Dying Matters Awareness

Next week is Dying Matters Awareness Week. The aim of the week is to encourage people to talk about dying, death and bereavement and making plans for their end of life care. The trust's end of life team, part of District Nursing, works alongside other organisations in the city to support and care for people who are in the final stages of life. You can find out more about this collaborative care at www.leedspalliativecare.co.uk 

Jane and Dianne 

Jane and her colleague, Dianne, have written a post about what their roles as a palliative care discharge facilitators involves, and how they work with patients and their families. 

"Dianne and myself are both district nurses. We began our role as palliative care discharge facilitators in 2011 after it was recognised improvements could be made to discharging patients who wish to die at home. Improvements included speeding up referrals to the District Nursing teams and cutting down on the delays in care planning meetings and care packages. Transfer of care at end of life needs to be organised safely and often within hours to ensure people can get home or to their care home quickly, if that is their wish and families feel well supported.

We support district nursing teams to deliver high quality end of life care by ensuring everything is well organised and the transfer of care is seamless e.g. completing the community nursing documentation, ensuring medications are available. This enables district nurses to spend more time with the patient and their family when they arrive home. Also as part of our role, we support district nursing teams by attending discharge care planning meetings on their behalf, often on the day of referral. If patients have a Leeds GP we will attend care planning meetings at Leeds or neighbouring hospitals and hospices. Care planning meetings are arranged either by a joint care manager or a medical social worker. The meeting gives the patient and relatives / carers the opportunity to express any concerns or anxieties regarding the discharge home and explore all options. Following  the  meeting, we co-ordinate equipment / care with the other healthcare professionals involved. The ward staff handover the patient's care and the home circumstances and environment are taken into consideration. The hospital occupational therapist and physiotherapist work closely with us to identify equipment required for discharge.

We both spent many years as part of the district nursing team looking after palliative patients at the end of their life and have developed advanced communication skills enabling us to have sensitive conversations at this difficult time. We have also built strong relationships with ward and community staff, acting as a link between the staff and patients / families when their care is transferred.

We are both passionate about what we do and endeavour to deliver a quality service. The most fulfilling part of our role is enabling patients to die in their place of choice and families feeling well supported at such a difficult time." 

Jane Wilde and Dianne Fawcett, palliative care discharge facilitators

Here is one example showing how the district nursing and end of life care staff recently worked together to ensure a patient's wishes were respected and the patient and family were well supported and cared for in the final stages of the patients life. 

On hearing the devastating news that his cancer had spread, there were no further treatment options left and his life expectancy was only weeks left, the patient felt very numb and fearful of what was ahead. His only thought was to return home to spend time with his wife and dog.

A discharge planning meeting was quickly organised. He and his wife said they were relieved to hear about the services and equipment available at home and to know funding was available to ensure they had adequate support. He commented it was good to hear he had choices and could change his mind about the decisions he had made if he wanted too. Also, knowing who would be involved in his care before they went home and that they could contact a nurse at any time day and night really reassured them and made them less fearful about returning home. 

The patient was impressed by how quickly everything happened to get him home and said his dog was happy to see him. A few weeks later he died peacefully at home.  

Meet our staff...

Lisa, Rosie and Deanna are three Occupational Therapy students from Leeds Metropolitan University, working with Integrated Services. During their three month placement, they have been undertaking a project, which they explain below.

We are a group of three students studying Occupational Therapy at Leeds Metropolitan University, currently on a role emerging placement with Integrated Services until the 11th July. 

For role emerging placements, students enter into a non-traditional placement setting and introduce or expand the role of occupational therapy within the service and develop a project around this. Occupational therapists (OTs) enable people to overcome obstacles which prevent them from participating in the occupations that matter to them. This may be a result of the aging process, illness, disability or other circumstances.

Our project is to promote occupational therapy to the other professionals working within Integrated Services in Beeston (where we are mainly based) who are predominantly District Nurses and Community Matrons.

During the beginning stages of the placement we gathered information to help us devise our project by shadowing nurses and OTs on client visits, conducting a focus group with OTs and surveying the nurses based at Beeston. Our rationale for the project was that most OT referrals are for equipment or adaptation provision and the OTs in Integrated Services are aiming to work more holistically. This includes enabling clients to engage in occupations that are important to them, such as being able to socialise with friends at a weekly coffee morning, being able to take their dog for a walk, or knitting a scarf for a grandchild.

As part of the project, we have created several posters which will be displayed at Beeston Health Centre, as well as leaflets which will be distributed to staff and patients, explaining the role of Occupational Therapy. During the last week of our placement, we are holding an interactive session with the nurses based at Beeston to explore the meaning of occupation and how beneficial engaging in meaningful occupations is to a person’s health and wellbeing. We will then discuss potential interventions OTs can provide, using case studies to illustrate the role of OT with several different clients.  

Our placement mentors believe there is an unmet need where occupational therapy could improve clients overall health and wellbeing (e.g. clients experiencing social isolation, disruption in roles and routines) however due to the perception of OT within the service these clients are not getting referred. Integrated working requires professionals to understand one another’s roles so we believe promoting OT to other professionals will serve this purpose while also addressing the unmet need of clients. We hope that when the placement is finished our mentors will continue to use the resources we have produced to promote OT across Leeds. 

Lisa Downing,  Rosie Longshaw and Deanna Stephens