Facilitator: Step 2

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

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 care 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 • 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

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. 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 CareWhat 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

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