acp learning pack session six1 acp learning pack session six offering acp in your care home

ACP Learning Pack Session Six 1

ACP Learning Pack

Session SixOffering ACP in your care

home


Groupwork One

• If ACP is not part of what you offer in your care home in any structured way, then this will need to be introduced to all relevant people.

• In your groups consider how you can do this. For example, who needs to know? How can you inform and prepare each group of people?


Who needs to know?

• Residents • People close to the residents, eg relatives• All staff • GPs • Other relevant visiting professionals


Informing and preparing residents - 1

Possible methods:-• an overview of ACP in a regular newsletter• ‘one-to-one’ contact with competent

member of staff • letter to each resident • written information • resident’s meeting


Informing and preparing residents - 2

• A sensitive approach is needed, so that people are not alarmed.

• Reassurance that thinking about, discussing and recording wishes for the future is a voluntary process.

• There is no compulsion to take part, but is an ‘opportunity’ only.

• ACP can be seen as a natural progression from thinking about care now, to thinking about possible care in the future


Informing and preparing people close to the residents, eg relatives • an overview in a regular newsletter • ‘one-to-one’ contact with competent

member of staff • letter • written information • relatives meeting


Informing and preparing staff

• an overview in a regular newsletter • ‘one-to-one’ contact with competent

member of staff• letter • written information • staff meeting• at supervision


Informing and preparing GPs

• ‘one-to-one’ contact with competent and senior member of staff eg Manager

• invitation to GP(s) to join a working group• letter to surgeries and/or written

information about what is planned • meeting with Practice Manager


Informing and preparing other visiting professionals

• ‘one-to-one’ contact with competent senior member of staff eg Manager

• invitation to professional to join a working group

• letter and/or written information about what is planned


Groupwork Two

• Devise a letter for a prospective resident introducing ACP and the approach to ACP in your home.

• The letter should set out what ACP is in clear terms and explain what benefit ACP can bring to the resident.


Practical considerations for ACP

• Where should wishes for the future be recorded?

• Where should the document be stored?

• Who should have a copy?

• Who should be aware of a resident’s ACP?

• How often should an ACP be reviewed?


Where should wishes for the future be recorded?

• In the care plan (service user plan)?• In a separate document?• On the computer?

Issues to consider:-• Accessibility• Confidentiality


Where should the document be stored?

Issues to consider:-

• Accessibility

• Confidentiality


Who should have a copy or be aware of the ACP?

• Care Home

• Resident

• GP

• Relative?

• Other professionals?

• On transfer?


How often should an ACP be reviewed?

• On the request of the person – at any time

• When the care plan is reviewed each month

• A formal review at least annually


How could religion, culture and ethnicity affect the approach to ACP?

• Each resident will have their own perspective on ACP• Religion,culture and ethnic origin may have some influence on this• Do not make assumptions about the effect of religion,culture and ethnic origin


What are the main religions of the world?

• Baha’i Buddhism Christianity Christian Science Hinduism Jainism

Judaism Islam Paganism Rastafarianism Sikhism Zoroastrianism

References:-Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.


Baha'i

• No rituals before death• Baha'i are always buried, never cremated• Place of internment within one hour's

journey of place of death• Prayers and observations arranged by

family or local Baha'i community



Buddhism

• Resuscitation is acceptable• Like full information about imminent death,

to make preparation• May not want sedatives and pain killers

near to death.• Buddhist priest to be informed as soon as

possible after death.



Christianity• Different views within different denominations of

Christian religion, eg Roman Catholic, Church of England, Free churches

• Roman Catholic – visit by priest to receive Holy Communion and/or Sacrament of the Sick (Last Rites)

• Afro-Caribbean people may want to have singing and special prayers near to death

• Many Travellers are Christian and Roman Catholic



Christian Science

• Relies on God for healing, so may not wish to have drug treatment

• Church does enable people to make their own choices about what treatments they will accept or refuse.

• There are no last rites



Hinduism • Prefer to die at home, as death in hospital can

cause distress• Readings from the Bhagavad Gita (Holy Book)• May wish to lie on the floor, near to death, to

symbolise the closeness to Mother Earth• Holy Rites, including a thread tied around the

wrist or neck• Eldest son to be present before, during and after

death • After death non Hindus should not touch the body

unless wearing gloves• All adult Hindus are cremated References:-Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.


Jainism

• Family to be present near to and after death



Judaism • Orthodox (conservative) or Progressive (liberal) –

needs will vary• Jewish law forbids euthanasia, as human life is

sacred• Psalms and prayers near to death• Rabbi to visit and someone with the dying person

at all times• As little intervention as possible from staff• Last offices usually by the Jewish Burial Society • A 'watcher' to stay with the body until the burial



Islam • Resuscitation allowed -a matter of choice• Suicide and euthanasia are considered to be major

sins• Muslims may wish to lie or sit facing Mecca if near to

death• Readings from the Qur’an / Koran (Holy Book) may

be recited. • If possible non-Muslims should not touch the body

after death, but if necessary gloves should be worn.• People from Pakistan may be sent to Pakistan for

burial.• Burial, never cremation



Rastafarianism

• Unwillingness to receive any treatment which will contaminate the body

• Preference for alternative therapies, herbalism or acupuncture

• Visits in groups, with praying at the bedside• Burial is preferred



Sikhism

• Wearing of the five symbols of Sikhism – these should not be removed unless absolutely necessary, even after death

• Reciting of readings from the Sikh Holy Book - Guru Granth Sahib

• After death the family may wish to wash and lay out the body

• Always cremationReferences:-Jackson C (2002, revised 2005) 'The religious, spiritual and cultural needs of patients: a guide and reference document for staff'. Derby Hospitals NHS Foundation Trust. Mootoo JS (2005) 'A guide to cultural and spiritual awareness.' Nursing Older People. Vol 17. No 5.


Zoastrianism

• Special shirt and girdle to be worn after death and sometimes a cap or hat



What additional support may some residents need?

• Language – written and spoken• Communication- making their views known• Understanding their options• Recording a signature• Promoting equality and diversity – a

‘personalised approach’. (CSCI 2008)


Groupwork Three

• Quiz – Reveiwing and Confirming knowledge of ACP


Summary • Advance Care Planning promotes residents’ dignity.• With ACP residents can be supported at all times as they

would want, even if they are unable to express their wishes.

• ACP enables their views to be recorded and known by all relevant people.

• Care Homes staff, GPs and other professionals can feel confident they are doing what the resident wants, as far as they are able.

• The Mental Capacity Act 2005 gives a framework to support care home staff with ACP.

• The process of ACP formalises acknowledged ‘good practice’ guidance.

• Care Home staff are well placed to offer ACP as they build trusting relationships with residents.

• ACP is a natural progression from planning care for now, to planning care for the future.


One Care Home Manager’s view of ACP

• “I think it is very helpful. It gives us a clear indication of what people want. It gives us more confidence to speak on behalf of our residents, to Doctors etc. I think it helps to establish a firm understanding and subsequently support for and from the family.”

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Advance Care Planning: offering residents the opportunity to record their wishes for the future.

Thank you for coming !

acp learning pack session six1 acp learning pack session six offering acp in your care home

Documents

residents acp

overview of acp

benefit acp

groupwork oneif acp

residents people

relativesall staff gps

gps onetoone contact

information relatives