Challenge
Published on Jul 22, 2018
'Using a SWOT or PESTLE analysis, outline what you see as the main challenges for hospices providing end of life care education to care home staff'
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PRESENTATION OUTLINE
Challenge
End of Life Care Education in the Care home
Thank you for offering me the chance to investigate this topic, even if nothing happens as a result of our meeting today I have been blessed by my research to date.
Photo by Ian Froome
Enough Research for a whole course!
Find it at: https://edu.symbaloo.com/mix/end-of-lifecareedu
In preparing, I was mindful of your strategy expressing an aspiration to integrate technology in your teaching. So, I have tried several tools that are available without special arrangements.
Symbaloo Education is one - creates a web page with resources.
https://edu.symbaloo.com/mix/end-of-lifecareedu
Symbaloo Education is one - creates a web page with resources.
https://edu.symbaloo.com/mix/end-of-lifecareedu
4 out of 10 nurses and HCA have no EoLC training (2017 Survey by Nursing Standard and Marie Curie) By 2037 the number of people aged 75 and over will nearly double to 9.1 million (PAH Strategy) 5,500 different providers in the UK operating 11,300 care homes for the elderly. Average cost for a self-funder in 2016 was £846 per week while LAs on average paid £621 per week (Competition and Market authority report 2017)
It is my intent for this slide to overwhelm. The numbers are indeed overwhelming. The silver tsunami is coming and we are not looking...
My take away? Training will not, in isolation, deal with the unsustainable economics of the care sector and government seems to be colluding with the problem by not paying fairly.
I could focus on any of the PESTL factors for this presentation, I have chosen to major on the economics as causal factors for the challenges to education of staff in the care home
My take away? Training will not, in isolation, deal with the unsustainable economics of the care sector and government seems to be colluding with the problem by not paying fairly.
I could focus on any of the PESTL factors for this presentation, I have chosen to major on the economics as causal factors for the challenges to education of staff in the care home
Photo by kjetikor
“The current model of service provision cannot be sustained without additional public funding; the parts of the industry that supply primarily local authority (LA)-funded residents are unlikely to be sustainable at the current rates LAs pay.”
Competition and Market Authority Report 2017
If this is the conclusion, how does this impact EoLC education in care homes?
Photo by athrasher
Barriers - BMJ Supportive & Palliative Care 2016
- Continuity of care
- Lack of coordination
- Care delivered by unqualified support workers with high turnover
- Residents are frail and dependent, and 50% have dementia
- Poor communication
- Failure to recognise the end is approaching due to societal taboos
In many analyses, this is the starting point: barriers that can be seen in the work of staff at the home and residents.
Yet, I see these barriers as a consequence of the unsustainable nature of the system.
One highlight (or low light) is the part-privatization by stealth of the National Health Service through outsourcing. This leads to ‘penny wise, pound foolish’ outcomes.
The tension between the 6 Ambitions Report and the reality homes are working within is evident.
http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-f...
Yet, I see these barriers as a consequence of the unsustainable nature of the system.
One highlight (or low light) is the part-privatization by stealth of the National Health Service through outsourcing. This leads to ‘penny wise, pound foolish’ outcomes.
The tension between the 6 Ambitions Report and the reality homes are working within is evident.
http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-f...
Photo by Osman Rana
“The single most important factor believed to confound the delivery of end-of-life care in nursing homes is the absence of appropriate education and training for staff: there are reports that they are not able to control distressing symptoms, communicate with residents, families, general practitioners and hospital staff or to co-ordinate services for people at the end of life.” BMJ Supportive & Palliative Care 2016
As this conclusion by the BMJ shows. It is sometimes difficult to distinguish the reality from the rhetoric; the list of 'reports' here implying that the cause is lack of training. It may be a contributing factor but economics, politics and systems at breaking point due to 'efficiency porn' rhetoric used uncritically play a significant role in the challenges of offering education that works to support staff and residents.
Some economist see the limitations of searching inefficiency for monetising opportunities:
“I believe that one ought to have only as much market efficiency as one need, because everything that we value in human life is within the realm of inefficiency – love, family, attachment, community, culture, old habits, comfortable old shoes.”
Some economist see the limitations of searching inefficiency for monetising opportunities:
“I believe that one ought to have only as much market efficiency as one need, because everything that we value in human life is within the realm of inefficiency – love, family, attachment, community, culture, old habits, comfortable old shoes.”
Photo by Osman Rana
“Many nurses have struggled to pay bills, missed rent or mortgage payments and say they cannot sleep at night due to money worries, reveals a major survey by the Royal College of Nursing, which paints a stark picture of the personal financial pressures weighing on the profession.” Nursing Times, 2017.
Whilst a home might invest in education from the highest level of leadership, can the recipients be said to be in a position to learn? If nurses are in this position economically, how much more so HCA who are less qualified and earn even less?
Potential obstacles abound and underlying issue is economics:
“Newly qualified nurses are cheaper than experienced ones and management are flooding the community with them"
“continuity of care is lacking patients have to tell the story over and over again”
“The local hospice runs courses that are free for staff, but fitting them in when our workload is very high is increasingly difficult.”
“Many nurses, even if there is training available, are not able to attend because there aren’t enough staff to cover, they can’t get the time off, or it is cancelled because not enough people can attend.”
“Currently, issues seem to arise from lack of education and support, staff members’ own personal fear of death and dying and not knowing what to do or say,”
“non-physical suffering is legitimate and needs to be recognized, but this can pose a challenging therapeutic quandary given the difficulty in differentiating between appropriate responses to illness and psychopathologies such as depression”
“goals of care at end of life should shift from life prolongation to comfort”
Potential obstacles abound and underlying issue is economics:
“Newly qualified nurses are cheaper than experienced ones and management are flooding the community with them"
“continuity of care is lacking patients have to tell the story over and over again”
“The local hospice runs courses that are free for staff, but fitting them in when our workload is very high is increasingly difficult.”
