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

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.

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

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

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

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 (1918-2005) Nurse, Physician, Writer, Founder of the Hospice movement Discuss what is holistic assessment?

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

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

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

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

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

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

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

Breathlessness Consider the causes of breathlessness

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

Pain Consider the causes of pain?

Holding or stroking body part Facial expression Body language Mood change Client tells you Recognising pain Restless Holding or stroking body part Agitation

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

Personal hygiene What are the issues?

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

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?

Diet Fluids Appetite Equipment Access to toilet Presentation

Elimination Constipation- What are the issues?

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

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

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

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

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

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

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)

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

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

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