Sharing Current Scottish Practice

Poster Abstracts of the Month - April

The SPPC Annual Conference in 2013 featured 36 poster displays, sharing work and research underway across Scotland. Each month, this blog will focus on the content of a few of these posters.

This month, we focus on:

Evaluating Namaste Care: Creating a sacred space for shared positive experiences with care residents with advanced dementia

Evaluation of a Pilot Bereavement Support Training Programme in Schools

Evaluation of the ACP process in a demonstration site in North Ayrshire

Expressive Support: an innovative, person-centred approach to spiritual assessment and holistic care

Health Promoting Palliative Care: Nurturing roots to bring new growth

Evaluating Namaste Care: Creating a sacred space for shared positive experiences with care residents with advanced dementia
Author(s): Reid L (ACCORD Hospice, Paisley)

Background: Despite the increasing incidence, challenge and cost of dementia care, questions remain about how best to care for people with End-Stage Dementia (ESD). Namaste Care (NC) is an emerging multi-sensorial model of palliative care which aims to improve the quality of living and dying for people with ESD.

Methods: This project explored care staff’s perspectives on NC for residents with ESD in one care home. Principles of Appreciative Inquiry guided the year long process of implementation, and an inductive template analysis framework was adopted to code and analyse over 100 staff diary entries.

Results: Staff satisfaction with NC was correlated to perceptions about: residents have a positive reaction to NC, NC improving residents’ quality of life, and having shared positive experiences of NC. When staff could create/access what was reframed as ‘sacred space’ they brought an intentional presence to their work that was not deemed possible outwith the NC room.

Creating/accessing and holding ‘sacred space’ was a complex activity; the space was fragile and easily disrupted.

Residents’ response to NC was predominantly positive. Residents demonstrated moments of connection with staff and engagement with NC through episodes of gestural communication, movement with intentionality, sociability and spontaneous, often apparently joyful, actions. Reading aloud while sitting close to residents, a modification to the original programme was a bonding activity which had the unexpected result of soothing and calming residents during periods of restlessness.

Conclusion: These findings mirror the growing literature base around embodiment and dementia which highlights the ‘self’ is not obliterated by disease, but can still be communicated through the body. NC can be used to organise intentional and meaningful opportunities for people with ESD to express themselves in an environment where someone is potentially ‘listening’ to their embodied communication thereby enabling them to retain involvement in their lives despite advanced disease.

Evaluation of a Pilot Bereavement Support Training Programme in Schools
Author(s): McManus E; Paul S (Strathcarron Hospice, Denny)

Recent policy making in the United Kingdom focuses on engaging communities to change attitudes and develop capacity in end-of- life care and bereavement (Scottish Government 2008, Department of Health 2008). In Scotland, engaging with schools to equip children with skills and knowledge to cope with death and bereavement has been emphasized (Scottish Government 2010). Based on findings of a PhD research project exploring how Strathcarron Hospice can develop work in this area with primary schools, providing bereavement training to school staff was identified as a high priority.

This poster presents the results of a pilot bereavement training workshop offered to two primary schools in Forth Valley. The training was delivered to 47 teaching and support staff. Confidence levels and beliefs/attitudes were measured pre and post workshop. A significant upward trend in confidence was clearly evident across all domains of the training compared with pre-workshop scores.

Participants noted the training positively influenced their ability to engage with bereavement experiences. This is significant given school staff experience anxiety in relation to their role in bereavement support and currently no undergraduate teacher training is provided.

Recommendations include longitudinal evaluation as the workshop is rolled out to all schools within Forth Valley.

Evaluation of the ACP process in a demonstration site in North Ayrshire
Author(s): Connolly J (NHS Ayrshire and Arran)

Aim: To find out if the implementation of the Advance/Anticipatory Care Planning (ACP) process reduced avoidable admissions to hospital and increased the likelihood that the person would receive their end of life care in the place of their choosing.

Methods: The UWS external evaluation team collected data from nine semi-structured interviews with care home and community nurses and 1GP who had utilised the ACP process and completed ACP documentation.

Results: The general consensus between those interviewed was that ACP was a worthwhile process and beneficial. Many recognised the positive influence and differences in their practice, others highlighted areas for further development such as completion of the ACP documentation, engagement of relatives and resistance from professional groups. The impact on individual patients were largely positive with many of the participants recalling positive outcomes for people achieving their preferred place of care and more consultation regarding hospitalisation.

