East of England End of Life Care Education Programme ABC Education Project Plan September 2010 Final Version Authors: Sarah Russell Project Lead: Bedfordshire and Hertfordshire sarah.russell@stfrancis.org.uk Carolyn.fowler@nhs.net
Contents: Page: 1. Introduction 03 2. The Project Plan 03 3. Pre Planning 03 4. Risk Assessment 04 5. Description of ABC Project 05 6. Participants 07 7. Evaluation of Learning and Impact Measurement 07 8. Stakeholders and Participants Communication Strategy 07 9. Education Pathways 08 10. Overview of ABC EOLC Education Pathway 11 11. Appendix 1 National E learning Mapping 12 Senior Medical Staff Junior Medical Staff Senior Nursing Staff Junior Nurisng Staff Clinical Support Worker/HCA Pharmacist Physiotherapist, Occupational Therapist, SALT and others Social Worker Acknowledgements: Palliative Care Practitioners, Educators and Commissioners across the project areas and the East of England Strategic Health Authority Page 2 of 27
1.1 Introduction This plan has been produced to give detail to the Education End of Life Care Education Project: ABC End of Life Care Education. The aim of ABC End of Life Care Education is to increase the level of confidence and competence of workforce group B&C staff in the delivery of end of life care. It is to be delivered over 2 years by the consortium established by the three End of Life Care Networks (EOLC)- Bedfordshire, Hertfordshire, Anglia and Essex. The project is facilitated by specifically funded End of Life Care Facilitator Educators (EFE s) and Project Leads for the three areas. The project has been funded by the East of England Strategic Health Authority. This plan covers a schedule of events, a risk assessment, a description of the project and an example journey of the work force group B and C participants taking part in the education programme. 2.1The Project Plan This plan covers the prerequisites needed before the East of England End of Life Care Education Programme (EOE EOLC) can be delivered. This includes the recruitment of a project leader per area and administrative support, End of Life Education Facilitators (EFE) and suitable settings. It considers the time line for the delivery of the education programme considering the number of care homes and individual participants required to complete the programme. ABC End of Life Care Education Project Bedfordshire & Hertfordshire Essex Anglia Workforce B ( Staff who frequently deal with end of life care as part of their role DOH 2008:118) (Includes 18 core www.e-lfh.org.uk modules) Jan 2011 March 2012 Year One = 625 staff 625 staff 1250 staff March 2012 March 2013 Year Two = 625 staff 625 staff 1250 staff (Total = 1250 staff) (Total = 1250 staff) (Total = 2500 staff) Bedfordshire & Hertfordshire Essex Anglia Workforce C (in this project residential and some nursing home staff) (Includes East of England End of Life Education Programme) Jan 2011 March 2012 Year One = 225 225 staff 450 staff March 2012 March 2013 Year Two = 225 225 staff 450 staff (Total = 450) (Total = 450 staff) (Total = 900staff) 4 WTE Band 6 EFE s 4 WTE Band 6 EFE s 8 WTE BND 6 EFE s 3.1 Pre Planning All settings participating will be made aware of the Train the Trainer model that will be adopted to reinforce the education delivery and support sustainability of the project. Workforce B Settings: Staff who frequently deal with end of life care as part of their role 1. Nursing Care homes with dedicated palliative care beds/a high incidence of End of Life patients being admitted to hospital. Page 3 of 27
2. Primary care roles with a high incidence of End of Life patients (e.g. District Nurses, Community Matrons, Disease Specific Specialist Nurses and Allied Health Care Professionals) 3. Secondary care settings with a high incidence of End of Life patients (e.g. mental health/dementia units, medical, c/o elderly wards and community hospitals). Process: 1. These settings will be targeted, firstly by letter explaining the project and inviting participation. 2. The letter will be followed up by a telephone call. 3. A launch event will provide more information, experiences of the learning resources to be used and a chance to explore challenges and barriers in the settings. 4. Commitment of the settings management to time and resources for training will be required and this will be evidenced by a signed contract. 5. Champions will be identified in each setting. 6. Staff will participate in 18 core sessions from the National End of Life e-learning programme. www.e-lfh.org.uk (over approximately 6 weeks) and can also access local education programmes. Workforce C Settings: (in this project staff working in residential and nursing homes) 1. Locality education/end of life implementation groups will identify groups of workforce C staff where a need for education has been indentified this will be in the nursing and residential care home setting and where residents have been inappropriately admitted to the acute sector. Process: 1. These settings will be targeted, firstly by letter explaining the project and inviting participation. 2. The letter will be followed up by a telephone call. 3. A launch event will provide more information, experiences of the learning resources to be used and a chance to explore challenges and barriers in the settings. 4. Commitment of the settings management to time and resources for training will be required and this will be evidenced by a signed contract. 5. Champions will be identified in each setting 6. Staff will participate in the EOE EOLC programme and can access local education programmes 4.0 Risk Assessment At key points in the project life risk of failure of the project or reduced output has been identified. 1. Pre implementation of the education programme Risk Solution Failure to recruit EFE s leading Ensure engagement of Human Resources to support to reduced output from project recruitment process. due to: Use of established educators to enable the project to start Delays in the Human but at a lower output Resource process Recruitment will be sourced from the established workforce, Lack of available staff. making it a quicker and more reliable process. Recruiting staff in similar posts who have capacity for more Settings not prepared to commit to the project hours, particularly from the existing posts Marketing the programme as attractive, flexible and initiative provided free of charge in the workplace setting Page 4 of 27
