L3/4 Induction Programme

Transcription

1 L3/4 Inductin Prgramme Authr: Psychlgical Supprt Grup (PSG) Reviewed: August 2015 Review date: August 2016 Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 1 f 15

2 1.0 Intrductin The Cheshire & Merseyside Strategic Clinical Netwrk Psychlgical Supprt Grup have adpted guidance develped by SIGOPAC Cmmittee (2011) in cnsultatin with Membership and the BPOS Exec Cmmittee fr use in the inductin f Level 3 r 4 psychlgical supprt staff wh are new t cancer care. It is called Inductin t Clinical Practice (psychlgical supprt) in Onclgy and Palliative Care 2011 Versin 1.0 and is available frm: /l3-4_inductin.pdf The Peer Review Measures state that all prfessinals require an inductin prgramme t maximise their clinical effectiveness and safety. Therefre, upn starting a new pst as a Level 3 r 4 wrker in cancer r palliative care, the new member f staff will have a meeting with an apprpriate persn (clinical lead, line manager, senir clleague) t identify gaps in the persn s knwledge and experience and t draft a Cntinuus Prfessinal Develpment (CPD) plan t address these. The inductin prgramme will include at least the fllwing fr the new member f staff Meeting sme key lcal staff and understand their services: i.e. lcal leads, ther Level 2, Level 3 and Level 4 staff (if applicable). Attendance at sme Cancer and Palliative Care Multi-Disciplinary Teams t experience the prcess and btain a better understanding f the varius different disciplines invlved, and their rles and cntributins, particularly key wrker rles. An awareness f the measures that their Cancer and Palliative & End f Life Care Netwrk has put in place (e.g. the Distress Thermmeter and/r Cncerns Checklist, the Macmillan ehna and the PEPSI COLA Hlistic Patient Assessment etc.) It is imprtant t see this being used and t then try ut such hlistic assessments under supervisin. Attendance at least ne meeting f the Cancer Netwrk Psychlgical Supprt Grup, as per Peer Review Measures. The new member f staff shuld attend at least ne meeting as an bserver, t meet ther clleagues, r be invited t jin in when apprpriate. It might be very helpful fr them t be n their minutes circulatin list. Visiting and shadwing ther staff, within and utside Psychlgical Supprt. Fr instance, Clinical Nurse Specialists; Cmmunity, Hspice, and Hspital staff, especially in areas relevant t the new pst-hlder s duties and where they have less experience. Time with a Level 3 r Level 4 psychlgical supprt clinician in cancer care (individually r in a training grup) t discuss: The differences wrking with cancer/end Of Life patients, in terms f transferable and new skills; Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 2 f 15

3 The issue f cnsent t assessment and treatment including appreciatin f hw vulnerable patients can feel and hw this culd affect their ability t decline assessment/treatment (e.g. if the patient is cnfined t a bed in a ward, d they have an pprtunity t say that they dn t wish t be assessed); Cnfidentiality and the pressures f wrking with family members/staff within that cntext; That even in the last days f life, sme peple d nt want t discuss dying; Develping the skill f a gentle assessment t find where the patient is physically and psychlgically, and what they need, rather than prematurely intervening r encuraging Advanced Care Plans. A list f recmmended reading. Links t relevant cnferences and membership f prfessinal bdies ffering prfessinal supprt and CPD, such as the British Psychscial Onclgy Sciety (BPOS), the BPS Faculty fr Onclgy and Palliative Care (SIGOPAC) and Divisin f Health Psychlgy, Palliative Care assciatins, etc. A Resurce Pack and ideas fr CPD. An agreement fr the CPD plan t be reviewed at three and six mnths 2.0 Supprt and Supervisin Wrking in nclgy and palliative care settings is emtinally and cgnitively demanding and can be inherently stressful bth in terms f wrking clinically with clients and families wh are experiencing high levels f distress, and because the practitiner is reminded n a daily basis f their wn mrtality. The stressful effects f this wrk may nt be immediately apparent s minimisatin f jb stress and burnut are essential. Clinical gvernance, prfessinal registratin and the research evidence have resulted in the requirement that all staff receive clinical supervisin. Everyne wrking in these specialties shuld therefre ensure that there is adequate prvisin fr their wn supprt and clinical supervisin (see Mannix et al, 2006). Everyne wrking in the specialty shuld receive ne hur f clinical supervisin per mnth as a minimum and further supprt as and when required depending n need. Management shuld fster supprt and supervisin, making it a rutine part f the service culture. Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 3 f 15

