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Palliative care is the active holistic care of patients with advanced progressive illness. Symptom management, and the provision of psychological, social and spiritual support is paramount. The key goal of palliative care is the achievement of best quality of life for patients and their families.
District Nursing teams are central to the delivery of palliative care services within the community, with some 40% of District Nursing time being spent caring for patients with palliative and end of life care needs.
The introduction and accelerated use of skill mix within the community has resulted in Health Care Assistants (HCAs) becoming an important part of the workforce. Health Care Assistants play a key role in the delivery of safe and effective care. However, any activity considered appropriate to the role must be supported by education and testing of competence.
Health policy in Northern Ireland directed that Trusts should establish multi-disciplinary palliative care teams, and supporting service improvement programmes. This was the rationale behind the development of this project.
Seven HCAs were recruited to work as an integral part of the District Nursing teams, to provide palliative and end of life care throughout the South Eastern Trust (Northern Ireland), which serves a population of approximately 440,000 people. An induction and training programme was devised and delivered to equip the HCAs to deliver appropriate palliative and end of life care.
To highlight the development of this service a number of networking strategies were employed. A referral pathway, referral criteria and the scope of the service were formulated and circulated to all concerned professional groups.
Formal feedback regarding the service was sought in the form of a questionnaire to all District Nurse Team Leaders, patients and carers. Robust training, supervision and mentorship provision for the HCAs was maintained throughout the project, facilitating learning through reflective practice.
The benefits identified by the district nurses were that the service was quick and responsive to need, and that it enhanced the work of the district nursing service. It provided a high standard of care and in some instances reduced the visits required by the district nurse.
The development of the Health Care Assistants through the training programme has led to a significant growth in their skills specifically in relation to the provision of end of life care, displaying perceptive and caring attitudes and greater attention to detail.
The number of patients and carers that have benefited from this service has been substantial, to the point that the service has often been at capacity level. This service has been able to offer elements of care such as respite care, which could not have been provided under the auspices of district nursing prior to this.
To date 412 patients have benefited from the delivery of this service through 3727 contact visits. District nurses report a high quality, timely, flexible service, which facilitates better use of District Nursing time.
Personally and professionally this project has afforded the opportunity to develop a service for which we have a vision, a passion and believe to lie at the heart of District Nursing.
Developing this project has involved networking outside of the teams in which we would previously have been involved and as such has raised our profiles throughout the Trust. This has strengthened our skills of communicating a vision amongst peers; developing negotiation skills; remaining tenacious and developing the ability to deal with criticism when problems arise; learning to be creative in order to find a way through or around problems and so develop a new way of working; developing the ability to keep people on board when it is not their priority or interest to do so; establishing ownership of the project and maintaining clear boundaries; promoting flexibility and creativity.
Elizabeth McCormick and Mary Doherty