Managers and staff in workforce B & C reluctant to engage due to high pressure in the work place The e-learning component may be at risk if resources are not in place, computers and access to the management system to run the National e-learning programme may be reduced. 2. During the delivery of the programme Risk Solution Mobility of staff, particularly in care homes, reducing the number of staff who complete the programme. With a new project there is a risk of it standing alone and therefore not becoming sustainable 3. At the end of the programme The education project finishing at end of funding Sustaining the education programme Inability to capture evidence to show competencies have been achieved Identifying the advantages of having a competent workforce in End of Life Using care homes that have completed the programme as a role model. Meeting Care Quality Commission Standards for Education Face to face meetings and opportunity to experience resources to be used. Marketing the programme as attractive, flexible and initiative provided free of charge in the workplace setting The importance of this project and the impact of End of Life Care will be highlighted by lead nurses throughout the EoLC Networks. This work has already started, nurse executive, ward managers meetings, safe guarding groups have been approached and visited. Trusts are already committed to delivering the EoL Strategy and understand education is at the heart of this. Blended approaches to delivery will enable flexibility while these issues are resolved and also allow for individuals a choice in their method of learning. The education programme will be transferable from one employer to another so staff can continue their study. It is hoped that this programme will increase job satisfaction and reduce the movement experienced at the moment. Build on good practice and develop what has already been shown to work. It will be integral into services and education already established. In each EoLC Network a collaborative steering group to lead this project will ensure cohesion with established services. Empowerment of staff taught on the programme to teach and support other staff. A programme of education will continue at the end of the 2 years. It is hoped learning sets developed will continue as a routine element of practice. Business case to be prepared for commissioners. Using different approaches to gather evidence, based on the individuals learning styles. A written reflective approach to learning will be encouraged. Difficulty in measuring impact and a change of practice Pre and post course confidence questionnaires will aid this. Possible follow up questionnaires 3 and 6 months after programme. Baseline information using a measure such as the Gold Standards Framework After Death Analysis Tool. Page 5 of 27
5.0 Description of Project Setting up 1. Once recruitment of the project lead, facilitators and settings has been accomplished, delivery of the programme will commence over 2 years. 2. There are specific workforce B & C target numbers for year one and two for each area. 3. Care homes will only be included if commitment via a formal contract has been agreed by the management of the home. This will include commitment to release staff to attend as well as providing data to measure the impact of the education programme. 4. Each setting will identify an EOLC champion who will take responsibility for the programme within that setting. This role will be a qualified health or social care professional who has taken part in the training and is committed to ensuring staff can take part in the training and be supported within the work place. They will also be able to highlight resources required and report to the EFE s with any problems or concerns, also feeding back to management. 5. The champions role will be crucial in sustaining education when the programme has finished, and maintaining links established through the process with generalist and specialist palliative and End of Life care providers. 6. Each individual participant will be expected to sign up to a minimum amount of training and supply evidence to support their learning and competencies. They will be provided with information regarding further learning if they wish to continue to develop their knowledge and skills in end of life care. Content of Learning (Both groups) 1. Signing of learning contract 2. Pre and post course confidence questionnaire on end of life care 3. Completion of core modules ( as per group B or C process) 4. Consideration of individuals learning needs, to be discussed with EFE mentor. 5. Mentorship will be flexible (e.g. a group or one to one or combination of both) in a learning set environment. This will increase the learning experience and make effective use of resources. Group B participants Will participate in a self assessment of learning needs supported by the EFE s. Staff will participate in 18 core sessions from the National End of Life e-learning programme. www.e-lfh.org.uk (over approximately 6 weeks) and can access local education programmes. Specific local workshops will be run for this group where there are gaps in education provision. Group C participants Will be expected to complete the 6 modules of the EOE EOLC programme developed by EPIC plus a consolidation face to face workshop at completion of the modules. This is a blended approach to learning and will include face to face teaching time. Education workshops will be delivered to reinforce e-learning, and used particularly for e.g. Communication skills, advance care planning or symptom specific care. 6. Extra e-learning for both groups will be available through The National E-learning programme. www.e-lfh.org.uk 7. Palliative and End of Life Care programmes already available within each End of Life/Cancer Network will also be accessible to the Individual. Page 6 of 27
