RAMGARD Margareta, BLOMQVIST Kerstin, PETERSSON Pia
Journal article citation:
Journal of Interprofessional Care, 29(4), 2015, pp.354-358.
Publisher:
Taylor and Francis
Collaboration between different professions in community care for older people is often both difficult and complex. In this project, a participatory action research (PAR) was conducted in order to support the professions involved in the care for older people to develop individualized health and social care plans. Cases from daily work were discussed in different professional groups over a period of one year. A key finding was that lack of knowledge regarding the other professions' field of expertise and their underlying professional culture and values was a barrier in their collaboration. However, as the continuous reflective dialogue process progressed, the participants began to reflect more about the importance of collaboration as a prerequisite to achieve the best possible care for the recipient. This process of reflection led to the often complex needs of the care recipients being given a more central position and thus care plans being better tailored to each person's needs.
(Publisher abstract)
Collaboration between different professions in community care for older people is often both difficult and complex. In this project, a participatory action research (PAR) was conducted in order to support the professions involved in the care for older people to develop individualized health and social care plans. Cases from daily work were discussed in different professional groups over a period of one year. A key finding was that lack of knowledge regarding the other professions' field of expertise and their underlying professional culture and values was a barrier in their collaboration. However, as the continuous reflective dialogue process progressed, the participants began to reflect more about the importance of collaboration as a prerequisite to achieve the best possible care for the recipient. This process of reflection led to the often complex needs of the care recipients being given a more central position and thus care plans being better tailored to each person's needs.
(Publisher abstract)
Subject terms:
action research, health care, social care, community care, older people, interprofessional relations, care planning, communication, collaboration;
Background: Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions. Methods: A theory-, evidence- and person-based approach to intervention development was undertaken. The intervention planning and development process included reviewing relevant literature and existing guidelines, developing guiding principles, conducting a behavioural analysis and constructing a logic model. Optimisation of the intervention and its implementation involved qualitative interviews with older adults with multimorbidity (n = 8), family caregivers (n = 2) and healthcare professionals (HCPs) (n = 20). Data were analysed thematically and informed changes to the intervention prototype. Results: Review findings reflected the importance of HCPs taking a person-centred (rather than disease-centred) approach to their work with older people living with multimorbidity. This approach involves HCPs giving health service users the opportunity to voice their priorities, then using these to underpin the treatment and care plan that follow. Findings from the planning stage indicated that taking a structured approach to interactions between HCPs and health service users would enable elicitation of individual concerns, development of a plan tailored to that individual, negotiation of roles and review of goals as individual priorities change. In the optimisation stage, older adults and HCPs commented on the idea of a structured conversation to promote person-centred care and on its feasibility in practice. The idea of a shared, person-centred approach to care was viewed positively. Concerns were raised about possible extra work for those receiving or delivering care, time and staffing, and risk of creating another "tick-box" exercise for staff. Participants concluded that anyone with the appropriate skills could potentially deliver the intervention, but training was likely to be required to ensure correct utilisation and self-efficacy to deliver to the intervention. Conclusions: CHAT&PLAN, a structured person-centred conversation guide appears acceptable and appealing to HCPs and older adults with multimorbidity. Further development of the CHAT&PLAN intervention should focus on ensuring that staff are adequately trained and supported to implement the intervention.
Background: Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions. Methods: A theory-, evidence- and person-based approach to intervention development was undertaken. The intervention planning and development process included reviewing relevant literature and existing guidelines, developing guiding principles, conducting a behavioural analysis and constructing a logic model. Optimisation of the intervention and its implementation involved qualitative interviews with older adults with multimorbidity (n = 8), family caregivers (n = 2) and healthcare professionals (HCPs) (n = 20). Data were analysed thematically and informed changes to the intervention prototype. Results: Review findings reflected the importance of HCPs taking a person-centred (rather than disease-centred) approach to their work with older people living with multimorbidity. This approach involves HCPs giving health service users the opportunity to voice their priorities, then using these to underpin the treatment and care plan that follow. Findings from the planning stage indicated that taking a structured approach to interactions between HCPs and health service users would enable elicitation of individual concerns, development of a plan tailored to that individual, negotiation of roles and review of goals as individual priorities change. In the optimisation stage, older adults and HCPs commented on the idea of a structured conversation to promote person-centred care and on its feasibility in practice. The idea of a shared, person-centred approach to care was viewed positively. Concerns were raised about possible extra work for those receiving or delivering care, time and staffing, and risk of creating another "tick-box" exercise for staff. Participants concluded that anyone with the appropriate skills could potentially deliver the intervention, but training was likely to be required to ensure correct utilisation and self-efficacy to deliver to the intervention. Conclusions: CHAT&PLAN, a structured person-centred conversation guide appears acceptable and appealing to HCPs and older adults with multimorbidity. Further development of the CHAT&PLAN intervention should focus on ensuring that staff are adequately trained and supported to implement the intervention.
