Step 2 workshop
Step 2 workshop

Step 2 workshop - PowerPoint Presentation

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Step 2 workshop - Description

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 Download Presentation

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Presentation on theme: "Step 2 workshop"— Presentation transcript


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



An example is ‘total pain’



Emotional &


Personal & Spiritual


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:





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


Loss of appetite/fluid intake


Urinary & faecal incontinence

Sleep disturbance

Increased confusion

Facial expression

Assuming a foetal position


Increased/decreased movement


Hard to settle

Observing behaviour

Also what we hear, smell & senseSlide14

Be aware of overlapping symptoms




Tools Do you have any examples of tools you use for assessment?Slide16

Assessment ToolsSkin Breakdown – Braden/Waterlow

Oral AssessmentHOPE - Spiritual assessment




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?


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



regularly reviewed, and communicated to key persons involved in their care

NHS End of Life Programme 2008Slide21

(Gold Standards Framework)







Formalises what individuals and their



wish to happen to them

Can be useful to clinicians in planning

of individual’s individual care

Not legally binding and may



Advance Decision

Formalises what individuals

do not


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


do they have, what


are they looking to reach, do they

understand their illness

and its


, 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


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


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


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


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


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



2013 Version One








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


Eloise (ii)Slide38

Find out more...

Advance Decision Making

List of resources from ‘Dying Matters’


Deciding Right – a northeast initiative for making decisions in advance


Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR)

Decision relating to cardiopulmonary resuscitation – (BMA/






decisions: who decides and how? (