8. Experiential learning such as shadowing, practice placements and visits can also be included in the individual learning objectives. 6.0 Participants Workforce C group will be from some nursing and residential care homes. Workforce B group will be from a variety of settings, e.g. nursing care homes (with palliative care beds/high level of end of life patients), acute and community trusts, social care and mental health care trusts. 7.0 Evaluation of Learning and Impact Measurement 1. Evaluation of participants learning and activity: a. A pre and post course end of life care confidence questionnaire will be given to all workforce B and C participants. b. The data will be collected across Beds, Herts, Anglia and Essex. c. The questionnaire will be mapped around the National End of Life competencies and St Christopher s End of Life Competencies with core areas identified by the ABC project leads. d. Expectations of levels of learning for Workforce B will be assessed by their individual pre course confidence questionnaire mapped against the End of Life Competencies but they will be expected to complete 18 core sessions (approximately 6 hours) from the www.e-lfh.org.uk e-learning these core modules have been identified by the ABC project leads and mapped against the competencies. e. A work book will guide the learner in the learning programme and in collecting evidence. f. Reflective practice will be encouraged. g. The work book will be expected to be completed. The participant will be encouraged to continue to collect evidence (such as certificates of completion from the Dept of Health national E learning www.e-lfh.org.uk and EOE EOL Programme as well as local education workshops). 2. Impact Measurement: a. Basic benchmarking of the education setting and impact measurement of the education will be based around a model such as the Gold Standards Framework After Death Analysis E.g measurement of end of life assessment and planning pre and post participation in education programme (5 patients before start of education programme, during programme and 5 at end of education programme) Possible family/carer satisfaction with care post education programme delivery? 8.0Stakeholders and Participants Communication Plan Stakeholders In Beds and Herts 1. Beds and Herts Care Home Steering Group (Sue Plummer, Jackie Tritton, Carolyn Fowler, Marie Savage) 2. Beds and Herts Education Steering Group (Carolyn Fowler) 3. Bedfordshire, Luton and Hertfordshire Communication Plan 1. Monthly detailed project plan update 2. Quarterly project plan update 3. Monthly detailed project plan update for Page 7 of 27
Commissioners (Nicky Bannister, Dawn Sue Simmonds) Essex 1. Essex Cancer Network Nurse Director (Carol Oleary) 2. Essex Cancer Network Education Group Anglia 1. Anglia Project Steering Group (Tonia Dawson, Cathy Alban Jones, Emma Harris) 2. Anglia Cancer, Supportive and Palliative Care Education Group 3. Cambridgeshire, Suffolk, Norfolk, Great Yarmouth and Peterborough Commissioners East of England 1. EoE StHA End of Life Education Lead (Vanessa Convey) 2. East of England Palliative EOL and Education & Training Sub Group All 1. Local End of Life Education Groups 2. Project Leads first 6 months and then quarterly 1. Quarterly project plan update 2. Quarterly project plan update 1. Monthly project plan update 2. Quarterly detailed project plan update 3. Monthly detailed project plan update for 6 months and then quarterly 1. Quarterly project plan update 2. Quarterly project plan update 1. Monthly briefing Monthly meetings for first 6 months and then quarterly Participants 1. EFE s in Beds and Herts, Anglia and Essex 2. Education settings 1. Project lead support and briefings 2. EFE updates and project briefings 9.0 Education Pathways The project for workforce B and C will run concurrently. Work Force Group B expected to complete 18 core sessions (approximately 6 hours) from the www.e-lfh.org.uk e-learning these core modules have been identified by the project leads and mapped against the project end of life competencies This group will have more diverse work settings and experience. 1. They will start with a pre course questionnaire and allocation of a mentor. 2. Individuals will be expected to identify their own objectives; this will be apparent from completing the questionnaire. 3. They have a choice of programmes to follow but must include the core modules/sessions of the National e-learning as identified in the EOE project. Core Modules for all Workforce B Staff www.e-lfh.org.uk Session Title Module title Competency e.g. A1 C2 etc Introduction to e-learning for End of Life Care Facilitator led pre-learning Page 8 of 27
Relationship between palliative care and End of Life Facilitator led pre-learning Care Introduction to the principles of assessment in end of Assessment: principles A1,A2,A3,A4,A5 life care part 1 Introduction to the principles of assessment in end of Assessment: principles A1,A2,A3,A4,A5 life care part 2 Introduction to principles of ACP Advance care planning: ACP1, ACP3 principles ACP in practice: using end of life care tools Advance care planning: ACP2 principles Advance Decision to Refuse Treatment: principles Advance care planning: ACP3,ACP4 context Introduction to conducting conversations about Advance care planning: ACP5,ACP6 advance care planning process The importance of good communication Communication skills: C1,C2 principles Principles of communication Communication skills: C1,C2,C3 principles Understanding and using empathy Communication: basic skills C4 Am I Dying? How long have I got? handling challenging questions Dealing with challenging relatives Communication: challenging scenarios C5 C5 General approach to assessment of symptoms Symptom management: SM1 principles Use of Syringe Drivers Symptom management: SM5 general issues Assessment of pain Symptom management: pain SM2 Symptom Management: Breathlessness Cause of nausea and vomiting Management of physical deterioration Recognising the dying phase, last days of life and verifying death Symptom management: breathlessness Symptom management; Nausea, vomiting and constipation Symptom management: advanced illness Symptom management: last days of life SM3 SM4 A2,A3,A4,A5,A6,A7,A 8,A9,A10 See appendix One for recommended further learning sessions for medical and junior staff from www.e-lfh.org.uk Workforce Group C Staff must complete all the EOE EOLC 6 Modules +/- other learning 1. This staff group will start by completing their pre course confidence questionnaire (with a post course confidence questionnaire at the end of the programme). 2. A work book will be given out with the EoL competencies and ideas on how to achieve levels of evidence. 3. Where possible within the care homes the EFE will set up a learning set; this will be a place for critical analysis/ reflection/problem solving of EoLC practice. 4. Time will also be allocated to discuss learning objectives and competency evidence. 5. EFE mentorship will be supported through these groups. Page 9 of 27
