ESSENTIAL SKILLS FOR END OF LIFE CARE
PRACTICE DEVELOPMENT RECORD
Healthcare and Nursing Assistants, Support Workers and Care Staff
Kent and Medway End of Life Care Network Education Group 2010
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Introduction to the Practice Development Record The aim of the Practice Development Record is to help your understanding of end of life care and assist you in demonstrating your achievement of the course learning outcomes. In working through the Practice Development Record you will be encouraged to reflect on your practice and consider how you contribute to the care of your clients with end of life care needs. It is advisable that you have an identified person (mentor) at work with whom you can share your thoughts and experiences from the course. How to use the Practice Development Record You may want to do some further reading around the topics covered on the course. A suggested reading list and useful websites can be found at the back of this booklet. Course handouts and reference material will help in answering the questions. To help guide you through the reflective exercises a copy of Gibbs (1988) reflective cycle has been included. Take time to revisit the learning outcomes and consider how they will influence your working practice.
Please do not hesitate to ask the course facilitators any questions.
As well as gaining an increased knowledge and confidence in end of life care the Practice Development Record can assist in providing evidence towards your competency framework.
Please use the spaces following the questions to record your answers. Use additional sheets of paper if required.
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THE REFLECTIVE CYCLE (GIBBS 1988)
Description What happened?
Action plan If it arose again what would you do?
Feelings What were you thinking and feeling?
Conclusion What else could you have done?
What was good & bad about the experience?
Evaluation
Analysis What sense can you make of the situation?
Adapted from Gibbs G. 1988. The reflective cycle. Available at: http://www.brookes.ac.uk/services/upgrade/a-z/reflective_gibbs.html
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QUALAITY PALLIATIVE CARE AND END OF LIFE CARE PLANNING
Think of a person who you have cared for at the end of life. Write a brief history of the person and his/her circumstances and consider the following:
Do you think he/she had any quality of life at the end of his/her life? What went well and what could have been better?
Can you explain the components of pain that this person experienced (total pain)? How were you able to help? Would you do anything differently?
What were the needs of the family/carers? How were you able to support the family? Would you have done things differently?
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What is your role within the multi-disciplinary team when caring for people at the end of life?
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CARING FOR SPIRITUAL NEEDS
Comment on your understanding of the significance of spirituality in palliative care
From your experience of working with patients and their families give examples of a) Spiritual needs b) Religious needs
Reflect on a situation where you may have identified signs of spiritual or religious distress but avoided acknowledging it or responding to it due to e.g. lack of confidence or sense of competence
Think of a patient and/or family that you have been involved with and reflect on what spiritual issues may have arisen. Reflect on how you engaged with the person and responded to their spiritual needs – and comment on what you may do or say differently in that situation now as a result of this training session.
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MANAGING COMMON SYMPTOMS
Consider one patient you have cared for at the end of their life. What symptoms have they experienced?
Select ONE symptom experienced and write a short reflective account on how this symptom was treated. Consider the following:
Was the treatment effective?
How did you assess the effect of any intervention?
Is there anything you would do differently now?
Please reference any literature you have used.
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ETHICS
Think of a situation you have been involved with as a carer that presented you with an ethical challenge or dilemma.
Describe the circumstances and particularly the challenge. Reflect upon the situation using your knowledge of healthcare ethics and the reflective framework provided.
What do you think you learnt from the experience?
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Barbara is a 55 year old lady living in a nursing home with a diagnosis of motor neurone disease. She is confined to bed, fed via a percutaneous endoscopic gastrostomy (PEG) tube and unable to communicate. She is thought by her carers to be approaching her dying phase and they have questioned the need for continuation of PEG feeding. You are a member of the multidisciplinary clinical team addressing this question. What are the ethical aspects of this situation that the team will need to consider in order to arrive at a conclusion?
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CARE IN THE LAST FEW DAYS
Reflect on the care of a patient who experienced a challenging dying phase.
What aspects of the experience were challenging?
