A multi-professional educational intervention to improve and sustain respondents' confidence to deliver palliative care: A mixed-methods study.

BACKGROUND: Education has been highlighted as fundamental in equipping healthcare professionals with essential knowledge and skills to provide good end-of-life care. Multiprofessional educational programmes have a positive influence on knowledge, attitude and confidence but few have sought to understand the longer term impact on care delivery. The European Certificate in Essential Palliative Care is an 8-week home-study-based programme for healthcare professionals and is currently run in nine centres. Successful candidates have undertaken the course from their own countries around the world. This article describes the evaluation of the European Certificate in Essential Palliative Care which has been evolving over 15 years. AIMS: To evaluate the impact an educational intervention has on participants' confidence in palliative care, to determine whether this is sustained over time and explore participants' perception of the influence of the course on confidence. DESIGN: A mixed-method longitudinal approach. SETTING/PARTICIPANTS: A survey using a self-efficacy scale was emailed to 342 candidates who received an educational intervention and semi-structured interviews to a sub-sample of 15 candidates at baseline, 3 and 6 months. RESULTS: At 3 months, candidates had almost 20 times higher odds of being above any given level of confidence than at baseline which was sustained at 6 months. Qualitative analysis identified examples of increased competence and confidence improving palliative care delivery. CONCLUSION: Findings suggest that the European Certificate in Essential Palliative Care improves confidence in palliative care and that this is sustained over time with evidence of confidence in symptom control, communication and a holistic approach in clinical practice.

Examining the nature of interprofessional interventions designed to promote patient safety: a narrative review.

PURPOSE: This narrative review aimed to scope the patient safety literature to identify interprofessional intervention approaches, sources of evidence and reported outcomes. DATA SOURCES: Two major databases (MEDLINE and CINAHL) were searched from 2005 to 2015. STUDY SELECTION: A total of 1552 abstracts were initially identified. After screening these abstracts, 129 full papers were obtained. Further screening resulted in a total of 89 papers included in this review. DATA EXTRACTION: The following information was extracted from each included paper: details on the patient safety intervention, study methods employed and outcomes reported. RESULTS OF DATA SYNTHESIS: It was found that the bulk of the included studies was undertaken in a North American acute care context. Most often, studies involved qualified professionals from nursing and medicine collaborating in hospitals and medical centres. Nearly half the studies reported in this review employed educational interventions, such as TeamSTEPPS, aimed at enhancing practitioners' competence of delivering safe patient care. Nearly a third of studies involved practice-based interventions (e.g. checklists) aimed at improving the delivery of safe care. Most of the studies used a quasi-experimental design and typically gathered survey data. The majority reported outcomes related to changes in professionals' attitudes, knowledge and skills. There were, however, fewer studies reporting changes in practitioners' safety behaviours, organizational practices or patient benefit. CONCLUSION: The use of different interprofessional interventions are key activities involved in promoting safe patient care practices. However, further work is needed to strengthen these interventions and their evaluations.

'This is my story, how I remember it': In-depth analysis of Dignity Therapy documents from a study of Dignity Therapy for people with early stage dementia.

Dementia is a progressive condition that impacts on individuals, families and care professionals. Maintaining quality of life through engagement with the person with dementia is an important part of their care. Dignity Therapy is an interactive, psychotherapeutic intervention that uses a trained dignity therapist to guide the person with dementia through an interview that then creates a written legacy called a generativity document. This can provide knowledge to inform care, as the condition progresses. Generativity documents were analysed using framework analysis. Main themes from the analysis were origin of values, essence and affirmation of self, forgiveness and resolution and existentialism/ meaning of life. These themes provide evidence of the type, scope and contribution that information generated from Dignity Therapy can make to the care and support of people with dementia. They provide information about the values, self-identity and the people and events that have been important to them and influenced their lives.

Living well with dementia: enhancing dignity and quality of life, using a novel intervention, Dignity Therapy.

AIMS AND OBJECTIVES: To assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to improve the quality of life and reduce psychological and spiritual distress in older people with early stage dementia. BACKGROUND: Dementia is a syndrome with several causes that leads to a progressive decline in multiple areas of functioning. The maintenance of dignity and enhancement of quality of life are key elements of care. Meaningful communication may become more difficult with condition progression. Improvements in communication may have positive effects on the person's quality of life. Dignity Therapy is a short psychotherapeutic intervention that uses a trained therapist to take the person with dementia through a guided interview process, producing a 'generativity' document that creates a lasting, written legacy during a time when they are still able to communicate well. DESIGN AND METHOD: This was a feasibility mixed method study. Dignity Therapy was undertaken with patients diagnosed as having early stage dementia. Data were gathe-red from pre- and post-Dignity Therapy interviews, a focus group, interviews with key stakeholders, and three outcome measures: The Herth Hope Index; The Patient Dignity Inventory; Perceived Quality of Life/Satisfaction with Quality Life Ratings. FINDINGS: This study demonstrated that Dignity Therapy is feasible, acceptable and potentially effective for older people with dementia. Three overarching themes emerged: A life in context, A key to connect and Personal legacy. CONCLUSIONS: We recommend that this feasibility study forms the basis for further study, advocating the prospective benefits to patients with dementia, families and nursing practice. IMPLICATIONS FOR PRACTICE: Dignity Therapy, as a psychosocial intervention, has the potential to improve the quality of life and enhance person centred care for people with dementia.