Conclusion: Overall the ACP implementation is progressing within the demonstration site. There is some emerging evidence that the ACP process is making a difference to patients/residents achieving their wishes for place of care. However reasons for these wishes not being met varied due to attitudes and behaviours of professionals, organisational culture and priorities within practice.

Expressive Support: an innovative, person-centred approach to spiritual assessment and holistic care
Author(s): MacDonald H; Macgregor R; McGee B (St Vincent's Hospice, Howwood)

Having completed a person centred art therapy course, specifically designed for those in caring professions, a Community Nurse Specialist extended her role to facilitate an innovative, six week pilot project as an approach to spiritual assessment and holistic care.

A person centred expressive support group was planned to investigate the therapeutic effectiveness of the use of colour and imagery as a vehicle for self and group expression. The aim was to evaluate the overall impact of the experience on the individual and the corresponding relationship to the professional assessment and quality care of ‘the person’.

Spiritual care is pivotal to person centred care. As far back as1993, Saunders and Sykes defined ‘the spirit’ as the vital principle within a person and it therefore follows that spiritual care is at the heart of all that we do. It is not an added extra (Wright and Neuberger, 2013).

Evaluation of participants experience was both individual and collective. The outcome generated a wealth of positive feedback and a desire from all the participants to continue with the group.

Health Promoting Palliative Care: Nurturing roots to bring new growth
Author(s): Keicher T (NHS Fife)

The Scottish Government response to global policy was the implimentation of Living and Dying Well to facilitate equity within palliative care. However, demand outweighs resources and burgeoning pressures on healthcare professional and communities are a real concern. Practitioners are pivitol in disseminating knowledge and skills to empower individuals to control their own health. Change is disconcerting to a workforce and difficulties can arrise with a shift from didactic to participatory forms of health care. Quality of life and social relationships alongside promoting well being are key areas in international and local policy. This is a creative education poster focusing on the role of critical reflection. The aim is to raise self awareness and facilitate change in perspective and to link health promotion with advanced practice in palliative care, shifting from a reactive to proactive model. The hope is that it can assist to challenge current practice and highlight future directions of alliative care whilst linking it to the past. The visual image of a tree encourages participation and learning through constructive alignment.

Poster Abstracts of the month - March

The SPPC Annual Conference in 2013 featured 36 poster displays, sharing work and research underway across Scotland. Each month, this blog will focus on the content of four of these posters.

This month, we focus on:

• Developing National Guidelines for Palliative Care
• Dying Matters... Let's Talk About It! Public Awareness Event
• End of life care in South Glasgow acute hospitals - the death of the LCP?
• Enhancing anticipatory care planning through partnership working: the STACCATO approach

Developing National Guidelines for Palliative Care

Author: Blues D (Scottish Partnership for Palliative Care

Summary of work to date to develop national palliative care guidelines.
Includes the methodology and work to date, next steps and information on how the guidelines and supporting resources will be available to users.

Dying Matters… Let's Talk About It! Public Awareness Event

Author(s): Donaghy C; Lindsay J; O'Donnell E; Silver A (St Margaret of Scotland Hospice, Clydebank)

Living and Dying Well, the Scottish Government’s action plan on palliative and end of life care was published in 2008. The action plan recommended the establishment of short life working groups (SLWGs) to take forward developmental work on specific issues.

The remit of SLWG 7 was: ‘to assist, within the context of Living and Dying Well in the development of a truly accessible and cohesive approach to palliative and end of life care across Scotland by: exploring ideas and issues for addressing palliative and end of life care from a public health and health promotion perspective, including public and professional awareness of and attitudes towards death, dying and bereavement; developing recommendations regarding appropriate initiatives to:

- address current low levels of awareness of palliative and end of life care
- address existing societal taboos around discussion of death and dying and
- enable people (patients, families, professionals and the general public) to feel more comfortable in speaking about such issues.’

and so Good Life Good Death Good Grief was born…

Many people are denied the opportunity to discuss and plan for their death and dying. There is limited understanding of the long term effects of bereavement and loss, together with a lack of opportunity to share common experiences. There are potential benefits from a more open approach to these issues, for society, communities and individuals.

