First of all I would like to say thank you to all the people who have got in touch with me in this new role as nursing national clinical lead for palliative care at Healthcare Improvement Scotland. Having conversations with like-minded colleagues is just great and, to me, the first step in working towards change and improvement. I am hoping that by engaging with as many teams as possible, I can learn about any particular issues and share best practice – please tell me about any good work going on, too! In providing palliative and end of life care we all have a common goal of getting it right for patients and those important to them at what can be a most difficult time, and we only get one chance to get it right.
In addition to working with six test sites in an advisory capacity, teams I have met to date include leads in NHS 24, Scottish Ambulance Service (SAS), Children’s Nurses, and Care Opinion, as well as teams within HIS and Scottish Government. All these conversations are about how we can ensure dignity at the end of life every time, such as through reducing the risk of inappropriate resuscitation attempts. Not surprisingly, it always comes back to the need for sensitive conversations earlier on in someone’s journey! It is essential that we support staff and teams to be able to have these conversations, which can be highly complex.
In July I attended a session at University College London Hospital recently on Talking DNACPR, and it was excellent. One thing I learned was the 5Ps model for sharing difficult information, based on work in St Christopher’s Hospice. Below is my adapted version:
P Purpose what is the purpose of this interaction?
P People who should be there? The patient/family? Should I take a colleague?
P Preparation what do I need to know?
P Process how will I construct the conversation – should I use a model, e.g. SPIKES?
P Product what is the outcome I expect? E.g. a completed Anticipatory Care Plan or DNACPR form?
I think this could be used as a simple approach when teaching staff.
Spotlight on the Four Principles
I mentioned the four principles from Caring for People in the Last Days and Hours of Life in my last blog post, and HIS have very kindly produced small cards that staff have can have in their pockets or use for teaching students, etc.
Please see below:
If you would like some, please contact: firstname.lastname@example.org.
Compliance with these principles will also ensure excellent delivery of the fundamentals of nursing as advocated in the Nursing and Midwifery Council Code.