Unified Do Not Attempt Cardiopulmonary Resuscitation (uDNACPR) An Introduction to the Training Programme

Direction from the NMC The Nursing Midwifery Council recognises that in certain cases it will be appropriate for appropriately trained Senior Nurses to fulfil this role

Aim of Training To increase confidence and competence in decision making regarding DNACPR and communicating these decisions with patients +/- relatives

All round winner….why?

Why? Benefits to patients/carers skilled communication in a timely discussion and less inappropriate resuscitation attempts Facilitates more, natural and dignified deaths Avoids repeated and sometimes distressing discussions if senior nurse can complete the process Benefits to organisations – part of skilled advance care planning, greater user satisfaction and less complaints Benefits to senior nurses – increased job satisfaction Potential to influence improved bereavement outcomes

“I let him down I didn’t know what else to do And when the ambulance....” Died in ambulance despite attempting CPR Mrs G, his wife

We don’t have any choice, Unless we have a DNACPR or an Advance Decision we have to follow protocols Default is to attempt CPR Any healthcare setting

“We’re not covered, Unless we have a DNACPR we have to take them to A&E” Terminally ill patient diverted to emergency department despite wife’s protestations Patient transport for hospice admissions

Compliance The Training Programme and Competency Framework is the agreed guide to support the South Central SHA Unified Do not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy The overarching principles are compliant with the Joint Statement on DNACPR by the BMA, RCN and Resuscitation Council, and the NMC advice statement

Organisational responsibility The South Central SHA makes no obligation for individual organisations to train senior nurses to undertake this role however – There are senior nurses who have the right competency and skills to enable them to have these discussions, to the benefit of their patients and organisations. The decision to train senior nurses in this extended role lies with individual organisations that retain accountability for the clinical governance for DNACPR decisions that originate within their operational jurisdiction. This allows for the portability of the decision making and the completed DNACPR form.

The process Senior Nurse checks competencies against framework Senior Nurse fulfils criteria and seeks recommendation by their manager using SHA competency assessment signing off form Senior Nurse may undertake training programme which is facilitated by a senior practitioners / educators with an appropriate skill set Following this process if the senior nurse feels confident and an organisational agreement is in place, the senior nurse can practice this extended skill

Competencies practitioners need for discussions around DNACPR decision making Organisational Skills Higher Level Decision Making Advanced Communication Skills Knowledge And Skills

The training This extended role will only be offered to senior nurses who fulfil all of the competencies, therefore, the training programmes should be able to be completed in 4 -5 hours.

The Booklet Contents (Pre course reading!) The booklet covered Introduction Pre Course explanation Explanation of role rehearsal Review of facilitative communication skills Review of the communication process The SHA uDNACPR policy….in context of the Mental Capacity Act When to have discussions – pivotal or transition points References and further reading prompts

Questions from the booklet

The training The training will include watching and reflecting on 3 DVD’s which represent 1a, 1b and 1 c decision making There will be an opportunity during the training programme for role play to engage in simulated real life scenarios These scenarios will relate to predominantly 1a and 1b decisions

Example of Training Programme

Expectation of Role Play Agree Ground Rules Avoiding triggers/connection to own experiences Telephones / Bleeps Give constructive feedback Non judgemental attitude Confidentiality Any others

Reviewing the DVD’s As you watch these please note…. What went well? Phrases you liked The facilitative skills used How they relate to the SHA policy?