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.