Clinical Skills Course Workbook to accompany on line learning programme
The National GSF Centre for End of Life Care Clinical Skills Programme February 2015 www.goldstandardsframework.org.uk Prof Keri Thomas, National Clinical Lead for the GSF Centre, Hon Professor End of Life Care, University of Birmingham, Royal College General Practitioners End of Life Care Clinical Champion Lucy Giles, Deputy Lead Nurse Chris Elgar, GSF Nurse/Trainer Admin Support: Sue Richards, Katie Lazell With many thanks also to Professor Max Watson. John Young Although great care has been taken in compiling this handbook, we take no responsibility for the clinical application of the recommendations in the course handbook. Ultimate responsibility lies with the health care professional who manages their patients. Please Note: All Rights Reserved. All materials and templates from the GSF Programmes are trademarked and fully copyrighted to the National GSF Centre in End of Life Care CIC. Permission to use the work and materials is granted to those registered for the National GSF Clinical Skills Training programme only. Specific permission for other use should be sought from the National GSF Centre. For further details please see the Terms and Conditions and information governance section of the GSF Website or contact the National GSF Centre.
Welcome Welcome to the GSF Clinical Skills course. It has been designed, initially, with care home staff, nurses and care assistants, as the target audience but we feel that much of the course content is transferable to other care environments where the elderly, in particular, are cared for. We trust you will find the course useful and relevant to your daily work and that it will enable you to grow in confidence and skill as you look after the people in your care. In the light of the growth in the number of elderly in the general population, we need to acknowledge the quality of care which is regularly delivered across the country and build on this expertise and skill to better serve people entering the final stage of their lives. The nature of care homes has changed over the years with people having more complex medical and nursing needs and indeed some care homes are like mini hospitals with ventilators and other equipment more associated with acute care, thus allowing quality care for people in their preferred place of care and avoiding hospital admissions, unless they are appropriate at that time. Although the average length of stay in care homes is now under 18 months it is well documented that many people are in the care home for just a few weeks or days before they pass away as they are knowingly admitted at end of life. The skills required to deliver such quality care require clinical expertise as well as being personally caring, compassionate, efficient and well organised. Good care involves a Head Hands and Heart approach Quality care is perhaps best defined as care that we would want to see our own family members receiving. Such care results from the combination of being evidence based with good clinical knowledge (head), systems minded with good systems and processes in place (hands) and person centred care (heart). Only when all three are working together will reliable, consistent, top quality care be delivered to all that need it at the time when they need it. The GSF Clinical Skills course focuses on key clinical aspects (head) of care. As well as providing a clear knowledge base for staff, it also encourages reflection on daily clinical practice, as such reflection is key to lifelong professional quality and satisfaction. It is our experience that training and education in clinical issues will reap maximum benefit when it is combined with the complementary work of improving the organisation of care. This clinical skills course will complement the GSF training programmes by helping staff with common clinical decisions that arise during daily practice. This course has been designed to allow staff to continue to study while they work and to reflect and learn from their own daily experience and that of their colleagues.
