Palliative Study Days - 26 Sept 2006
New Holmwood Hotel, Cowes
The day started with an update on issues affecting palliative care nationally,
whilst we can sometimes feel detached from a lot of decision-making, the
impact of new guidelines, and policy inevitably will impact on practice,
it is therefore very helpful to be forewarned about impending changes in
palliative care. Alan Horwell mentioned the
Mental Capacity Act which comes into force in April 2007, also that although
the Assisted Dying for the Terminally Ill Bill, failed, (by only 48 votes),
in the House of Lords, it is inevitable that this will be re-visited.
The Voluntary Euthanasia Society is now called Dignity in Dying, which it
hopes to make its’ trademark, as dignity in dying is a core principle
of palliative care, representations are being made to try to stop this happening.
Dignitas, (the organisation which arranges suicides in Switzerland), has
published figures for those attending their clinic, from Britain, 54 people
have now committed suicide since 2003, and as an organisation, it now has
800 members in this country. This topic is currently being highlighted on
national TV via the popular hospital soap, Holby, where one of the characters
is terminally ill.
Another TV series, (8 parts), is due to screened in the Autumn, which looks
at Helen House Hospice for children.
The Palliative Care Bill is due to be debated on the 20th of October.
Anne-Marie Phillips expertly delivered a session
on Lymphoedema, which was extremely insightful to this condition, some of
the session reminded us about the anatomy of the Lymphatic system and how
this affected by disease, both directly and as a secondary problem, for example
caused by the surgical removal of lymph tissue. The results of un-treated
lymphoedema were graphically illustrated by some very clear photographs.
Anne-Marie described the different forms of treatment and that although not
curable with careful management, patients can still lead a fairly normal
life, however, in relation to palliative care, the emphasis is very much
on quality and comfort, rather than rehabilitation. How patients are referred
to this service was also explained.
Jo Hockley gave two presentations about a major
study which was carried out in Scotland, which looked at end of life care
in nursing homes, together with adapting the Liverpool Care Pathway for nursing
homes.
This 5 year study illustrated the need for a structured approach in order
to both raise the awareness of staff in nursing homes, and also educate the
staff in order that best end of life care could be achieved.
As the numbers of people who die in this setting is increasing, it was important
that this study was carried out.
Whilst recognising that end of life care is only one part of the care that
nursing homes deliver, it is an important part. The approach used to gather
information regarding care was action research which involved the use of
reflective groups in order that no vital information was missed, however,
this highlighted some important issues in relation to education, as some
of the carers, were unable to give written feedback effectively if at all.
The implementation of the LCP in nursing homes, was generally accepted positively,
acting as a framework for that care. Some issues were raised regarding the ‘diagnosis’,
were raised, i.e. when to put a patient on the pathway, but figures relating
to care showed that the recording of end of life care was significantly better
after the implementation.
‘Key Champions’ were identified in the nursing homes, who were
responsible for helping staff with all aspects of the LCP, including educating
staff. The presentation ended with this quote –
“Death must simply become the discreet but dignified exit of a peaceful
person from a helpful society without pain or suffering and ultimately without
fear”
Aries, P (1977)
Anne Snow gave an insightful presentation on
Mesothelioma, this disease which affects the pleura and less commonly the
peritoneum is caused mainly by exposure to asbestos. This area has quite
a high prevalence due to the ship building which used to be carried out along
the South Coast.
Anne gave an overview of the how the disease affects patients, how it is
diagnosed, and how it progresses. An explanation of some of the treatments
was given, together with some slides of surgical interventions.
Interestingly the numbers of patients presenting with this condition is rising.
The Occupational Therapy Team, (Kirsty Orchin, & Ruth Elphick), gave an overview of the service provided at the Hospice by the occupational therapy department, this includes, the assessment of individual patient needs, in order that patients may return home as quickly as possible. Some of the practical interventions were highlighted including how adaptations are made to patients’ homes. Kirsty highlighted the fact that patients have more complex needs due to a wider range of conditions. The team then described the referral process and how individual assessments are made.
Irene Nicholson gave a stunning presentation
on dementia awareness, which included audience participation and very moving
visual examples of how dementia affects individuals.
This presentation was very much about looking at the person and not the condition,
Irene gave an overview of the condition itself, which included some information
and pictures of the physical effects of dementia and then moved onto looking
at the people it affects, both patients and families. She described how we
all store memories and how these may be affected by dementia, for example
how short term memories are lost and may be replaced by deeper memories,
and that if these deeper memories are not pleasant, then the patient would
be for ever re-living these memories, which may explain some of the turmoil
that patients are constantly in.
Irene illustrated some issues which are affected for example nutrition, walking
and washing and dressing, but the ‘real’ examples used in this
session were very moving and thought provoking.
The day concluded with Jackie Hazeldine who
spoke about caring for the dying person in the community, she started by
saying that ‘the care of all dying patients must improve to the level
of the best’. This was expanded to look at a number of markers of best
practice and how these could be delivered in to the community setting; Jackie
used some ‘real’ examples of how these standards have been met.
This moving approach to illustrating this was very interesting. Studies show
that the majority of people would wish to die at home, therefore providing
palliative care in the community is the most natural thing to do we all live
in a community. But this produces some challenges. As a carer in someone
else’s home, you are a visitor and you cannot bring your own values
into this setting. But as she quotes ‘nursing is seen as one of the
most demanding interpersonal endeavours that can be undertaken, it is best
accomplished when it is least noticed’.
With this in mind delivering care which meets the Gold Standards Framework
can be achieved.
All of the above presentations can be downloaded from this page. (left menu)
If you need any further information please do not hesitate to contact Phil
Warren.
(Please go to our Contact's page)
