1

Facilitator: Step 2

2

Review / Recap

• Step 1 workshop review

• Review of ‘To Do’ List

• Reflection discussions

3

Objectives

Step 2 objectives:

• Recognise the importance of holistic care planning

• Show awareness of assessment of mental capacity

• Show awareness of advance care planning

• Recognise collaborative working methods

4

Step 2

Assessment, care planning and review

“As the end of life approaches it will be essential that an assessment of an individual’s needs has taken place, and that the care worker is familiar with it’s requirements.

The assessment should include physical, psychological, spiritual and cultural and, where appropriate, environmental and financial issues”

The Route to Success in End of Life Care – achieving quality in domiciliary care

5

Activity - A Good Death

• Groups:

The individual

The family

The domiciliary care worker

6

Holistic Assessment

“You matter because you are you, and you matter to the last moment of your life”

Dame Cicely Saunders

What is holistic assessment?

7

Holistic Assessment

• Ensures that all needs of a person are known so that those caring for them can respond accordingly

• Identifies unmet needs

• Co-ordinates care

• Continual process

8

The Whole Person

The Whole Person

Emotional

Cultural

Physical

SocialPsychological

Religious

Spiritual

9

Activity – Holistic assessment

• Discuss current tools in use for assessment of individuals

• Group work: Step 2 case study

• Domains: Physical, Psychological, Spiritual, Social

10

Physical Problems

• Hair Care• Eye problems• Oral problems• Breathlessness• Pain• Constipation• Urinary problems

11

Hair careCleanliness

Sexuality.

Dignity

Body image

Bedbound clients

What can you do to help?Shampoo Cap

Dry shampoo

Washing technique in the bedbound client

Maintain dignity

12

Eye careCommon eye problems• Infection• Injury • Dry eyes• Damage to cornea in unconscious patients

Aims of eye care• Comfort• Cleanliness• Moisture• Prevention of infection• Alleviate pain and discomfort• Management of infection

Follow local eye care protocol

13

Mouth care

Common mouth problems;• Cracked lips• Poor fitting dentures• Fungal infections e.g thrush• Lack of saliva, dry mouth

Aims of good mouth care;• Comfort• Cleanliness• Moisture• Prevention of infection• Alleviate pain and discomfort and promote oral intake• Prevent halitosis and freshen the mouth

Follow local mouth care protocol

14

Breathlessness

Consider the causes of breathlessness

How can you help the breathless client?

15

Don’t panic yourself

Keep calm

Encourage client to relax

Different breathing techniques

Fan

Medications as prescribed

Referral

16

Pain

Consider the causes of pain?

17

Recognising pain

Client tells you

Agitation

Holding or stroking body

part

Facial expression

Restless

Mood change

Body language

Management of pain

18

Assessment- VAS Regular medication as prescribed Changes in position Bedding/support pillows Quiet environment Distraction activities e.g. music Massage Sitting talking Referral

19

Personal hygiene

What are the issues?

20

Personal care

Consider;Keeping patients feeling fresh

Tiredness

Pain

Lack of equipment

Maximising the persons independence

Maintaining dignity

Is your patient well enough for a full shower or bath?

Access to clean clothes/nightwear

Maintaining the clients usual routine

Moving and handling

21

Skin integrity

• Pressure area care assessment

• Specialist aids; beds, mattresses

• Repositioning

• Cleansing of the skin

• Management of incontinence

• Observation and recording

Urinary & Catheter Care

What are the issues?

23

DietFluidsAppetiteEquipmentAccess to toiletPresentation

24

Elimination

Constipation-

What are the issues?

25

Mental Capacity

The ability to make one’s own decisions. The individual must be able to:

• Understand the information given to them

• Retain that information long enough to be able to make

a decision

• Weigh up the information available to make a decision

• Communicate their decision

26

Abilities

Consider:

• An individual with communication difficulties

• An individual with reduced mental capacity

27

Two Stage Test

To assess mental capacity we consider:

• Stage 1: Is there an impairment of, or disturbance in the functioning of a person's mind or brain? If so,

• Stage 2: Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision?

28

Best Interest Decision Making

• Decisions can be made for the individual in their considered ‘best interests’, if they are unable to express their wishes independently (i.e. lack capacity / inability)

• Discuss the legal and ethical implications of ACP and best interest decision making

29

Advance Care Planning

• The expression and documentation of an individual’s clear wishes about future care

• May include place of care at end of life, treatments to have and not to have, whether to be resuscitated or not, whether to be hospitalised or not

30

ACP in practice

• How does ACP work in your organisation?

Discuss:

Preferred priorities of care (PPC) Advance decision to refuse treatment (ADRT) Do not attempt resuscitation (DNAR)

31

Collaborative working

• Who supports the individual’s care at the end of life?

• In groups create a spider diagram

• What systems exist for discussion, recording and communicating...?

32

Remember...

“Death is a personal journey that each individual approaches in their own unique way. Nothing is concrete, nothing is set in stone. There are many paths one can take on this journey but all lead to the same destination.”

(Morrow, A. 2010)

33

Objectives

Step 2 objectives:

• Recognise the importance of holistic care planning

• Show awareness of assessment of mental capacity

• Show awareness of advance care planning

• Recognise collaborative working methods

34

Onwards...

• ‘To Do’ List

• Reflective practice

• Evaluation of session

• Next session: Step 3: Co-ordination of care