While wide ranging, the course is not comprehensive and can never replace the clinical decision making process of the individual doctor and nurse at the bedside with whom ultimate responsibility rests. Rather it provides outline guidance on what to look out for in common clinical situations, and gives pointers to further advice or investigation. For example, in each clinical section there is advice as to when the person safely be cared for in the home, require a GP intervention, or hospital admission. The course does not seek to prevent all people from being transferred to hospital, but rather to reduce the numbers of inappropriate transfers. The GSF Clinical Skills has been developed under the auspices of the Gold Standards Framework Care Home programme and the Hospice Friendly Hospitals Programme in Ireland. Course workbook Overview: This workbook is designed to reflect and complement the content of the sessions on the virtual learning zone which candidates work through, completing the questions at the end of each session as well as six short clinical reflections on care that the candidate has personally experienced in their own work setting. The workbook is divided into the six sessions to reflect the content of the VLZ. These are:- 1. Frailty 2. 3Ds- depression, delirium, dementia 3. Organ failure including heart failure, respiratory failure and renal failure 4. Neurological disorders including, strokes/tias, Parkinson s Disease and Motor Neurone Disease/Multiple Sclerosis, 5. Pain 6. Care of the dying Each session of this course follows a similar pattern. A Clinical Scenario which highlights some of the common problems that people in their care and staff face in managing this issue. Before moving on, consider the question that is asked. Key clinical facts Assessment
Management options End of Life Care Issues Red flags Highlight crucial clinical issues that must be remembered Empathy box. Empathy is key to long stay care, as it allows us to appreciate what difficulties and also what joys a person may be experiencing and thus allows us to ensure that our care meets THEIR particular needs. Questions. At the end of each chapter there is also a short set of questions to answer. These need to be submitted on the virtual learning zone where they will be marked as part of your assessment at the end of the course. Clinical Reflection. At the end of each session there is space for clinical reflection which should be submitted as part of your course Virtual Learning Zone The VLZ will supplement the course handbook providing learning examples in relation to the sessions with clinical information and contributions/interviews from experts in their respective fields. There are multi choice questions and clinical reflection at the end of each session which will be marked and assessed.
Course Duration The course is designed to be completed at the learners own pace. Once the learner has registered onto the course they will be given a personal password to access the VLZ and they will be able to start the programme. Although there is no set time limit the passwords will be deactivated after a 6 month period as it is expected that the learner will have competed the course and assessments within that 6 month timeframe. Course Assessment 1. Completion of the work book assessment questions at the end of each session. 2. Completion of six clinical reflections within the course workbook. (There is a clinical reflection section associated with each of the course session.
INTRODUCTION The last part of life has an importance out of all proportion to its length. Dame Cicely Saunders, 1919 2005. Introduction Every year in the UK, approximately 1% of the population will die. Of those deaths, over 20% over the age of 65yrs of age are likely to take place in a care home. 50% of deaths (1 in 2) will take place in an acute hospital 22% at home, 20% in a care home and 6% in hospices, though many more than this will derive benefit from Hospice care in the community (1) There are certain common characteristics of the people who die in care homes Elderly (Over 80 years old) Up to 80% of residents have some form of cognitive impairment Many have mixed social, emotional and physical needs Many have several major illnesses and are taking a large number of medications Most relatives of people in care homes are much older than was the case in the past The average length of stay in a UK Nursing Home has now decreased to 18 months. This means that many people are spending much less than 18 months in Nursing homes and with length of stay reducing it may be hard for staff to get to know the person well. Over recent years the age at which people are admitted to care homes has increased as people are enabled to stay in their own homes for longer with social support. When someone does enter a care home they often have multiple comorbidities making care quite complex at times This means that Care Home Staff require increased training and help to provide the best quality of care to those people that they would like.
The term end of life care is used in many different ways. In this course we take it to mean the period from which a person is admitted to a care home for the last part of their life. The skills which are required to ensure that they enjoy the best quality of life during his or her time of residency in the home are the same skills that will be required when they are actually dying. This course is focusing on the attitudes, skills and the knowledge required in order to make the quality of life for people as good as possible. What is good quality end of life care? Good quality end of life care is care that we would like to receive ourselves, or would like to see our parents, brothers, sisters or children receiving when they reach that period of their lives What is poor quality end of life care? Poor quality end of life care is care that would upset us if it was given to ourselves or our family members. Unfortunately it is hard in many circumstances to deliver the best quality of care to everyone when they need it. This clinical course aims to help care home staff to develop their skills, knowledge and attitudes in supporting people towards and at the end of life. These are the same skills which are needed in supporting people, their relatives and staff in all aspects of long term care. Reference 1. National Council of Palliative Care. 2014. The End of Life Care Strategy: New Ambitions.