification of Training/Development Needs

Clearly articulated and expressed in measurable terms andobjectives/outcomes

Training Plans AgreedEducationExternal

HCI Provided

Education=Trust/in-House

programmes

AppraisalsTNA

ServiceDevelopment

CriticalIncidentsPatients

expectationsfeedback

complaints

Tool Used in Project Preferred Method Of Delivery

• Train the Trainers Model

• ‘Key Champions’ in Palliative Care from each care home

Macmillan Foundations in Palliative CareA programme of Facilitated Learning for Care-home Staff

Challenges

• C Collaboration/Communication • H Healthcare Professionals• A Achieving our project goals• L Leadership• L Learning Environment• E Educational Opportunities• N Nursing practice/clinical focus• G Government Issues• E Evaluation

Challenges in Practice

Resources Staffing Levels /financial implicationsAnnual LeaveSicknessMandatory Training overwhelmingShift PatternsFamily CommitmentsAttendance in own timeRecruitment and retention problemsResistance to changeLow motivation/low moraleUndervalued

Recommendations from First Cohort to resolve some of the barriers faced

• Involve the Manager more in tightening the Inclusion criteria for key champion so that we do not loose them initially

• Deliver the programme over 3.5.days

Participants Comments• Registered Nurse

• Understanding models of grief and bereavement have given me a better view of how the client and those related to the client and also those who care for the client may feel or react. The models of pain and the breakthrough of pain were most helpful and I will integrate these into my work as a nurse as a more effective strategy of dealing with pain.

• Also discussing the nature of relationships between the dying patient, staff and family has made me think more on the emotional side of my job which is something I think most nurses tend to become quite clinical about. This course has made me think more about how much more comfortable we can make the final months, hours, days or years for the dying client and how effective a more structured team orientated approach can be.”

• Support Worker

• “Since doing the palliative care course it has opened my eyes to many things. It has made me understand the needs of the elderly a lot better, also levels of pain and how you can help them in many ways medically and emotionally.

• Helping relatives through their grief and sometimes a cuddle say’s much more than words. Helping each other as well, as grief can affect people in many different ways.”

ADVANTAGES OF HAVING INPUT FROM THE EDUCATION TEAM

• Offers opportunities to gain knowledge and skills to both registered and non-registered staff with the aim to influence clinical practice and improve patient care.

• Palliative care needs tailored to each individual care homes

• Professional development and continuing learning opportunities

• Consultancy basis

• Educational remit

• Key Link person for Care Homes for practice development opportunities in NHS Fife

Benefits for the Care Home and the Older Person

Ongoing support for Healthcare professionals

Collaborative partnership

between education and practice

Quick response to care commission issues and NHS

agenda

Patient Focussed/palliative care

issues

Multi-professionalinvolvement in PD

teaching

Support the creation of

learning environement

Development of relevant

educational and training

programmes

VISION FOR THE FUTURELiving and Dying Well (2008)

Phase 2

• Improve People’s Quality of Life with end of life issues.

• Address the inequality of care of the older person

• Adopt an innovative approach to education and develop good communication channels across the boundaries of NHS and the Private Sector.

• Empower staff to become competent, reliable and trustworthy people in dealing with palliative care and end of life issues.

• Collaborative and shared working.

• Continued evaluation