1. Facilitator: Step 2 Welcome group, housekeeping, register
Ice breaker if choose to do one
Ground rules to flip chart for weekly display.

2. Review / Recap Step 1 workshop review Review of ‘To Do’ List
Reflection discussions
Step 1 revisit/summary – ask participants to identify one thing they learned from the step 1 workshop
Discuss homework completions – ‘To Do’ list and reflection piece
Facilitator to emphasise that evidence may be used for QCF end of life unit, award, certificate – if undertaking now or in the future.

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
Progress through ppt as prompt screens

4. Assessment, care planning and review
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
Review RTS workbook pages 13-14

5. Activity - A Good Death Groups: The individual The family
The domiciliary care worker
Using homework sheets from last week – participants to work in the group to identify what makes a good death?
Groups to take one heading from above and list what is a “good death” from that heading perspective ‘post its’ of comments and place under the step they consider appropriate
Facilitator then to identify 2 steps to each group to work on, participants also to identify what aspects are their own roles and responsibilities
Facilitator to consolidate activity

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?
Dame Cicely Saunders ( ) Nurse, Physician, Writer, Founder of the Hospice movement
Discuss 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
Information references not handouts for support – per facilitator session plans

8. The Whole Person
The Whole Person
Emotional
Cultural
Physical
Social
Psychological
Religious
Spiritual
An individual with unique thoughts, feelings, wishes, preferences
Facilitator to expand

9. Activity – Holistic assessment
Discuss current tools in use for assessment of individuals
Group work: Step 2 case study
Domains: Physical, Psychological, Spiritual, Social
Current tools – Visual Analogue Score (pain), Abbey pain scale, HOPE assessing spiritual needs, depression and anxiety scales, MUST (nutrition), skin integrity, etc – measure assessment of one part of the person. Facilitator to example.
Groups with one heading to focus on/ or ask all to be considered (dependant on facilitator preference) : Physical, Psychological, Spiritual and Social – Review case study distributed
Discuss care planning from own group heading perspective in relation to the case study and record findings onto the care plan
Feedback

10. Physical Problems Hair Care Eye problems Oral problems Breathlessness
Pain
Constipation
Urinary problems

11. Hair care What can you do to help? Cleanliness 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 care Common eye problems Aims of eye care 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; Aims of good mouth care;
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

15. How can you help the breathless client?
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. Holding or stroking body part
Facial expression
Body language
Mood change
Client tells you
Recognising pain
Restless
Holding or stroking body part
Agitation

18. Management of pain 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

22. Urinary & Catheter Care What are the issues?

23. Diet
Fluids
Appetite
Equipment
Access to toilet
Presentation

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
How can worker support a person in EOLC with LD, dementia, stroke, mental health difficulties? Discuss

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?
Emphasis this may not be permanent
The formal assessment of mental capacity comes from professionals, i.e. The GP; however the DCW may contribute to the process by highlighting concerns of mental capacity issues
Handout / Information reference signpost

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
Handouts

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)
Handouts
Group activity – identify changes which indicate a need to review care plans and initiate referrals

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...?
Into groups for creation of spider diagram of support involved for the individual (keep these for future step workshops)
Feedback findings
Facilitator to prompt discussion for how discussions, communication and records take place....summarise to NW EOLC register use to co-ordinate care (refer back to file copy)

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)
Our choices and thoughts may not be the same as the individuals, but it is our job to support them in the best way possible

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
Revisit

34. Onwards... ‘To Do’ List Reflective practice Evaluation of session
Next session: Step 3: Co-ordination of care