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Facilitator:
Step 2
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Review / Recap
• Step 1 workshop review
• Review of ‘To Do’ List
• Reflection discussions
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Objectives
Step 2 objectives:
• Recognise the importance of holistic care planning
• Show awareness of assessment of mental capacity
• Show awareness of advance care planning
• Recognise collaborative working methods
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Step 2
Assessment, care planning and review
“As the end of life approaches it will be essential that an
assessment of an individual’s needs has taken place,
and that the care worker is familiar with it’s requirements.
The assessment should include physical, psychological,
spiritual and cultural and, where appropriate,
environmental and financial issues”
The Route to Success in End of Life Care – achieving quality in
domiciliary care
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Activity - A Good Death
• Groups:
The individual
The family
The domiciliary care worker
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Holistic Assessment
“You matter because you are you, and you matter
to the last moment of your life”
Dame Cicely Saunders
What is holistic assessment?
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Holistic Assessment
• Ensures that all needs of a person are known so
that those caring for them can respond
accordingly
• Identifies unmet needs
• Co-ordinates care
• Continual process
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The Whole Person
Emotional
Spiritual
Religious
Cultural
The Whole
Person
Psychological
Physical
Social
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Activity – Holistic assessment
• Discuss current tools in use for
assessment of individuals
• Group work: Step 2 case study
• Domains: Physical, Psychological,
Spiritual, Social
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Physical Problems
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Hair Care
Eye problems
Oral problems
Breathlessness
Pain
Constipation
Urinary problems
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Hair care
Cleanliness
Sexuality.
Dignity
Body image
Bedbound clients
What can you do to help?
Shampoo Cap
Dry shampoo
Washing technique in the bedbound client
Maintain dignity
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Eye care
Common eye problems
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Infection
Injury
Dry eyes
Damage to cornea in unconscious patients
Aims of eye care
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Comfort
Cleanliness
Moisture
Prevention of infection
Alleviate pain and discomfort
Management of infection
Follow local eye care protocol
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Mouth care
Common mouth problems;
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Cracked lips
Poor fitting dentures
Fungal infections e.g thrush
Lack of saliva, dry mouth
Aims of good mouth care;
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Comfort
Cleanliness
Moisture
Prevention of infection
Alleviate pain and discomfort and promote oral intake
Prevent halitosis and freshen the mouth
Follow local mouth care protocol
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Breathlessness
Consider the causes of breathlessness
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How can you help the breathless
client?
 Don’t panic yourself
 Keep calm
 Encourage client to relax
 Different breathing techniques
 Fan
 Medications as prescribed
 Referral
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Pain
Consider the causes of pain?
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Facial
expression
Body
language
Client
tells you
Holding or
stroking body
part
Mood
change
Recognising
pain
Restless
Agitation
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Management of pain
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Assessment- VAS
Regular medication as prescribed
Changes in position
Bedding/support pillows
Quiet environment
Distraction activities e.g. music
Massage
Sitting talking
Referral
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Personal hygiene
What are the issues?
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Personal care
Consider;
Keeping patients feeling fresh
Tiredness
Pain
Lack of equipment
Maximising the persons independence
Maintaining dignity
Is your patient well enough for a full shower or bath?
Access to clean clothes/nightwear
Maintaining the clients usual routine
Moving and handling
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Skin integrity
• Pressure area care assessment
• Specialist aids; beds, mattresses
• Repositioning
• Cleansing of the skin
• Management of incontinence
• Observation and recording
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Urinary & Catheter Care
What are the issues?
Diet
Fluids
Appetite
Equipment
Access to toilet
Presentation
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Elimination
ConstipationWhat are the issues?
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Mental Capacity
The ability to make one’s own decisions. The
individual must be able to:
• Understand the information given to them
• Retain that information long enough to be able to make a
decision
• Weigh up the information available to make a decision
• Communicate their decision
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Abilities
Consider:
• An individual with communication
difficulties
• An individual with reduced mental capacity
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Two Stage Test
To assess mental capacity we consider:
• Stage 1: Is there an impairment of, or
disturbance in the functioning of a person's mind
or brain? If so,
• Stage 2: Is the impairment or disturbance
sufficient that the person lacks the capacity to
make a particular decision?
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Best Interest
Decision Making
• Decisions can be made for the individual in their
considered ‘best interests’, if they are unable to
express their wishes independently (i.e. lack
capacity / inability)
• Discuss the legal and ethical implications of ACP
and best interest decision making
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Advance Care Planning
• The expression and documentation of an
individual’s clear wishes about future care
• May include place of care at end of life,
treatments to have and not to have,
whether to be resuscitated or not, whether
to be hospitalised or not
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ACP in practice
• How does ACP work in your organisation?
Discuss:
 Preferred priorities of care (PPC)
 Advance decision to refuse treatment (ADRT)
 Do not attempt resuscitation (DNAR)
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Collaborative working
• Who supports the individual’s care at the
end of life?
• In groups create a spider diagram
• What systems exist for discussion,
recording and communicating...?
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Remember...
“Death is a personal journey that each
individual approaches in their own unique
way. Nothing is concrete, nothing is set in
stone. There are many paths one can take
on this journey but all lead to the same
destination.”
(Morrow, A. 2010)
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Objectives
Step 2 objectives:
• Recognise the importance of holistic care planning
• Show awareness of assessment of mental capacity
• Show awareness of advance care planning
• Recognise collaborative working methods
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Onwards...
• ‘To Do’ List
• Reflective practice
• Evaluation of session
• Next session: Step 3: Co-ordination of
care
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