“Many nurses, even if there is training available, are not able to attend because there aren’t enough staff to cover, they can’t get the time off, or it is cancelled because not enough people can attend.”
“Currently, issues seem to arise from lack of education and support, staff members’ own personal fear of death and dying and not knowing what to do or say,”
“non-physical suffering is legitimate and needs to be recognized, but this can pose a challenging therapeutic quandary given the difficulty in differentiating between appropriate responses to illness and psychopathologies such as depression”
“goals of care at end of life should shift from life prolongation to comfort”
Photo by Osman Rana
There is no thick line that says “life essentially ends here.” How we love and care for things—and our human desire to keep reaching for the new and exciting and stimulating—is a lifelong experiment."
Bill Thomas
Bill Thomas' work mirrors the ethos of the hospice movement for more than the last year of life. His Eden Homes offer life until we die rather than a wait-for-death-here ethos.
As educators in this setting should we be aspiring to this ethos? Futurists and other countries suggest that segregation has to end - immigrants, children, dogs and cats, etc. part of initiatives to keep us all loving and caring for things until we die. This I believe. But how to implement?
As educators in this setting should we be aspiring to this ethos? Futurists and other countries suggest that segregation has to end - immigrants, children, dogs and cats, etc. part of initiatives to keep us all loving and caring for things until we die. This I believe. But how to implement?
“The guidelines recommend that all health workers should understand the physical, psychological, social and spiritual issues that affect people with life-limiting conditions, recognise the requirements of different cultural groups and be able to adopt a palliative care approach as soon as the individual enters the end-of-life period.” BMJ Supportive & Palliative Care 2016
Life-limiting conditions in the care home.
Content based education alone will not tackle systemic issues. 'Understanding' does not necessarily imply critical thinking or action. Clearly these guidelines are aspirational, addressing these via education needs a particular kind of pedagogy - one that works with the whole system not just delivering content for understanding.
The BMJ does hint at this need when they highlight that: "There were no reports of e-learning, blended learning or reflective practice."
Guidelines refer to Ambitions document:
http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-f...
Content based education alone will not tackle systemic issues. 'Understanding' does not necessarily imply critical thinking or action. Clearly these guidelines are aspirational, addressing these via education needs a particular kind of pedagogy - one that works with the whole system not just delivering content for understanding.
The BMJ does hint at this need when they highlight that: "There were no reports of e-learning, blended learning or reflective practice."
Guidelines refer to Ambitions document:
http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-f...
Photo by highersights
Problem-posing Dialogue Processes
"When we make a commitment to become critical thinkers, we are already making a choice that places us in opposition to any system of education or culture that would have us be passive recipients of ways of knowing. As critical thinkers we are to think for ourselves and be able to take action on behalf of ourselves. This insistence on self-responsibility is vital practical wisdom. The vital link between critical thinking and practical wisdom is
the insistence on the interdependent nature of theory and fact coupled with the awareness that knowledge cannot be separated from experience.
And ultimately there is the awareness that knowledge rooted in experience shapes what we value and as a consequence how we know what we know as well as how we use what we know. When we create a world where there is union between theory and practice we can freely engage with ideas." bell hooks on Critical Thinking.
the insistence on the interdependent nature of theory and fact coupled with the awareness that knowledge cannot be separated from experience.
And ultimately there is the awareness that knowledge rooted in experience shapes what we value and as a consequence how we know what we know as well as how we use what we know. When we create a world where there is union between theory and practice we can freely engage with ideas." bell hooks on Critical Thinking.
Let death be what gets us...
- PESTLE shows complexity of system
- Dialectal Tension
- Content is the residue of relationship
- "Nobody educates anyone, nobody is self-educated, people educate each other mediated by the world"
"Let death be what gets us, not our lack of imagination" Bruce Miller
The way that Freire posited this was via dialogue and identification of “generative themes.” This is a problem posing methodology that does not direct the conversation to a specific outcome, but allows what is relevant for the community to evolve.
"Let us look at how a generative word can be used, such as: wages.
1. Ideas for discussion: the value of work and its rewards. The use of wages: maintaining the worker and his family. The timetable for work, according to the law. The minimum wage and a just wage. Weekly rest, holidays, bonus salary.
2. Aims of the talk: make the group discuss the situation of the salary of the rural farm workers. Discuss the reason for the situation. Discuss their value and rewards of work. Help the group to discuss the right each of them has to demand a just salary.
3. Steps of the talk: What can you see in this picture? What is the situation of the wages of rural farm workers? Why? What are wages? How much should your wages be? Why? What do you know about the laws about wages? What can we do to get a just wage?" (Gadotti, 1994, p. 20)
The way that Freire posited this was via dialogue and identification of “generative themes.” This is a problem posing methodology that does not direct the conversation to a specific outcome, but allows what is relevant for the community to evolve.
"Let us look at how a generative word can be used, such as: wages.
1. Ideas for discussion: the value of work and its rewards. The use of wages: maintaining the worker and his family. The timetable for work, according to the law. The minimum wage and a just wage. Weekly rest, holidays, bonus salary.
2. Aims of the talk: make the group discuss the situation of the salary of the rural farm workers. Discuss the reason for the situation. Discuss their value and rewards of work. Help the group to discuss the right each of them has to demand a just salary.
3. Steps of the talk: What can you see in this picture? What is the situation of the wages of rural farm workers? Why? What are wages? How much should your wages be? Why? What do you know about the laws about wages? What can we do to get a just wage?" (Gadotti, 1994, p. 20)
Photo by steven w