To fulfil two points of the NHS Greater Glasgow and Clyde MCN Action plan -

Point 1: Patient and Carer Preferences and Experiences and Point 2: Introduce Anticipatory Care Planning, St Margaret of Scotland Hospice - Hospice Lecturer, NHSGG&C Health Improvement Senior Officer and two NHSGG&C Anticipatory Care Plan Nurses - developed a steering group to creatively address the remit and recommendations of SLWG 7. Three Public Awareness ‘Dying Matters, Let’s Talk About It’ events were planned for 2013, two of which have been fulfilled. In total 101 people have attended from across public and professional realms all sharing a desire to address the great taboo of death, dying and bereavement.

End of life care in South Glasgow acute hospitals – the death of the LCP?

Author(s): McEvoy K; McKeown A; Walker SHJ; Wotherspoon I (NHS Greater Glasgow and Clyde)

Following recent negative publicity and the concerns identified in the Neuberger Report (‘More Care, Less Pathway: A Review of the Liverpool Care Pathway’) we thought it topical and important to review and reflect upon the current practice of end of life care in South Glasgow Hospitals and consider future changes.
A retrospective review was performed of the last 5 expected deaths occurring on all of the medical wards at SGH and VI.

Data collected included evidence of documentation of: recognition of the patient deteriorating by the medical team, patient and family; discussion regarding the initiation of the LCP; whether a DNACPR was in place; the patient’s primary diagnosis; medication review and whether anticipatory medications were prescribed; assessment of the patient’s spiritual needs; and the standard of nursing care received.

The data was analysed by the clinical effectiveness department. 51 audit forms were returned. Areas of good practice and areas needing improvement were highlighted, and comparison was made between the documented end of life care received by patients on the LCP and those who were not.

Enhancing anticipatory care planning through partnership working: the STACCATO approach

Author(s): Bilsland T; Cormie P; Highet G; Medley L; Small D (STACCATO Project Team NHS Borders; Scottish Borders Council)

The poster describes a multi-disciplinary anticipatory care project currently being piloted in the Scottish Borders. STACCATO is the Stow Anticipatory Care Community Assessment Tool, a computer-based tool developed jointly between Health and Social Work, assessing both health and social care needs. It comprises a full assessment of what a person is able to do for themselves and what help they are currently receiving. Using information gained, families will be helped to form a care plan for when the person being assessed is unwell. The aim is to help health and social care staff ensure people are getting all the assistance they need to try and prevent problems and to keep them as independent as possible at home. If people have a relative or friend who helps look after them (their carer) then the assessment will also help to make sure they are receiving the support they need to continue to do this. Early findings from the STACCATO evaluation demonstrate that the project shows great promise and is leading the way in providing integrated, joined up support for the increasing numbers of people living into older age, many with multiple, complex support needs.

Poster abstracts of the month - February

The SPPC Annual Conference in 2013 featured 36 poster displays, sharing work and research underway across Scotland. Each month, this blog will focus on the content of four of these posters.

This month, we focus on:

Poster abstracts of the month - January

The SPPC Annual Conference in 2013 featured 36 poster displays, sharing work and research underway across Scotland. Each month, this blog will focus on the content of four of these posters. This month, we focus on:

• A limited systematic review of the efficacy of the management of paraneoplastic sweating in palliative care populations
• Audit of oxygen therapy in a specialist palliative medicine unit
• Audit of the efficacy of Snoezelen Therapy in a specialist palliative care unit
• Better palliative care for heart failure patients, the Caring Together Programme

A limited systematic review of the efficacy of the management of paraneoplastic sweating in palliative care populations

Author(s):Mullin J (Cicely Saunders Institute; NHS Lothian)

Background: Paraneoplastic sweating is a distressing symptom to both patients and carers, interrupting sleep and causing daytime hyper-somnolence, fatigue and mood disturbance. Various therapeutic approaches have been trialled but there are no published clinical guidelines in place.

Aims: To present and critically appraise the published literature regarding pharmacological and non-pharmacological treatments for paraneoplastic sweating.

Method: A literature search was performed on Health Management Information Consortium, International Pharmaceutical Abstracts, OvidMEDLINE®, Embase, EmbaseClassic and OvidNursing. Further papers were identified from the reference lists.