4 3.0 Required Cmpetencies A. UNDERPINNING KNOWLEDGE Medical Theretical Mdels Service Cntext Epidemilgy Causes Nature and curse f cancer (lng term cnditins and life limiting illnesses) Treatments and side-effects Fllw-up and physical rehabilitatin Prcess f dying (i.e. One Chance t Get it Right Pririties fr care f the dying persn) An understanding f sme f the challenges relating t specific types f cancer/tumurs Treatment pathways fr particular cancer/tumur types (i.e. lcal/specialist arrangements) Neurpsychlgical sequelae assciated with disease prcess/treatment A number f clinical and health psychlgy mdels may be useful and apprpriate in different cntexts. Fr example: An understanding f the bi-psych-scial-spiritual apprach t persn-centred hlistic healthcare Illness Representatin Mdel Scial-cgnitive mdels f adjustment Attachment theries Cping theries Mdels f lss, grief and bereavement Trauma mdels The Multi-disciplinary Team: The rles f prfessinals with whm the patient with cancer is likely t meet, e.g. GPs, surgens, nclgists, specialist and ward nurses, radigraphers, AHPS, Palliative Care Clinical Nurse Specialists (e.g. Macmillan Nurses), hspice staff, etc. Psychlgical Supprt services (Levels 3 & 4). The rle f psychlgical supprt within r available t the Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 4 f 15

5 MDT and cancer services; face-t-face clinical wrk (individuals, cuples, carers, families, grups); wrking with in-patients and ut-patients; cnsultatin; teaching; staff supprt and supervisin; the rle f cancer infrmatin and supprt; cmmunicatin training, etc. Services Settings: Primary care, acute hspitals, hspices, etc. Lcal Directry f Services B. CORE CLINICAL SKILLS Assessment Frmulatin, pathways and interventin planning Bi-psych-scial-spiritual apprach Expectatins f psychlgical supprt Understanding prblems frm within the client s narrative Client s understanding f what cancer represents Assessing within time cnstraints Defining the prblem(s) t be addressed Wh is the client? (systemic understanding) Persnal and sci-cultural cntext f the client The client s resilience, strengths and resurces and the psitive respnses they have already made etc. Risk assessments Using pertinent theretical mdels t help understand the client s prblems and distress, and t suggest ways f helping clients vercme them. Negtiating with the client the parameters f the service that can be ffered What are reasnable targets fr interventin given the pssible restraints? (e.g. the illness and its prgnsis, nging treatment, the distance the client is frm the service etc). Pathway planning. If the prblems predate the cancer r are relatively uncnnected with the illness, shuld the client be ffered treatment by psychlgists wrking in the nclgy setting r be referred t ther services? Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 5 f 15

6 Interventin Strategies Evaluatin Individuals, cuples, carers, families, grups Nrmalisatin Self-management Rehabilitatin appraches (e.g. survivrship) Adjustment, Acceptance, Mindfulness and Cmpassin appraches CBT appraches (e.g. Adjuvant Psychlgical Therapy) Slutin-fcused Psych-educatinal appraches Systemic ways f wrking Cuple and family therapy Lss and bereavement care Psychdynamic appraches Pst-traumatic grwth Persn Centred therapy fr bereavement/lss Screening methds/tls fr identifying client cncerns Auditing clinical effectiveness, bth individually and acrss a service. Service evaluatins, etc. Cnducting needs assessments Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 6 f 15

