What does holistic mean to you What is an holistic assessment Definition of holistic An holistic assessment is one which not only looks at the physical aspects of a person but looks also at the psychological social and spiritual aspects ID: 541198
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Slide1
Step 2 workshopSlide2
What does holistic mean to you?Slide3
What is an holistic assessment?Definition of ‘holistic’
An holistic assessment is one which not only looks at the physical aspects of a person, but looks also at the psychological, social and spiritual aspectsSlide4
Holistic assessmentIs a continuous process & leads to:More effective care and treatment of symptomsMore client-centred (client’s priority)
Improves communication between all professionals involved with careImproves evaluation of treatments
Reassures/includes client’s family
Improves the client’s quality of lifeSlide5
The whole person?PHYSICALPSYCHOLOGICALSPIRITUAL
SOCIALSlide6
An example is ‘total pain’
‘TOTAL PAIN’
Social
Emotional &
Psychological
Personal & Spiritual
PhysicalSlide7
Group Work Slide8
Case study Eloise Griffiths is a 68 year old lady with severe heart failure. She lives with her husband, Eric, who has advancing dementia. Eric was the sole carer for Eloise until 2 years ago when he was diagnosed with Alzheimer’s Disease. He remains independent, but his son and daughter have noted that he is getting confused at times.
As part of a package to increase the support for Eric, to enable him to stay at home and to care for Eloise, you have been asked to provide two visits per day, one morning to help Eloise get up and one in the evening to assist her to bed. The referral you received says the Eloise has a very limited life expectancy and that there are no other medical alternatives to managing her heart failure. She gets extremely breathless on the minimum of movement and requires continuous oxygen.
This lady is at the end of her life (on the Northwest Model and your Supportive Care Record she would be ‘Amber’). Considering the above issues, how do you carry out your assessment, both generally and in relation to potential end of life issues?
Using a care planning template, consider the four following areas:
Physical
Psychological
Spiritual
SocialSlide9Slide10Slide11
Help with assessmentsWhat questions should you ask?Slide12
Ask….Nature – what is it likeLocation – where do you get it
Severity – what is it like at its worst
Frequency – how often do you get this
Duration – how long does it last
Triggers – does anything bring it on/ make it worse
Alleviating factors – does anything relieve it
Assessment tools useful e.g. body charts, symptom diaries.Slide13
Sweating
Loss of appetite/fluid intake
Guarding
Urinary & faecal incontinence
Sleep disturbance
Increased confusion
Facial expression
Assuming a foetal position
Agitation
Increased/decreased movement
withdrawal
Hard to settle
Observing behaviour
Also what we hear, smell & senseSlide14
Be aware of overlapping symptoms
OUTCOME FOR
CLIENT:
IMPROVED QUALITY OF LIFESlide15
Tools Do you have any examples of tools you use for assessment?Slide16
Assessment ToolsSkin Breakdown – Braden/Waterlow
Oral AssessmentHOPE - Spiritual assessment
Pain
Fluids
BowelsSlide17
Advance Care PlanningSlide18
Aims of the session
How does ACP fit in with a ‘good death’?
What is ACP?
An introduction to some of the broader aspects
Mental Capacity Act
Advance Decisions to Refuse Treatment (ADRT)
Do Not Attempt Resuscitation (DNAR)Slide19
What is a ‘good death’ in relation to a person’s choices and decision making?Slide20
What is Advance Care Planning?
A
voluntary process of discussion
about future care between an individual and their care providers, irrespective of discipline. If the individual wishes, their family and friends may be included. It is recommended, with the individuals agreement, that this discussion is
documented
,
regularly reviewed, and communicated to key persons involved in their care
NHS End of Life Programme 2008Slide21
(Gold Standards Framework)
ADVANCE CARE
PLANNING
ADVANCE
STATEMENT
ADVANCE
DECISIONS
Formalises what individuals and their
family
do
wish to happen to them
Can be useful to clinicians in planning
of individual’s individual care
Not legally binding and may
also
need
Advance Decision
Formalises what individuals
do not
wish
to happen to them
Legally binding document, eg (Advance
Decision to Refuse Treatment (ADRT)
and/or DNACPR
Related to capacity of decision making-
Mental Capacity Act
Diagram to illustrate Advance Care Planning process Slide22
Individual’s agenda:
What are the individuals
feelings about their illness
, what
concerns
do they have, what
goals
are they looking to reach, do they
understand their illness
and its
prognosis
, do they have particular care
preferences, now and in the future
?
