Palliative Care Education in Nursing Homes Project Sian Williams, Powys LHB Specialist Palliative Care Nursing Team A South West Wales Cancer Network Funded Project

Aims To improve End-of Life care within four nursing homes in North Powys, through integration and implementation of the ICP. To understand the basic principles of Palliative Care. To have confidence in the use of the Integrated Care Pathway for the Last Days of Life. To empower managers and other senior staff to support nursing staff in the competent use of syringe drivers.

Aims (continued) To understand the role of the Palliative Care Multi-disciplinary team, and the referral process. To develop a resource file, containing contacts, useful links, palliative care information. To have an awareness of the goals of the Gold Standards Framework, and Key Tasks to aim for in practice.

Starting the project Project outline agreed with Specialist Palliative Care Team Social Services Independent Sector Liasion Officer. CSIW locality manager Meetings with home managers to outline project. Questionnaires to homes. Workshop programme developed following analysis of questionnaires.

Other Multi-disciplinary meetings Datix administrator. District Nursing Teams visiting homes. Nurse assessors All specialist Palliative Care Nurses in Powys.

Time Scale for project development

Questionnaires Staff numbers? Training? Palliative Care experience? ICP? GP involvement? Link Nurse? Syringe drivers? Palliative admissions? Perceived training needs?

Staff and training Mix of Trained Nurses and Care Assistants Many part time and bank staff

Palliative Care Training Minimal-one RN had Diploma in care of the dying Informal teaching sessions 2-3 years ago. Syringe driver training (hospice or Macmillan team)

Integrated Care Pathway Answered ‘Yes' in all cases to being used in home. Variety of versions-i.e. some personalised. Two sending variance sheets in to North Wales. Minimal training in use of ICP

GP involvement All homes sited GP’s with and interest in Palliative Care. Some had regular visits, often on set days. Others random visits or when called

Link Nurses No link nurses within the homes identified. (Link nurses have a special interest in an area of care. They are nominated to the role, and attend meetings, study sessions and other areas pertinent to the subject area. They form a ‘link’ with other members of the MDT).

Syringe Drivers All homes had at least one syringe driver. Most stated Graseby. Some reported maintenance at RSH yearly. Training either at RSH or with Macmillan team No set pattern for training except at one home.

Perceived Training Needs Oral Care Syringe driver training Pain control Breathlessness Bereavement and loss ICP

Perceived training needs Nutrition Talking to relatives Verification of death. Communication with dying person

Developing the programme Workshop style sessions based on Macmillan Principles of Palliative Care module. (3 parts) Syringe driver session. ICP and GSF Macmillan Team role and referral.

Delivery of workshops All sessions delivered in-house. All sessions other than syringe driver for trained RN’s and RMN’s, HCA’s and Care assistants. All sessions except syringe driver training repeated later in secondment to allow for A/L and other absence. Workbooks accompany first three.

Benefits Greater understanding of care staff in principles of Palliative care. More informed use of ICP. Improved understanding of the goals underpinning the GSF. Competency in syringe driver use. Potential for improved End-of-Life care within each home.

Results A total of 93 participants (approximately 50% Care Assistant and 50% RN or RNM) attended 1 or more sessions. 45 participants completed full module (three workshops) of ‘First Principles’ in Palliative Care.

Attendance Figures of Workshops

Analysis Managers in all homes report positive feedback from staff. Individual evaluations reveal change in thinking and practice. Staff have requested further workshops and modules.

Example Evaluations The following quotes are taken directly from evaluations completed by staff attending the programme.

‘……I can honestly say that this particular course in the Foundations of Palliative Care has left me stunned with new knowledge I have gained, and am eager to learn more. It has opened my mind to various approaches………

I am looking forward to future lectures immensely because I feel I am being challenged to help residents in my care and their families to make sometimes difficult decisions and to advise, if needed, but most importantly to support in way that is comfortable and right for them.’

It gave me a better understanding about the care people need when coming to the end of their life, their feelings and their fears, and frustrations. Also with my own feelings about death.’

‘Excellent…we must have more ‘Excellent…we must have more. Really good for our workplace, it gave us confidence to know we are doing things right and to speak out to senior members of staff….Thank you for giving me more knowledge…’

The future…. Many other educational needs identified by homes. Other care staff groups could benefit-e.g. Domiciliary staff, residential homes. Staff turnover dictates need for ongoing programme. Training identified in DoH End-of Life Care strategy (2008) -important at induction, and ongoing to meet developmental needs. Funding ???

Further Information If you would like further information about the project, please contact sian.williams2@powyslhb.wales.nhs.uk Tel 07971308486

Thank-you