7 C. PERSONAL AND PROFESSIONAL SKILLS Ethics: cnfidentiality, respecting and wrking with denial, euthanasia and assisted dying, cmmunicatin within teams Self-care impact f wrking lng-term with issues f mrtality, grieving fr clients, clinical supervisin and persnal supprt Spiritual-existential issues (bth persnal and clinical) Staff supprt Cmmunicatin training and ther staff training Research as a balance with clinical wrk Wrking with medical agendas Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 7 f 15

8 D. TRANSLATING PREVIOUS KNOWLEDGE AND EXPERIENCE Appreciating differing Clarifying expectatins: differences and similarities framewrks Cntracting Recgnising and utilising transferable skills Understanding agendas and expectatins f different prfessinals Clarifying service expectatins and remit Mix f supervisin and n the jb learning Facilitative aspect Tw Levels Shadw existing Psychlgical Supprt Staff recgnised as wrking at Level 3 & 4 Cnsult ther prfessinals prir t develping service Wrking in a physical health cntext cmpared t wrking in a mental health cntext: Differences Everybdy has a cancer stry Adjusting t pace Bundaries Wrk setting (inpatient) Speed f referrals Creativity Flexibility us and them vs. it culd be me mentality Cntaining staff distress Similarities Team wrking skills (MDT) smetimes lne Psychlgical Supprt Wrker Use f mdels (CBT, BSFT, CAT, Systemic ) but adapted t here and nw Cre Psychlgical Supprt skills- e.g. reflective practice (awareness f impulse t rescue/ persnal lss) Transferability f trauma and lss skills Experience f endings Supprting ther disciplines Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 8 f 15

9 E. ORGANISATIONAL CONTEXT Calman-Hine Review Natinal Cancer Plan; Cancer Refrm Strategy; Imprving Outcmes: A strategy fr cancer Impact n NHS generally Natinal Service Framewrks and cancer site specific Imprving Outcme Guidance Restructuring f cancer services Cancer netwrks Care pathways NICE Supprtive and Palliative Care Guidance 4.0 Training Opprtunities Curse Link Curse Overview Anatmy and Onclgy fr nn-clinicians O Hallran Cnsultancy _and_nclgy.html This anatmy and nclgy curse develped in cnjunctin with the Nrthern and Yrkshire Cancer Registratin and Infrmatin Service (NYCRIS), is designed t cver the develpment f cancer by discussing cell and cancer bilgy whilst reinfrcing cancer terminlgy. CBT in Cancer / Palliative Care Cgnitive Cnnectins Based n clinical and research experience in using CBT with peple with cancer intrduces participants t the mdel described in The Oxfrd Guide t CBT fr Peple with Cancer. A ne day wrkshp intrduces this apprach; it can be extended t include mre skills based training. Advanced Cmmunicatins Skills Training Cnnected The Tavistck and Prtman NHS Fundatin Trust, Lndn ining.php The curse is aimed at senir healthcare prfessinals wh wrk primarily in the field f cancer and utilises an interactive wrkshp apprach. Curses designed t imprve knwledge and understanding f cmplex human relatins r develpment f prfessinal skills in mental health, scial care, educatin r management. Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 9 f 15

10 CBT Clinical Supervisin: High Intensity Pstgraduate Certificate University f Chester PTSD Wrkshps Oxfrd Cgnitive Therapy Centre, Oxfrd This prgramme is aimed at British Assciatin fr Behaviural and Cgnitive Psychtherapies (BABCP)-accredited (r accreditable) cgnitive behaviur therapists with a current CBT clinical supervisin caselad. It aims t equip supervisrs with: a critical awareness f mdels f CBT clinical supervisin the cmpetences required t cnduct safe effective CBT clinical supervisin with trainee and qualified cgnitive behaviur therapists. The wrkshp addresses: Understanding the wide range f psychlgical prblems that develp as a cnsequence f psychlgical trauma in childhd and /r in adulthd Develping a cncise but cmprehensive understanding f the impact f trauma using the ripple effect heuristic. Cnsidering clinical treatment implicatins and building n yur strengths Institute f Family Therapy, Lndn The Institute f Family Therapy ffers curses at all levels f training in family and systemic psychtherapy and runs a cmprehensive prgramme f day wrkshps and cnferences Clinical Inductin, e.g. lead nurse/cancer manager explain hw cancer services are rganised Please refer t intranet r Learning and Develpment department fr lcal arrangements Basic insight int hw the cancer service is rganised Hw is psychlgical supprt lcated within that, especially if cming frm a different Trust Lcal arrangement SIGOPAC/BPOS/IPOS membership The Psychlgical and Scial Aspects f Disfigurement Changing Faces e/training-fr-health-prfessinals Cntext relevant Changing Faces ffers ne-day curses t enable nurses, ccupatinal therapists, physitherapists, speech and language therapists, scial wrkers and dctrs frm many specialties t: understand hw the Changing Faces' psych-scial mdel supprts patients with disfigurements and their families adapt these principles t their particular hspital / clinic setting Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 10 f 15