Tools that may help trigger conversations:
Thinking about it! Prompt card
Notice board posters
Conversations for life cards
Dying Matters Resources/ Events
Reminiscence groups/ memory boxesSlide23
Documentation
The process of ACP is more important than completing any document
………….
but it is important to document any ACP outcomes in the most appropriate way and communicate this with appropriate others.Slide24
Preferred Priorities for Care (PPC)Slide25
Person held document, so...Ideally the individualCould be a relative with individual inputCould be professional/ carer with individual
Then
Keep it in a visible and easily accessible place
Communicate the presence of a PPC to others involved in their care
Take any necessary actionsSlide26
The explicit recording of individuals/carers wishes can form the basis of care planning in multi-disciplinary teams and other services, minimising inappropriate admissions and interventions.
In relation to your health what has been happening to you?
What are your preferences and priorities for your future care?
Where would you like to be cared for in the future?Slide27
Provides simple information around:Lasting Power of Attorney
Advance Decisions to Refuse TreatmentAdvance Care PlansGood way to test the waterSlide28
Version for use with individuals who have communication difficulties i.e. Learning disabilities, early dementiaSlide29
The PPC is
NOT
legally binding...
However the
Mental Capacity Act 2005
dictates that when making a ‘best interest decision’ the decision maker must consider, so far as is reasonably ascertainable—
(a) the person’s past and present wishes and feelings (and, in particular, any relevant written statement made by him when he had capacity),
(b) the beliefs and values that would be likely to influence his decision if he had capacity, and
(c) the other factors that he would be likely to consider if he were able to do so.Slide30
Let’s go back to Eloise (i
)Slide31
Choice and decision- making by, and on behalf of, people with impaired mental capacity 5 Core PrinciplesBest Interest Decisions
Independent Mental Capacity Advocates (IMCA’s)
Advance Decision to Refuse Treatment (ADRT)
Appointment of a Lasting Power of Attorney (LPA)
Mental Capacity Act (MCA) 2005 Slide32
5 Core Principles of the MCA
A person must be
assumed to have capacity
unless it is established that they lack capacity
A person is not to be treated as unable to make a decision unless
all practicable steps
to help him to do so have been taken without success
A person is not to be treated as unable to make a decision merely because of
diagnosis
or because he makes an
unwise decision
An act done, or decision made under this Act for, or on behalf of a person who lacks capacity must be done or made in his
best interests
Before the act is done, or the decision is made , regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is
less restrictive of the persons rights
and freedom of actionSlide33
Used in order to decide whether an individual has the capacity to make a particular decision:Is there an impairment of, or disturbance in the functioning of a person's mind or brain?
if so Is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision
Two stage test for capacitySlide34
Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR)
– the local documentationSlide35
Local DNA(CPR) form
Patient InformationLeaflet
Hard copy
with patient
Standardised procedures
Information for you,
your relatives and carers about
Do Not Attempt Cardiopulmonary
Resuscitation(DNACPR) Decisions
April
2013 Version One
Slide36
Unfortunately, as a complex subject, there is no ‘quick overview’ but there is plenty of guidance available (see resources)Be aware of local policy and local documentationCommunication is key
Be aware of/have systems to document individuals with completed DNACPR documentation
DNACPRSlide37
Eloise (ii)Slide38
Find out more...
Advance Decision Making
List of resources from ‘Dying Matters’
http://www.dyingmatters.org/page/advice-professionals
Deciding Right – a northeast initiative for making decisions in advance
http://www.theclinicalnetwork.org/end-of-life-care---the-clinical-network/decidingright
Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR)
Decision relating to cardiopulmonary resuscitation – (BMA/
Resus
Council/RCN)
https://
www.resus.org.uk/pages/DecisionsRelatingToCPR.pdf
DNACPR
decisions: who decides and how? (
NeOLCP
)
http://
www.nhsiq.nhs.uk/media/2395952/dnacpr_web_resource_final_27.09.12.pdf