6. In the first week participants will be expected to do module 1 of the East of England SHA EoLC programme delivered by EPIC. 7. In the following 5 weeks they will be expected to complete the following 5 modules (6 in total) 8. Communication skills and advance care planning can be offered as extra workshops. 9. Learners will be expected to complete their workbooks and discuss in their learning sets. 10. At the end of the e-learning a face to face follow up session will be delivered. Workforce C Education Programme Overview Module EoE EoLC Title +/- sessions 1. Overarching Principals of End of life 2. Communication Skills 3. Assessment & Care Planning, 4. Comfort and Well Being 5. Advance Care Planning 6. End of Life Tools, +/-practice placements +/- National e learning modules +/- local workshops +/- local workshops +/- local symptom control workshops +/- local advance care planning workshops +/- local LCP, GSF workshops 7. EFE facilitated face to face workshop Page 10 of 27
10.0 Over view: Education Pathway for Workforce Group B and C Summer/Autumn 2010 Autumn 2010 Autumn 2011 Autumn 2012 Recruitment of EFE s EFE Train the trainer sessions for delivery of project and EoE EoLC education programme plus additional session if necessary ( e.g. teaching and presentation tips) Recruitment of education settings Start of education programme First year target review Second year target review Workforce B Pre course confidence questionnaire Learning Contract Completed with EFE (including objectives and time span) 18 core e-lfh modules have to completed over approx 6 weeks (= 6 hours) www.e-lfh.org.uk +/-practice Introduction to the principles of placements and assessment in end of life care National e learning part 1 modules Introduction to the principles of +/- local assessment in end of life care communication part 2 skills workshops Introduction to principles of ACP ACP in practice: using end of life +/- local workshops care tools Advance Decision to Refuse +/- local symptom Treatment: principles control workshops Introduction to conducting +/- local advance conversations about advance care planning care planning workshops The importance of good +/- local LCP, GSF communication workshops Principles of communication Understanding and using empathy Am I Dying? How long have I got? handling challenging questions Dealing with challenging relatives General approach to assessment of symptoms Use of Syringe Drivers Assessment of pain Symptom Management: Breathlessness Cause of nausea and vomiting Management of physical deterioration Recognising the dying phase, last days of life and verifying death Workforce C Pre course confidence questionnaire Learning Contract Completed with EFE (including objectives and time span) All EOE EoLC modules have to completed over approx 6 weeks (= 6 hours) EOE EoLC Module 1 +/-practice Overarching Principals of placements +/- End of life National e EOE EoLC Module 2 learning modules Communication Skills +/- local EOE EoLC Module 3 workshops Assessment & Care Planning, EOE EoLC Module 4 +/- local Comfort and Well Being workshops EOE EoLC Module 5 Advance Care Planning +/- local EOE EoLC Module 6 symptom control End of Life Tools, workshops +/- local advance care planning workshops +/- local LCP, GSF workshops EFE facilitated face to face workshop Post course confidence questionnaire Evidence of completed workbook Activity monitor ( login into EoE EoLC programme/certificate of completion of e-lfh programme) East of England Certificate of Programme Completion Page 11 of 27
11.0 Appendix One: Recommended further www.e-lfh.org.uk learning for staff (Acknowledgements Dr Bee Wee and www.elfh.org team) Senior Medical Staff Session Title Essential Advance Decision to Refuse Treatment: in practice Mental Capacity Act: aims and principles Mental Capacity Act: in practice Approaching ACP when capacity is uncertain, fluctuating or likely to deteriorate How to get started and get the timing right How to handle patients questions and concerns How to document conversations about advance care planning How to negotiate decisions which may be difficult to implement How to review previous ACP decisions Assessment of physical symptoms Assessment of physical function Assessment of psychological well-being Assessment of social and occupational well-being Assessment of spiritual well-being Context of assessment: cultural and language issues Bereavement assessment and support Carer assessment and support Assessing through proxies Assessing those with fluctuating mental capacity Assessment of dying phase and after-death Information giving Breaking bad news Communicating with non-english speaking patients Communicating with people with speech and hearing difficulties Communicating with children and young people Request for organ and tissue donation Request for euthanasia Legal and ethical issues embedded in communication Please don t tell my husband managing collusion How dare you do this to me! managing anger I don t believe you, I m not ready to die! managing denial What will it be like? talking about the dying process Why can t I stay here? I don t want to stay here when preferred place of care cannot be met I m not loveable anymore.. discussing intimacy in end of life care Why me? discussing spiritual distress Discussing do not attempt CPR decisions Discussing foods and fluids Silence: the withdrawn patient Distress: the crying patient Challenging communication with colleagues Non-drug interventions in symptom management Symptom management in people with learning difficulties or mental health problems Symptom management in people with learning difficulties or mental health problems Symptom management complicated by co-existing conditions Management of symptoms associated with wounds Page 12 of 27