11 examine hw assumptin, beliefs, attitudes and language arund disfigurement can influence cmmunicatin learn hw t equip patients with a range f cmmunicatin skills and cping strategies t handle difficult scial situatins. In-huse wrkshps training days Lcal arrangement Shadw pprtunities: Psychlgical supprt staff in Onclgy in bth current wrkplace and wrking ther regins Other health care prfessinals Please refer t intranet r Learning and Develpment department fr lcal arrangements Please refer t intranet r Learning and Develpment department fr lcal arrangements Therapeutic interventins e.g. mindfulness Hspices hlistic appraches Teaching pprtunities With nclgists, CNS, ther HPs. Wrking 1-1, familiar, cuples, cnsultants, GPs, patient grups Lcal arrangement Other therapeutic training particularly suited t Cancer wrk, e.g.: Slutin-fcused Mtivatinal interviewing Cmpassin fcussed Therapy Acceptance and Cmmitment Therapy Mindfulness-based Cgnitive Therapy CAT CBT (i.e. Marie Curie-DOH) Grup therapy Supervisin Narrative Existential Nature f Cancer Curse (Plus) The Clatterbridge Cancer Centre NHS Fundatin Trust CMSCN L2 Training Varius Curses The Ryal Marsden Schl Please refer t intranet r Learning and Develpment department fr lcal arrangements /educatin-and-curses/clinical-educatincurses/shrt-curse-and-custmisedcurses/nature-f-cancer-curse-plus SCHOOL/curses T intrduce the bilgical and genetic prcesses invlved in the develpment f cancer and their relatinship t cancer treatments Psychlgical screening & assessment skills The Schl ffers cmprehensive cancer and palliative care curses tailred t meet the needs f healthcare prfessinals frm a brad and grwing range f backgrunds Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 11 f 15

12 Understanding Cancer E-learning Natinal Cancer Intelligence Netwrk urse/categry.php?id=5 An verview f hw cancer services are rganised in the NHS as well as infrmatin abut diagnsis, treatments and cancers by tumur site Macmillan Cancer Supprt Learn Zne Learn Zne prvides a variety f free learning resurces, nline curses and prfessinal develpment tls frm Macmillan Cancer Supprt 4. Suggested Apprach Spread training ver > 6 18 mnths Tailr t individual nce needs identified and learning styles determined Supervisr and Mentr lng term plan and nging supervisin Managing the transitin beynd the training perid Cnsider the impact and benefits f shrt versus lnger term curses Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 12 f 15