Results: Reports of reduced sweating were identified for 5 pharmacological and 2 non-pharmacological treatments:

1. Cannabinoids: 1 case series

2. Thioridazine: 2 un-controlled trials

3. Somatostatin anologues: One case report

4. Thalidomide: 3 case reports & a crossover study of 6 patients

5. Etanercept: Incidental finding in open-label pilot study

6. Gabapentin: One case series

7. YuPing FenSan: One prospective trial.

Conclusions: The evidence for each treatment largely relies upon case reports and under-powered, uncontrolled, unblinded trials. As such, the evidence is currently of insufficient quality to create guidelines for clinical practice. Moreover, the success of some individual drugs has been handicapped by the palatability of treatment, side-effects and financial constraints.

Audit of oxygen therapy in a specialist palliative medicine unit

Author(s):Simmons C; Welsh J (St Margaret of Scotland Hospice, Clydebank)

Introduction: We audited the use of normobaric hyperoxia against guidelines issues by the British Thoracic Society (BTS). These state that oxygen should be prescribed to achieve target oxygen saturation of 94-98% for most acutely ill patients or 88-92% for those at risk of hypercapnic respiratory failure. Moreover, the target saturation should be documented on the drug prescription chart.

Methods: Retrospective analysis of the drug charts for all in-patients throughout January 2013 (cycle1) and April 2013 (cycle 2) was performed by 2 clinicians in St Margaret of Scotland Hospice.

Results: Cycle 1: Four of twenty one patients (19%) required supplemental oxygen. All patients had oxygen prescribed (100%) but only 1 (25%) had oxygen prescribed with the correct target saturation documented.

Results were presented orally to medical staff and via posters, and formal presentation of standards issued. Anticipatory care prescription sheets were modified to include oxygen for all in-patients for administration at time of need.

Cycle 2: Three of twenty patients (14%) required supplemental oxygen and all of these (100%) had oxygen prescribed regularly and all (100%) with correct target saturation documented which represented an improvement.

Conclusion: After intervention there was improvement to 100% adherence to the standard required for oxygen prescription.

Audit of the efficacy of Snoezelen Therapy in a specialist palliative care unit

Author(s):McMillan J (St Margaret of Scotland Hospice, Clydebank)

Introduction: Snoezelen is a therapy developed in the seventies in an establishment caring for disabled people. It is a multisensory environment. The evidence suggests it is beneficial for use within a Specialist Palliative Care unit for promotion of relaxation and some anxiety and pain management within a supportive setting.

Aim: To explore the effectiveness of Snoezelen Therapy for patients with specialist palliative care needs.

Methodology: Retrospective analysis of participants. Evaluation was performed on 11 random participants after 1 or more session(s) in the Snoezelen with a set questionnaire focussing on the benefits and experience participants felt through the use of the Snoezelen room.

This Specialist Palliative Care unit has a dedicated Snoezelen room with state of the art equipment. Results were disseminated and presented to a Multi-professional Meeting.

Result:

Ÿ number of participants who enjoyed the session – 9

Ÿ number of participants who would like to experience further sessions – 11

Ÿ number of participants who experienced relaxation – 9.

Snoezelen Therapy for patients who have Specialist Palliative Care needs can be beneficial to patient care and quality of life through providing relaxation, enjoyment and a peaceful environment.

Better palliative care for heart failure patients, the Caring Together Programme

Author(s):Armstrong I; Millerick Y (British Heart Foundation; Marie Curie Cancer Care; NHS Greater Glasgow and Clyde)

Heart failure is a life-limiting condition affecting up to 100,000 people in Scotland. Compared with many cancer patients, heart failure patients have a worse prognosis , poorer quality of life, and limited access to social services and palliative care.

In the first two years of the programme (June 2011 and June 2013), over 230 heart failure patients with palliative care needs have been referred to the Caring Together. These patients have benefited from a holistic assessment, anticipatory care planning, identification of a care manager and appropriate onward referral to other services such as day therapies and benefits assessment.

Caring Together designed and developed six core components with the support of key stakeholders including patients and carers. These core components were implemented as part of integrated models in three pilot sites across NHS Greater Glasgow and Clyde to meet local patient needs and within existing healthcare resources and structures. These models of care and core components were refined over two action research cycles to ensure that the models meet patient, care and clinician needs.

A key outcome is that Caring Together patients are less likely to die in hospital and more likely to be cared for and die in their preferred place of care, home.