Principles of pain management Drug management pain core knowledge Assessment of breathlessness Drug management of breathlessness Non drug management of breathlessness Assessment of nausea and vomiting Management of nausea and vomiting Assessment of constipation Management of constipation Assessment of mood Assessment of management of anxiety Management of depression Assessment and management of agitation Recognising and managing fatigue Assessment and management of weight loss and loss of appetite Management of sore mouth and other oral probs Assessment of physical and cognitive deterioration in function Management of cognitive deterioration Management of bleeding Management of seizures Recognising and managing malignant spiral cord compression Managing death rattle Managing agitation and restlessness in the dying phase Managing distress during the dying phase Initiating conversations about EoLC: COPD Initiating conversations about EoLC: cancer Initiating conversations about EoLC: dementia Initiating conversations about EoLC: long term neurological conditions Scenario: terminal agitation patient in a care home Scenario: patient dying in acute hospital: optimising situation When the dying process is protracted or unexpectedly fast Sudden unexpected death End-stage cardiac disease Motor Neurone Disease COPD End-stage renal disease Dementia Useful Developing ACP in your organisation Developing your practice, clinical supervision, further reading Opioids in pain management advanced knowledge Managing different types of pain Dying as a prisoner Dying as a homeless person Dying in intensive care unit Interesting Uses and limitations of assessment tools Page 13 of 27
Junior Medical Staff Session Title Essential Advance Decision to Refuse Treatment: in practice Mental Capacity Act: aims and principles Mental Capacity Act: in practice Approaching ACP when capacity is uncertain, fluctuating or likely to deteriorate How to get started and get the timing right How to handle patients questions and concerns How to document conversations about advance care planning How to negotiate decisions which may be difficult to implement How to review previous ACP decisions Assessment of physical symptoms Assessment of physical function Assessment of psychological well-being Assessment of social and occupational well-being Assessment of spiritual well-being Context of assessment: cultural and language issues Bereavement assessment and support Carer assessment and support Assessing through proxies Assessing those with fluctuating mental capacity Assessing urgent situations with limited information Assessment of dying phase and after-death Information giving Breaking bad news Communicating with non-english speaking patients Communicating with people with speech and hearing difficulties Communicating with children and young people Request for organ and tissue donation Request for euthanasia Legal and ethical issues embedded in communication Please don t tell my husband managing collusion How dare you do this to me! managing anger I don t believe you, I m not ready to die! managing denial What will it be like? talking about the dying process Why can t I stay here? I don t want to stay here when preferred place of care cannot be met I m not loveable anymore.. discussing intimacy in end of life care Why me? discussing spiritual distress Discussing do not attempt CPR decisions Discussing foods and fluids Silence: the withdrawn patient Distress: the crying patient Challenging communication with colleagues Non-drug interventions in symptom management Symptom management in people with learning difficulties or mental health problems Symptom management in people with learning difficulties or mental health problems Symptom management complicated by co-existing conditions Management of symptoms associated with wounds Principles of pain management Drug management pain core knowledge Assessment of breathlessness Drug management of breathlessness Page 14 of 27
Useful Interesting Non drug management of breathlessness Assessment of nausea and vomiting Management of nausea and vomiting Assessment of constipation Management of constipation Assessment of mood Assessment of management of anxiety Management of depression Assessment and management of agitation Recognising and managing fatigue Assessment and management of weight loss and loss of appetite Management of sore mouth and other oral probs Assessment of physical and cognitive deterioration in function Management of cognitive deterioration Management of bleeding Management of seizures Recognising and managing malignant spiral cord compression Managing death rattle Managing agitation and restlessness in the dying phase Managing distress during the dying phase Initiating conversations about EoLC: COPD Initiating conversations about EoLC: cancer Initiating conversations about EoLC: dementia Initiating conversations about EoLC: long term neurological conditions Scenario: terminal agitation patient in a care home Scenario: patient dying in acute hospital: optimising situation When the dying process is protracted or unexpectedly fast Sudden unexpected death End-stage cardiac disease Motor Neurone Disease COPD End-stage renal disease Dementia Developing your practice, clinical supervision, further reading Managing different types of pain Dying as a prisoner Dying as a homeless person Dying in intensive care unit Developing ACP in your organisation Uses and limitations of assessment tools Opioids in pain management advanced knowledge Page 15 of 27
Senior Nursing Staff Session Title Essential Advance Decision to Refuse Treatment: in practice Mental Capacity Act: aims and principles Mental Capacity Act: in practice Approaching ACP when capacity is uncertain, fluctuating or likely to deteriorate How to get started and get the timing right How to handle patients questions and concerns How to document conversations about advance care planning How to negotiate decisions which may be difficult to implement How to review previous ACP decisions Assessment of physical symptoms Assessment of physical function Assessment of psychological well-being Assessment of social and occupational well-being Assessment of spiritual well-being Context of assessment: cultural and language issues Bereavement assessment and support Carer assessment and support Assessing through proxies Assessing those with fluctuating mental capacity Assessment of dying phase and after-death Information giving Breaking bad news Communicating with non-english speaking patients Communicating with people with speech and hearing difficulties Communicating with children and young people Request for organ and tissue donation Request for euthanasia Legal and ethical issues embedded in communication Please don t tell my husband managing collusion How dare you do this to me! managing anger I don t believe you, I m not ready to die! managing denial What will it be like? talking about the dying process Why can t I stay here? I don t want to stay here when preferred place of care cannot be met I m not loveable anymore.. discussing intimacy in end of life care Why me? discussing spiritual distress Discussing do not attempt CPR decisions Discussing foods and fluids Silence: the withdrawn patient Distress: the crying patient Challenging communication with colleagues Non-drug interventions in symptom management Symptom management in people with learning difficulties or mental health problems Symptom management in people with learning difficulties or mental health problems Symptom management complicated by co-existing conditions Management of symptoms associated with wounds Principles of pain management Drug management pain core knowledge Assessment of breathlessness Drug management of breathlessness Page 16 of 27