Subject terms:
intervention, evaluation, complex needs, comorbidity, person-centred care, older people, communication, long term conditions, needs assessment, care planning, self-directed support;
This joint Jewish Care study funded by the King’s Fund aimed to put in place and evaluate an intervention to improve end of life experience of residents, with advanced dementia, as well as reducing the stress for staff. The study took place in Lady Sarah Cohen House, London, and the intervention consisted in a 10-session interactive training programme, which covered the challenges of dementia end of life care; the physical process and symptoms of end of life; emotional and psychological needs at end of life; planning for end of life care; care planning and communication with residents and relatives; religion and spirituality at end of life; holistic care for people with dementia at the end of life and finally a summarising and reflective session. The report outlines the positive impact of the intervention and details key outcomes. After the intervention more people with dementia died in the care homes compared to hospital. A greater number of residents had advance wishes in their notes after the intervention than before and all advance wishes were adhered to. Median days in hospital in the three months prior to death fell from 4 (pre-intervention) to 1.25 post intervention. Interviews with a small number of relatives after they had been bereaved suggested they were less stressed than prior to the intervention. Staff felt better equipped to deal with the increasing frailty of the residents and staff exhibited a better understanding of the management of distress and pain in older people with dementia. In addition, staff found it easier to discuss death and dying with relatives, and therefore became more confident and comfortable with end of life planning and communication.
(Edited publisher abstract)
This joint Jewish Care study funded by the King’s Fund aimed to put in place and evaluate an intervention to improve end of life experience of residents, with advanced dementia, as well as reducing the stress for staff. The study took place in Lady Sarah Cohen House, London, and the intervention consisted in a 10-session interactive training programme, which covered the challenges of dementia end of life care; the physical process and symptoms of end of life; emotional and psychological needs at end of life; planning for end of life care; care planning and communication with residents and relatives; religion and spirituality at end of life; holistic care for people with dementia at the end of life and finally a summarising and reflective session. The report outlines the positive impact of the intervention and details key outcomes. After the intervention more people with dementia died in the care homes compared to hospital. A greater number of residents had advance wishes in their notes after the intervention than before and all advance wishes were adhered to. Median days in hospital in the three months prior to death fell from 4 (pre-intervention) to 1.25 post intervention. Interviews with a small number of relatives after they had been bereaved suggested they were less stressed than prior to the intervention. Staff felt better equipped to deal with the increasing frailty of the residents and staff exhibited a better understanding of the management of distress and pain in older people with dementia. In addition, staff found it easier to discuss death and dying with relatives, and therefore became more confident and comfortable with end of life planning and communication.
(Edited publisher abstract)
Subject terms:
dementia, end of life care, training, care planning, health needs, emotions, holistic care, communication, staff-user relationships, spirituality, advance care planning, advance decision, older people;
Good end of life care is an important component in the care of older people. Palliative care seeks to influence improvement in the quality of life of patients with incurable disease by advocating a holistic, problem-orientated approach, including symptom control. However, end of life care for older people is often suboptimal. This guide considers: what constitutes a good death; improving end of life care; ethical and legal aspects of end of life care; and end of life care and the geriatrician. Comprehensive geriatric assessment plays an important part in enabling older people to live well until they die. Along with enhanced communication and honest prognostication, comprehensive geriatric assessment is important to identify treatment priorities as part of effective clinical decision making. Advanced planning and integrated care pathways enhance the quality of end of life care. Although most people would prefer to die at home, most die in hospital. However, regardless of the place of care or diagnosis older people should have access to specialist palliative care teams where appropriate.
Good end of life care is an important component in the care of older people. Palliative care seeks to influence improvement in the quality of life of patients with incurable disease by advocating a holistic, problem-orientated approach, including symptom control. However, end of life care for older people is often suboptimal. This guide considers: what constitutes a good death; improving end of life care; ethical and legal aspects of end of life care; and end of life care and the geriatrician. Comprehensive geriatric assessment plays an important part in enabling older people to live well until they die. Along with enhanced communication and honest prognostication, comprehensive geriatric assessment is important to identify treatment priorities as part of effective clinical decision making. Advanced planning and integrated care pathways enhance the quality of end of life care. Although most people would prefer to die at home, most die in hospital. However, regardless of the place of care or diagnosis older people should have access to specialist palliative care teams where appropriate.