13 5.0 Suggested Reading Barraclugh J. (1994) Cancer and Emtin. Jhn Wiley. Bray, D et al. (2015). First d n harm : a slutin-fcused apprach t pain measurement and management. Eurpean Jurnal f Palliative Care. 22 (4) Brennan J. (2001) Adjustment t cancer: cping r persnal transitin? Psych-Onclgy, 10, 1-18 Brennan J. (2004) Cancer in Cntext - A practical guide t supprtive care. Oxfrd University Press Burtn M. and Watsn M. (1998) Cunselling Peple with Cancer. Jhn Wiley and Sns Chchinv H.M. and Breitbart W. eds. (2000) Handbk f Psychiatry in Palliative Medicine. Oxfrd University Press de Hennezel M. (1998) Intimate Death: Hw the Dying Teach Us t Live, Time Warner Hlland J.C. and Rwland J.H. eds. (1989) Handbk f Psychnclgy: Psychlgical Care f the Patient with Cancer. Oxfrd University Press Jünger S., Payne S.A., Cstantini A., Kalus C. and Werth Jr J.L. (2010) The EAPC Task Frce n Educatin fr Psychlgists in Palliative Care. Eurpean Jurnal f Palliative Care, 17(2), Kissane D. W. and Blch S. (2002) Facing Death: Family Fcused Grief Therapy. Oxfrd University Press Kumar S.M. (2005) Grieving Mindfully. New Harbinger Lendrum S. and Syme G. (2004) Gift f Tears. Rutledge Machin L. (2009) Wrking with Lss and Grief. SAGE Malkinsn R. (2007) Cgnitive Grief Therapy. Nrtn & c. Mannix K. et al. (2006) Effectiveness f brief training in cgnitive behaviur therapy techniques fr palliative care practitiners, Palliative Medicine, 20, Mrey, S. and Greer S. (2002) CBT fr peple with cancer. Oxfrd University Press Mrris S. (2008) Overcming Grief. Cnstable and Rbinsn Mukerjee S. (2011) The Emperr f All Maladies. Furth Estate Sage N et al. (2008) CBT fr Chrnic Illness and Palliative Care. Wiley Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 13 f 15

14 SIGOPAC (2011) Inductin t Clinical Practice (psychlgical supprt) in Onclgy and Palliative Care, Versin 1.0. BPOS-SIGOPAC-BPS Publicatin Watsn M. and Kissane D. W. eds. (2011) Handbk f Psychtherapy in Cancer Care. Wiley-Blackwell Winstanley (2000) Manchester Clinical Supervisin Scale. Nursing Standard, 14:19, User Guide available at: Yalm I. (2009) Staring at the Sun: Overcming the Terrr f Death. Jhn Wiley & Sns Fr a huge general, all-purpse reference bk with up-t-date cmprehensive reviews, albeit with a strng American bias, Jimmie Hlland et al, eds. (2010) Psych-nclgy. Oxfrd University Press. Fr reviews specifically related t advanced disease, the Dyle, D., Hanks, G., and Macdnald, N. eds. (1998) Oxfrd Textbk f Palliative Medicine (2nd Editin), Oxfrd University Press has sme excellent material. 6.0 Plicy dcuments British Psychlgical Sciety Prfessinal Practice Bard (2008) The Rle f Psychlgy in End f Life Care Department f Health (1995) A Plicy Framewrk fr Cmmissining Cancer Services: A Reprt by the Expert Advisry Grup n Cancer t the Chief Medical Officers f England and Wales Department f Health (2000) The NHS Cancer Plan Department f Health (2007) Cancer Refrm Strategy Department f Health (2008) End f Life Care Strategy Department f Health (2011) Imprving Outcmes: a Strategy fr Cancer Natinal Institute fr Clinical Excellence (2004) Imprving Supprtive and Palliative Care fr Adults with Cancer Natinal Leadership Alliance fr Dying Peple (2014) One Chance t Get it Right Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 14 f 15

15 Appendix 1 Glssary/Useful Links ACP ACST AHP BPOS EOL Advance Care Planning Advanced Ccmmunicatin Skills Training Allied Health Prfessinal British Psychscial Onclgy Sciety End f Life CNS GSF MCCN NCAT NCSI NCPR SIGOPAC Clinical Nurse Specialist Gld Standard Framewrk Merseyside & Cheshire Strategic Clinical Netwrk Natinal Cancer Actin Team Natinal Cancer Survivrship Initiative Natinal Cancer Peer Review prgramme BPS Faculty fr Onclgy and Palliative Care Psychlgical Supprt Grup (PSG) - L3/4 Inductin Prgramme Page 15 f 15