A mixed methods exploration of families' experiences of the diagnosis of childhood spinal muscular atrophy.

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease with a carrier frequency of 1 in 41 in Australia. Childhood SMA is classified into three types based on the age at which children present with symptoms and the clinical severity. Families' experiences leading up to the diagnosis have not been described, but are important when considering the potential for a diagnostic odyssey. Using a mixed methods approach, data were collected from interviews and a national survey of families of children with SMA to explore their experiences of this journey. The combined findings (n=28) revealed that the journey to receiving a diagnosis was protracted. The time from first noticing symptoms to finally receiving a diagnosis was emotional and frustrating. Once parents or other family members became aware of symptoms, almost all had consulted with multiple different health professionals before the diagnosis was ultimately made. Not surprisingly, receiving the diagnosis was devastating to the families. The nature of the information and the way it was given to them was not always optimal, particularly because of the difficulties predicting clinical severity. Most felt that their child could have been diagnosed earlier and, although there were mixed views around the benefit of this for their child, they felt it may have reduced the emotional impact on families. Overall, families were more in favour of population carrier screening for SMA when compared with newborn screening of the population. Despite an increasing awareness of SMA, the diagnostic delay continues to have negative impacts on families.

Timely symptom management at end of life using 'just in case' boxes.

This article discusses the successful implementation of anticipatory prescribing using 'just in case' boxes (JICB) in primary care across the Grampian region and a subsequent follow up survey one year later. The implementation approach used local educational sessions to primary care clinicians. The survey was distributed to 65 primary care bases to gauge awareness and use of the JICB and thoughts about how the box was used. An estimate of prescription costs was undertaken using stock balance forms. The response rate was 89%. All respondents had heard about the JICB and most had used a JICB. There were 37 positive comments about the benefits to patients, 15 comments about the process and 11 negative comments, often about possible drug wastage. The cost of a prescription was estimated at pounds 22.12. The findings have informed our ongoing educational programme and build on the strong links that exist between primary care and the specialist palliative care service.

Introducing the Palliative Performance Scale to clinicians: the Grampian experience.

OBJECTIVES: The Palliative Performance Scale (PPS) was introduced across NHS Grampian. Our aim was to determine how practical and useful the PPS was for clinicians looking after palliative patients in a variety of settings. METHODS: A prospective audit approach was used in primary, secondary and nursing home care settings who. Demographic and assessment data were gathered for 3 months; feedback was gathered at the end of the data collection phase. Patient follow-up status was determined at 12 months. RESULTS: Fifteen clinical sites participated and feedback was obtained from all clinical areas (n=30). Most respondents found the PPS easy to use and that it helped recognise disease progression in cancer patients, but not in patients with dementia/frailty. Assessment data were gathered on 666 patients. Sixty per cent had a malignant diagnosis and 62.5% of the sample died within 12 months. Lower PPS scores at initial assessment indicated poorer prognosis. Median survival figures differed from previously published data. Falling PPS scores increased the risk of death compared with patients whose PPS scores remained static or improved. CONCLUSION: Clinicians found the PPS to be a quick, useful way of assessing and reviewing functional changes in palliative patients. However, it may not identify the subtle changes in individuals with advanced dementia. The survival figures confirm that caution is needed in generalising survival data across different settings and populations. Further work is needed to examine changing functional status in patients with non-malignant diseases or dementia/frailty.

Use of an adapted problem-based learning approach to aid the development of clinical audit skills in a palliative care setting.

AIM: To share the experiences of an adapted problem-based learning approach to audit within a palliative care setting. METHOD: A small group learning approach to design and undertake an audit. RESULT: This approach was a positive learning experience within clinical practice that enabled the group to develop their knowledge of audit planning, design, analysis and reporting as well as their problem-solving, written and communication skills. CONCLUSION: The facilitated group approach promoted shared learning, problem solving and the opportunity to develop audit skills within a supportive environment. Overall, this approach enabled the participants to gain confidence by engaging in learning within the work setting.

Assertiveness: making yourself heard in district nursing.

Being assertive is not the same as being aggressive. Assertiveness is a tool for expressing ourselves confidently, and a way of saying 'yes' and 'no' in an appropriate way. This article explores issues concerned with assertiveness in district nurse settings. It outlines helpful techniques to develop assertiveness, such as the broken record, fogging, negative assertion and negative inquiry.

Communication skills and district nurses: examples in palliative care.

This article discusses some communication skills that may be challenging for district nurses who are working with palliative care patients. The article suggests that assessing what the patient knows about their illness is a key factor to effective communication. It pays particular attention to the first visit made by the district nurse. The article also discusses some specific situations that the district nurse may encounter, such as answering direct patient questions, denial, collusion and anger. A framework of communication styles developed by Wilkinson is used to understand the responses that may be given in such challenging situations.

Continuing professional development: a review.

In the UK health sector, continuing professional development for nurses is now clearly identified as necessary to the continued improvement of clinical services. The clinical governance movement that is driving this improvement has had a great effect on the NHS and it is now necessary to demonstrate service maintenance and improvement. Lifelong learning and the enhancement of skills through training or self-development are mentioned as ways of providing staff governance (DoH 1999, SEDH 1999).