1. CONTINUING TRAINING AS A TOOL FOR CHANGE IN CARING FOR
PEOPLE AT THE END OF THEIR LIVES 2005 - 08
Ruiz - Barbosa, Carmen. Family Nurse, Cádiz. Andalusian Health Service
Rabadán - Asensio, Andrés. Chief Public Health Service. Provincial Health Delegation. Cádiz
SERVICIO ANDALUZ DE SALUD Ruiz – Pau, Concha. Head of the Palliative Care Unit. University Hospital Puerto Real. Cádiz
PREAMBLE 2005 A PROFESSIONAL INITIATIVE A PILOT EXPERIENCE
Objectives of the first activity, to acquire skills Evaluation: that medical professionals (specialists, trainee
The first training activity for medical in: specialists, nurses and nursing assistants) request that more
professionals aimed at improving the
- Approach to symptoms
s mptoms activates
acti ates of this kind be organised “All medical professionals
care provided to patients and their
- Subcutaneous administration of drugs should do this course” with additional teaching on
families during the terminal stages of
their illness was held in the Puerto - Response during the death process communicating with patients and families, dealing with grief and
Real Teaching Hospital in 2005 - Communicating with patients and families the anxiety that professionals feel in these situations “We need to
- Dealing with grief be trained to provide the best response in these situations”
WORKING FOR MISSION
PATIENTS To respond to the health care needs of patients and their families, through improved knowledge,
skills, and attitudes of the professionals of the Puerto Real University Hospital.
EXPERIENCE 2004-08
Expectations of citizens bank andalusian
Determination of needs of patients Integral Plans: • Surveys of healthcare professionals (after the
and their families • Andalusian Integral Cancer Plan courses)
•Andalusian Plan of palliative care • Proactive professional proposals
Satisfaction surveys
•Plan family caregivers care in Andalusia • Results from previous years
Guides of Processes •Plan Family Support
Integral Plans
Care processes and Standardized Care Plans :
•Palliative care Meetings with clinical units
Identification of training needs of •Colorectal cancer
professionals •Cervical cancer - Cancer of uterus
•Breast cancer. Early detection of breast cancer
Performance evaluation
•Skin cancer
Surveys of professional guides Processes •Lung cancer Subcommittee on trade union training
(Map Skills) •Benign prostatic hypertrophy. Prostate cancer
Integral Plans (Map Skills)
From: Consejería de Salud – Junta de Andalucía From: Continuing Training Unit – University Hospital Puerto Real
Objectives TO ACQUIRE SKILLS IN:
• APPROACH TO SYMPTOMS
• SUBCUTANEOUS ADMINISTRATION OF DRUGS
Acquisition of new skills • RESPONSE DURING THE DEATH PROCESS
Maintenance or improvement
• COMMUNICATING WITH PATIENTS AND FAMILIES
• DEALING WITH GRIEF
Extinction old skills
The following methodologies have been used:
Preparation of training plan •Lectures by experts
The courses have been based on different formats and
various methodologies have been used: •Demonstrations
Contents •Role play
• Clinical sessions and treatment sessions
• Workshops on subcutaneous delivery •Debate and suggestions for improving care in these
Methodology situations
• Care during the final moments and last days
• Course on grief management •Discussion of clinical cases
Teachers (Database .....)
)
• Communication workshop •Practising techniques
Facilities (classrooms, computer platform …) • Workshop on anxiety management •Individual reflections on specific situations encountered in
• Seminar “Learn to live, learn to die” daily practice
Scheduled Planning •Viewing scenes (films documentaries) and real-life
testimonials
Spread-oriented target Annual program, Groups, Sms, Website, Anothers …
•The group of activities has received a 100% satisfaction
100%
Realization of training and
rating by students.
students.
monitoring of professionals Each activity has included different leaning •Perceived usefulness was rated at 9.5 out of 10.
10.
assessment techniques: •There is still a demand for training in the tools and
•Evaluations resources used in each activity. Professionals request
Evaluation more in-depth training and ask for areas for debate and
•Observations made by students
•Proposals to improve care in real-life situations individual and group reflection to be created.
Resource management •Observation of skills (re-enactment of interviews, re- •As far as quality is concerned, professionals have a very
enactment of real clinical practice situations,..) positive opinion “Training in these situations can help to
Satisfaction of professionals
•Observation of anxiety control management techniques correctly deal with these experiences which are particularly
Transfer •Resolving clinical cases difficult for us, finding a new way along well-beaten and
empty paths” (extract from an article in a scientific journal
Impact on nursing published by a hospital nurse. “Formación y
duelo perinatal. El legado de Candela”. 2008
•Si
Since 2008 the activity has been consolidated i t a t i i
th ti it h b lid t d into training • Over 500 professionals trained on a total 1171 (2005-08)
1171.(2005-08).
1171.(2005 08)
).
programme called “Care of the terminally ill patient and his
family and carers” comprising different training activities with • We must continue to train professionals in this area and
a common aim: include an overall evaluation model which enables us to
Dissemination of results for measure the level of skills obtained.
practitioners and teachers, etc… • To improve the quality of care provided to terminally ill
patients, their families and carers, providing professionals • The training programme must include an assessment of
with the best resources (knowledge, skills and attitudes) to the quality of care given in these situations using clinical
enable them to respond in the best way to needs that arise.
arise. audits and including the opinion of patients, their families
and carers.