Useful Interesting Non drug management of breathlessness Assessment of nausea and vomiting Management of nausea and vomiting Assessment of constipation Management of constipation Assessment of mood Assessment of management of anxiety Management of depression Assessment and management of agitation Recognising and managing fatigue Assessment and management of weight loss and loss of appetite Management of sore mouth and other oral probs Assessment of physical and cognitive deterioration in function Management of cognitive deterioration Management of bleeding Management of seizures Recognising and managing malignant spiral cord compression Managing death rattle Managing agitation and restlessness in the dying phase Managing distress during the dying phase Initiating conversations about EoLC: COPD Initiating conversations about EoLC: cancer Initiating conversations about EoLC: dementia Initiating conversations about EoLC: long term neurological conditions Scenario: terminal agitation patient in a care home Scenario: patient dying in acute hospital: optimising situation When the dying process is protracted or unexpectedly fast Sudden unexpected death End-stage cardiac disease Motor Neurone Disease COPD End-stage renal disease Dementia Developing ACP in your organisation Developing your practice, clinical supervision, further reading Uses and limitations of assessment tools Managing different types of pain Dying as a prisoner Dying as a homeless person Dying in intensive care unit Opioids in pain management advanced knowledge Page 17 of 27
Junior Nursing Staff Session Title Essential Mental Capacity Act: aims and principles Mental Capacity Act: in practice How to get started and get the timing right How to handle patients questions and concerns How to document conversations about advance care planning How to negotiate decisions which may be difficult to implement How to review previous ACP decisions Assessment of physical symptoms Assessment of physical function Assessment of psychological well-being Assessment of social and occupational well-being Assessment of spiritual well-being Context of assessment: cultural and language issues Bereavement assessment and support Carer assessment and support Assessing through proxies Assessing those with fluctuating mental capacity Assessing urgent situations with limited information Assessment of dying phase and after-death Information giving Breaking bad news Communicating with non-english speaking patients Communicating with people with speech and hearing difficulties Communicating with children and young people Request for organ and tissue donation Request for euthanasia Legal and ethical issues embedded in communication Please don t tell my husband managing collusion How dare you do this to me! managing anger I don t believe you, I m not ready to die! managing denial What will it be like? talking about the dying process Why can t I stay here? I don t want to stay here when preferred place of care cannot be met I m not loveable anymore.. discussing intimacy in end of life care Why me? discussing spiritual distress Discussing foods and fluids Silence: the withdrawn patient Distress: the crying patient Challenging communication with colleagues Non-drug interventions in symptom management Symptom management in people with learning difficulties or mental health problems Symptom management complicated by co-existing conditions Management of symptoms associated with wounds Assessment of pain Principles of pain management Drug management pain core knowledge Assessment of breathlessness Drug management of breathlessness Non drug management of breathlessness Assessment of nausea and vomiting Page 18 of 27
Useful Interesting Management of nausea and vomiting Assessment of constipation Management of constipation Assessment of mood Assessment of management of anxiety Management of depression Assessment and management of agitation Recognising and managing fatigue Assessment and management of weight loss and loss of appetite Management of sore mouth and other oral probs Assessment of physical and cognitive deterioration in function Management of cognitive deterioration Management of bleeding Management of seizures Recognising and managing malignant spiral cord compression Managing death rattle Managing agitation and restlessness in the dying phase Managing distress during the dying phase Scenario: terminal agitation patient in a care home Scenario: patient dying in acute hospital: optimising situation When the dying process is protracted or unexpectedly fast Sudden unexpected death Advance Decision to Refuse Treatment: in practice Approaching ACP when capacity is uncertain, fluctuating or likely to deteriorate Developing your practice, clinical supervision, further reading Uses and limitations of assessment tools Discussing do not attempt CPR decisions Developing your practice, clinical supervision, further reading Managing different types of pain Initiating conversations about EoLC: COPD Initiating conversations about EoLC: cancer Initiating conversations about EoLC: dementia Initiating conversations about EoLC: long term neurological conditions Dying as a prisoner Dying as a homeless person Dying in intensive care unit End-stage cardiac disease Motor Neurone Disease COPD End-stage renal disease Dementia Developing ACP in your organisation Opioids in pain management advanced knowledge Page 19 of 27
