Authors: Faye Thrasivoulou and Laura Slack, Care Home Development and End of Life Care Support Nurses
Date: August 2024
Introducing Faye and Laura
We provide education, training, practical support and mentorship to residential care homes across Erewash. This is a two-year project funded by The Sir Jules Thorn Charitable Trust.
Our aim is to educate care home staff to recognise when a resident’s health declines and have the knowledge and skills to best meet their needs and final wishes.
Monday
Our week begins with a visit to a local residential care home to deliver training on recognising dying and symptom management. This is a 3-hour session which supports staff to recognise when a resident may be deteriorating and empowers them to support residents at the very end of life. The training includes how to manage symptoms without the use of medication. For example, helping a resident who is suffering with breathlessness to sit up. Or to open a window which can help them to feel more comfortable. The training also covers when to seek support.
Training for care homes
All our training sessions are tailored to the individual needs of each care home and each session is delivered face-to-face. We educate entire teams, from care staff and managers to domestic staff. Seventeen staff took part in today’s training.
Real-life case studies and group activities are included in our training to make it as interactive as possible, and check understanding as learning needs amongst staff are varied. We’ve had great feedback which shows how encouraging staff to be actively involved in the learning process has helped them to gain the most out of the sessions. We encourage staff to ask questions.
Making a huge difference to care homes
We also offer communication skills training, mouth care training, and advance care planning sessions. The communication skills and advance care planning sessions upskill staff to listen and talk sensitively to their residents. This is vital to identify and record their final wishes in advance.
The project is unique and aims to influence the delivery of end-of-life care locally and nationally through best practice.
The project started in January. We’ve trained 314 staff from eleven care homes within Erewash and five outside this area.
We’ve established some excellent working relationships with the care homes which has made a huge difference locally.
"The training has been fantastic. It was very interactive, and Faye and Laura were very approachable and patient with all my questions. It will impact a lot on my future practice.”
Tuesday
In addition to delivering face to face training, we also offer hands-on support to care home staff. Staff are supported to apply theory into practice. This aims to increase their confidence and practical skills, and embed to face-to-face education sessions. Practical support complements existing support already in place from GPs, district nurses and other healthcare professionals. It can help with the coordination of these services, avoiding unnecessary delays.
Empowering staff
We receive a referral for a resident who needs support due to a decline in their condition. We assess the urgency and make plans to visit the care home tomorrow.
Residents may be living with several different conditions such as frailty, dementia, respiratory conditions, heart failure or other chronic illness. If it’s a residents wish to die in the residential home, our goal is to achieve this, avoiding crisis situations and unnecessary hospital admissions. Some residents may have lived in the care home for many years, and it is their home.
We empower staff to put advance care planning skills into practice. We guide them to have discussions with a resident and make any relevant referrals to other professionals.
So far, we’ve offered practical, bedside support for 27 residents.
At the end of the day, we have a catch-up with our line manager. We let her know how our project is progressing and agree actions going forward.
Wednesday
Today, we are shadowed by a Treetops Hospice at Home registered nurse. This is all part of her Continuing Professional Development to gain some of her competencies.
We make an initial visit to the resident referred to us yesterday. We help the care home staff to complete an assessment involving the resident’s family.
Effective communication
We encourage staff to communicate effectively. It is important family members are informed of any changes in a relative’s condition if they wish to be involved.
The care home staff are supported to make a referral for an urgent swallow assessment, as the resident has a choking risk.
We encourage staff to contact us for any further support if needed and ensure they are aware of contact numbers for support out-of-hours.
Thursday
We visit a care home to attend their monthly palliative care register meeting. This is a meeting we encourage through our training.
The register looks at all the residents within the home. The care staff are then encouraged to go through each resident individually and score them using a traffic light system. All staff within the home are encouraged to attend and can contribute any concerns they have. Where a resident’s needs are changing or deteriorating, this prompts care staff to ensure everything is in place. For example, if a resident is losing weight or has had several hospital visits, this will prompt them to organise a GP review.
The palliative care register supports the care home with advance care planning and encourages staff to be proactive rather than reactive. Eleven care homes have set up these regular meetings so far as part of our project.
At today’s meeting, staff highlight a resident’s condition has declined recently. This resident has decided that they don’t want to be admitted to hospital. This is communicated and documented to avoid any unplanned hospital admissions in the future. It will ensure that the resident's wishes for their preferred place of care and death is met.
Sharing best practice
We attend an education team meeting with professionals from other organisations within Derbyshire. We discuss any issues we might have come across in our area of practice and share ideas and best practice of how to overcome these.
Friday
On Friday, we deliver a mouth care training session at a residential care home. Mouth care is often overlooked at the end of life. When people can’t eat or drink, their mouths become dry and are more likely to get an infection. Good mouth care and oral hygiene can provide comfort and avoid complications.
The training covers the anatomy of the mouth, common complications – and how to manage these, and how to best support their residents.
A flexible approach
We recognise that not all staff are available for training at any one time. Staff move on, and new staff join their teams. We overcome these issues with a flexible approach. We fit in with care home routines and availability, often providing more than one session for staff to attend.
In the afternoon, we support a district nurse with setting up a syringe driver for a resident who is experiencing pain and breathlessness in the care home. We have a close working relationship with the district nursing and frailty service which enhances care. Symptoms are managed in the community avoiding an unnecessary hospital admission.
Later in the day we attend an online end-of-life medicines working group. This is made up of community professionals such as consultants, specialist nurses, and senior pharmacists. We discuss any current issues with medication, review guidance, and plan how to overcome any issues. It keeps us up-to-date with information that we can then share with care homes.
We feel privileged to have a role which makes such a difference. We’re continuously learning and developing ourselves and enjoy passing our knowledge and skills on to others for them to be able to make a difference.