Describe how the patient, family and staff were supported.
Suggest changes in your future practice within a similar scenario.
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Reflect on a patient’s death where the verification process or after-death procedures were problematic or challenging. And consider the following:
What aspects of the experience were challenging?
Suggest changes in your future practice that may improve the experience for both families and staff.
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PRACTICAL WAYS TO COPE WITH GRIEF AND BEREAVEMENT
Think of a patient and family that you have recently been involved with, and start to reflect what psychological and social issues they may have had.
Identify any psychological, social, financial or cultural issues you observed and how these affected the patient and their family.
Discuss your role in supporting the psychological and social needs of the patient and their family.
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Consider common reactions associated with bereavement and loss and explore the following:
Identify physical and emotional responses you have observed.
Discuss ways in which you can support people in grief and what can you do to take care of yourself.
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COMMUNICATION CHALLENGES FOR CARERS
Using a framework or model for reflection (e.g. Gibbs 1988, Johns 1994, Rolfe 2001) choose an incident at work involving communication in which you were not entirely happy with the outcome of your involvement. On reflection, you feel you could have improved your communication skills. The situation can involve as many people as you like but you should or could have been central to the activity. Think back to the incident and provide a full description of the experience. The following questions may help in your reflection on the incident.
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What was happening?
When was it happening?
Where was it happening?
What was the setting like in terms of location, sounds and sights?
Why was it happening?
Who was involved?
How were you involved?
What were you trying to achieve?
What were the outcomes of the situation?
How did you honestly feel about the situation?
On reflection- what might you do differently (when faced with a similar incident) next time?
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SUPPORTING LITERATURE Ellershaw, J. and Wilkinson (2003) Care of the Dying. A Pathway to Excellence. Oxford: Oxford University Press. Lugton, J. and Kindlen. (1999) Palliative Care. The Nursing Role. Edinburgh: Churchill Livingstone. Payne, S., Horn, S. and Relf, M. (1999) Loss and Bereavement. Buckingham: Open University Press. Reddall, C. (2009). Palliative Care for Care Homes. A practical handbook. Oxford: Radcliffe Publishing Regnard, C. and Kindlen, M. (2002) Supportive and Palliative Care in Cancer. Radcliffe Medical Press Ltd.. Thomas, K. (2003) Caring for the Dying at Home. Companions on the journey. Oxon: Radcliffe Publishing Ltd. Twycross, R.(2003).Introducing palliative Care. Oxon: Radcliffe medical Press Ltd. Watson, M., Lucas, C., Hoy, A. & Back, I. (2005) Oxford Handbook of Palliative Care. Oxford University Press. Oxford. Online www.advancecareplanning.org.uk (Free learning pack on advanced care planning) www.dyingmatters.org (Dying Matters Coalition set up by NCPC to promote public awareness of death, dying and bereavement) www.endoflifecareforadults.nhs.uk (National End of Life Care Programme. Information on advanced care planning) www.e-elca.org.uk (interactive e-learning on end of life care) www.goldstandardsframework.nhs.uk (Gold Standards Framework website) www.helpthehospices.org.uk (Use Education & Training link for online palliative care training sessions) www.macmillan.org.uk (Cancer & end of life care information sheets) www.ncpc.org.uk (National Council for Palliative Care - NCPC) Useful insight to meanings of supportive, palliative & specialist palliative care
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www.nice.org.uk (National Institute for clinical Excellence). Guidance on improving supportive & palliative care for adults with cancer – executive summary. Useful links http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digital asset/dh_086437.pdf (End of Life Care Strategy executive summary) http://www.bma.org.uk/ethics/end_life_issues/GeneralguidanceConfirmationandcertificationof deathApril1999.jsp http://www.coronersofficer.org.uk/role.php http://www.bma.org.uk/ethics/cardiopulmonary_resuscitation/CPRDecisions07.jsp (decisions relating to cardiopulmonary resuscitation Publications International Journal of Palliative Medicine Palliative Medicine End of Life Care
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