Clinical Support Worker / HCA Session Title Essential Useful Mental Capacity Act: aims and principles Assessment of physical function Assessment of psychological well-being Context of assessment: cultural and language issues Carer assessment and support Assessing through proxies Assessing those with fluctuating mental capacity Identifying the patient s goals and priorities Documentation, communication and co-ordination Following up assessments and evaluating outcomes Telephone communication Written communication Communication with non-english speaking patients Communication with people with speech and hearing difficulties Communication with children and young people Legal and ethical issues embedded in communication How dare you do this to me! managing anger Why me? discussing spiritual distress Challenging communication with colleagues Symptom management in people with learning difficulties or mental health problems Management of symptoms associated with wounds Principles of pain management Drug management pain core knowledge Assessment of breathlessness Non drug management of breathlessness Assessment of nausea and vomiting Assessment of constipation Management of constipation Assessment of mood Assessment of management of anxiety Assessment and management of agitation Recognising and managing fatigue Assessment and management of weight loss and loss of appetite Management of sore mouth and other oral probs Assessment of physical and cognitive deterioration in function Management of cognitive deterioration Management of bleeding Management of seizures Managing death rattle Managing agitation and restlessness in the dying phase Managing distress during the dying phase Scenario: terminal agitation patient in a care home Scenario: patient dying in acute hospital: optimising situation When the dying process is protracted or unexpectedly fast Sudden unexpected death Mental Capacity Act: in practice How to handle patients questions and concerns How to review previous ACP decisions Developing your practice, clinical supervision, further reading Assessment of physical symptoms Assessment of social and occupational well-being Page 20 of 27
Interesting Assessment of spiritual well-being Bereavement assessment and support Assessing urgent situations with limited information Assessment of dying phase and after-death Information giving Breaking bad news Please don t tell my husband managing collusion I don t believe you, I m not ready to die! managing denial What will it be like? talking about the dying process I m not loveable anymore.. discussing intimacy in end of life care Discussing foods and fluids Influence of transition points and cries on decision making in symptom management Non-drug interventions in symptom management Symptom management complicated by co-existing conditions Drug management of breathlessness Management of nausea and vomiting Management of depression Recognising and managing malignant spiral cord compression Dying as a prisoner Dying as a homeless person Dementia Advance Decision to Refuse Treatment: in practice Approaching ACP when capacity is uncertain, fluctuating or likely to deteriorate How to get started and get the timing right How to document conversations about advance care planning How to negotiate decisions which may be difficult to implement Uses and limitations of assessment tools Comm skills for admin staff, volunteers and other non-clinical workers Request for organ and tissue donation Request for euthanasia Why can t I stay here? I don t want to stay here when preferred place of care cannot be met Discussing do not attempt CPR decisions Silence: the withdrawn patient Distress: the crying patient Managing different types of pain Initiating conversations about EoLC: COPD Initiating conversations about EoLC: cancer Initiating conversations about EoLC: dementia Initiating conversations about EoLC: long term neurological conditions Dying in intensive care unit End-stage cardiac disease Motor Neurone Disease COPD End-stage renal disease Page 21 of 27
Pharmacist Session Title Essential Useful Mental Capacity Act: aims and principles Mental Capacity Act: in practice Context of assessment: cultural and language issues Communication with non-english speaking patients Communication with people with speech and hearing difficulties Communication with children and young people Legal and ethical issues embedded in communication Challenging communication with colleagues Management of symptoms associated with wounds Principles of pain management Drug management pain core knowledge Drug management of breathlessness Management of nausea and vomiting Management of constipation Assessment of management of anxiety Management of depression Assessment and management of agitation Management of sore mouth and other oral probs Management of bleeding Management of seizures Managing death rattle Managing agitation and restlessness in the dying phase Managing distress during the dying phase End-stage cardiac disease Motor Neurone Disease COPD End-stage renal disease Dementia Advance Decision to Refuse Treatment: in practice How to handle patients questions and concerns Assessment of physical symptoms Assessment of psychological well-being Assessment of social and occupational well-being Carer assessment and support Assessing through proxies Identifying the patient s goals and priorities Documentation, communication and co-ordination Following up assessments and evaluating outcomes Symptom management in people with learning difficulties or mental health problems Symptom management complicated by co-existing conditions Opioids in pain management advanced knowledge Managing different types of pain Assessment of breathlessness Non drug management of breathlessness Assessment of nausea and vomiting Assessment of constipation Recognising and managing fatigue Assessment and management of weight loss and loss of appetite Scenario: terminal agitation patient in a care home Page 22 of 27
Interesting Scenario: patient dying in acute hospital: optimising situation Dying as a homeless person Dying in intensive care unit Approaching ACP when capacity is uncertain, fluctuating or likely to deteriorate How to get started and get the timing right How to document conversations about advance care planning How to negotiate decisions which may be difficult to implement How to review previous ACP decisions Developing ACP in your organisation Developing your practice, clinical supervision, further reading Assessment of physical function Assessment of spiritual well-being Bereavement assessment and support Assessing those with fluctuating mental capacity Assessing urgent situations with limited information Uses and limitations of assessment tools Breaking bad news Request for organ and tissue donation Request for euthanasia Please don t tell my husband managing collusion How dare you do this to me! managing anger I don t believe you, I m not ready to die! managing denial Discussing foods and fluids Non-drug interventions in symptom management Assessment of mood Assessment of physical and cognitive deterioration in function Management of cognitive deterioration Recognising and managing malignant spiral cord compression Initiating conversations about EoLC: COPD Initiating conversations about EoLC: cancer Initiating conversations about EoLC: dementia Initiating conversations about EoLC: long term neurological conditions When the dying process is protracted or unexpectedly fast Dying as a prisoner Page 23 of 27