Subject terms:
integrated services, older people, palliative care, quality of life, terminal illness, assessment, care pathways, care planning, communication, death, end of life care;
This training manual is designed specifically for residential and day care staff who work with older people. Topics covered in the manual are closely linked to the new requirements for training in social care work as outlined in the TOPSS induction and foundation standards. Each of the chapters contains exercises, case studies, a reading list and a simple discussion of the relevant theory. The key areas covered include: the principles of care, the role of the care worker, the needs of older people, care planning and risk assessment, effective communication and recording, supervision, dealing with challenging behaviour, death and dying, and elder abuse.
This training manual is designed specifically for residential and day care staff who work with older people. Topics covered in the manual are closely linked to the new requirements for training in social care work as outlined in the TOPSS induction and foundation standards. Each of the chapters contains exercises, case studies, a reading list and a simple discussion of the relevant theory. The key areas covered include: the principles of care, the role of the care worker, the needs of older people, care planning and risk assessment, effective communication and recording, supervision, dealing with challenging behaviour, death and dying, and elder abuse.
Extended abstract:
Author
PRITCHARD Jacki
Title
Training manual for working with older people in residential and day care settings.
Publisher
Jessica Kingsley, 2003
Summary
This manual is designed specifically for residential and day care staff who work with older people. Topics covered are closely linked to the new requirements for training in social care work as outlined in the TOPSS induction and foundation standards.
Context
The book is intended to support the recently-introduced national standards on induction for care workers. Designed to promote good practice in working with older people in residential and day care, it is aimed at helping care workers meet the new requirements.
Contents
A glossary is followed by 12 chapters on training care workers and using the manual; principles of care; the role of the care worker; the needs of older people; care planning; risk assessment; effective communication; recording; supervision; dealing with challenging behaviour; death, dying and bereavement; and abuse. Each chapter clearly outlines the TOPSS Induction and Foundation Standards and NVQs it is relevant to and contains a simple discussion of the relevant theory together with exercises, case studies, photocopiable handouts and other materials, a reading list, related training videos and useful organisations. Appendices list BVS videos and contact details of useful organisations.
93 references
Subject terms:
older people, residential care, risk assessment, supervision, case records, challenging behaviour, care homes, care planning, communication, day services, death, dying, elder abuse;
Positive Publications/ Anglia Polytechnic University, Faculty of Health and Social Work
The authors suggest that assessment and care planning needs a system which can be understood by services users as well as by professionals. They show how the 'four magnets' - control, skills, pain and contact - can be unifying and holistic.
The authors suggest that assessment and care planning needs a system which can be understood by services users as well as by professionals. They show how the 'four magnets' - control, skills, pain and contact - can be unifying and holistic.
Subject terms:
learning disabilities, models, needs, older people, physical disabilities, planning, quality of life, service users, social role valorisation, user participation, assessment, care management, care planning, communication;
This book provides knowledge for nurses and members of care teams who support older people. It incorporates evidence-based and outcomes-based practices throughout, describing everyday clinical issues and providing guidance on practical management problems. Contents include: aged care nursing; nursing assessments; skin and oral hygiene; pressure ulcers and leg ulcers; foot care; nutrition; enteral feeding; incontinence; falls; manual handling and mobility; wandering; dysfunctional behaviour; pain management; palliative care; care plans; delirium and dementia; medications; complementary therapies; cultural differences; occupational health and safety; elder abuse; communicating in frustrating situations.
This book provides knowledge for nurses and members of care teams who support older people. It incorporates evidence-based and outcomes-based practices throughout, describing everyday clinical issues and providing guidance on practical management problems. Contents include: aged care nursing; nursing assessments; skin and oral hygiene; pressure ulcers and leg ulcers; foot care; nutrition; enteral feeding; incontinence; falls; manual handling and mobility; wandering; dysfunctional behaviour; pain management; palliative care; care plans; delirium and dementia; medications; complementary therapies; cultural differences; occupational health and safety; elder abuse; communicating in frustrating situations.
Subject terms:
holistic care, incontinence, medication, mobility, nursing, nutrition, older people, pain, palliative care, wandering, assessment, care planning, complementary therapies, communication, conduct disorders, dementia, cultural identity, elder abuse, falls, health care, health professionals;