Physio, Occupational Therapist, Speech and Language Therapist, Other therapists Session Title Essential Advance Decision to Refuse Treatment: in practice Mental Capacity Act: aims and principles Mental Capacity Act: in practice Approaching ACP when capacity is uncertain, fluctuating or likely to deteriorate How to get started and get the timing right How to handle patients questions and concerns How to document conversations about advance care planning How to negotiate decisions which may be difficult to implement How to review previous ACP decisions Assessment of physical symptoms Assessment of physical function Assessment of psychological well-being Assessment of social and occupational well-being Context of assessment: cultural and language issues Carer assessment and support Assessing through proxies Assessing those with fluctuating mental capacity Information giving Breaking bad news Communicating with non-english speaking patients Communicating with people with speech and hearing difficulties Communicating with children and young people Legal and ethical issues embedded in communication Please don t tell my husband managing collusion How dare you do this to me! managing anger I don t believe you, I m not ready to die! managing denial What will it be like? talking about the dying process Why can t I stay here? I don t want to stay here when preferred place of care cannot be met I m not loveable anymore.. discussing intimacy in end of life care Why me? discussing spiritual distress Silence: the withdrawn patient Distress: the crying patient Challenging communication with colleagues Non-drug interventions in symptom management Symptom management in people with learning difficulties or mental health problems Symptom management complicated by co-existing conditions Principles of pain management Assessment of breathlessness Non drug management of breathlessness Assessment of mood Assessment of management of anxiety Assessment and management of agitation Recognising and managing fatigue Assessment and management of weight loss and loss of appetite Management of sore mouth and other oral probs Assessment of physical and cognitive deterioration in function Management of cognitive deterioration Recognising and managing malignant spiral cord compression Page 24 of 27
Useful Interesting End-stage cardiac disease Motor Neurone Disease COPD End-stage renal disease Dementia Assessment of spiritual well-being Bereavement assessment and support Assessing urgent situations with limited information Assessment of dying phase and after-death Uses and limitations of assessment tools Request for euthanasia Discussing food and fluids Management of symptoms associated with wounds Drug management of pain core knowledge Managing different types of pain Drug management of breathlessness Assessment of nausea and vomiting Management of nausea and vomiting Management of depression Management of bleeding Management of seizures Recognising the dying phase, last days of life and verifying death Scenario: patient dying in acute hospital: optimising situations Developing ACP in your organisation Developing you practice, clinical supervision and further reading Uses and limitations of assessment tools Request for organ and tissue donation Assessment of constipation Management of constipation Initiating conversations about EoLC: COPD Initiating conversations about EoLC: cancer Initiating conversations about EoLC: dementia Initiating conversations about EoLC: long term neurological conditions When the dying process is protracted or unexpectedly fast Dying as a homeless person Dying in intensive care unit Page 25 of 27
Social Workers Session Title Essential Useful Advance Decision to Refuse Treatment: in practice Mental Capacity Act: aims and principles Mental Capacity Act: in practice Approaching ACP when capacity is uncertain, fluctuating or likely to deteriorate How to get started and get the timing right How to handle patients questions and concerns How to document conversations about advance care planning How to negotiate decisions which may be difficult to implement How to review previous ACP decisions Context of assessment: cultural and language issues Bereavement assessment and support Carer assessment and support Assessing through proxies Assessing those with fluctuating mental capacity Information giving Breaking bad news Communicating with non-english speaking patients Communicating with people with speech and hearing difficulties Communicating with children and young people Request for euthanasia Legal and ethical issues embedded in communication Please don t tell my husband managing collusion How dare you do this to me! managing anger I don t believe you, I m not ready to die! managing denial What will it be like? talking about the dying process Why can t I stay here? I don t want to stay here when preferred place of care cannot be met I m not loveable anymore.. discussing intimacy in end of life care Why me? discussing spiritual distress Silence: the withdrawn patient Distress: the crying patient Challenging communication with colleagues Assessment of mood Assessment of management of anxiety Assessment and management of agitation Assessment and management of weight loss and loss of appetite Assessment of physical and cognitive deterioration in function End-stage cardiac disease Motor Neurone Disease COPD End-stage renal disease Dementia Developing ACP in your organisation Assessment of physical symptoms Assessment of physical function Assessing urgent situations with limited time Assessment of dying phase and after-death Uses and limitations of assessment tools Discussing do not attempt CPR decisions Discussing food and fluids Page 26 of 27