Enhancing Palliative Care at Royal Gardens
Praxis Note 1 and Reflection
The NURS 2020 Community Care placement that I am a part of is through Royal Gardens Retirement Home. My partner (Emily Reinstra) and I are under the supervision of Jeannette Larsen, who is the Director of Care at the facility. The project was determined by Jeannette, after she performed a needs assessment and noticed that the palliative care in Royal Gardens was lacking. The project name is “Enhancing Palliative Care at Royal Gardens”. The project that Jeannette suggested for Emily and I was to make “tea carts” that are stocked with amenities to provide comfort for the family and the patient in palliative care, and to provide brochures for staff and family members regarding different medications that palliative care patients are often on, and different resources available in the community. The other part of the project is to develop a volunteer team to run the “tea cart” service, and to provide “palliative sitting” to enhance the comfort of the patients who have no family to visit them.
Royal Gardens is located in the west end of Peterborough on Clonsilla avenue. The sociological significance of it’s location is that it is close to many amenities for the residents who live there, like churches, malls, pharmacies, grocery stores, and the hospital. The economic factor of the location is that it is located in a middle-class neighbourhood, however it is privately funded, and is expensive for those who live in the retirement home. The target population is senior citizens who are looking to live permanently in a retirement setting, as the philosophy of Royal Gardens is, “if your needs change, your address doesn’t have to”. The agency serves everyone, regardless of postal code, and has residents from as far as the United States living there currently. Royal Gardens has been open for 12 years, and abides by it’s mission statement, which is, “AON builds communities. We develop and manage innovative properties for residential and senior living, business and leisure. We are a family of employees who excel in the delivery of quality service and care through dynamic options for living well”. Royal Gardens is privately funded, and is run under the administrative structure of the AON Corporation (CEOà VP of Companyà Executive Director of Royal Gardensà Managers of each departmentà Professional Staffà Non-professional staffà Volunteers). Royal Gardens, as previously mentioned, is a part of the AON Corporation, which owns all of “The Gardens” in Peterborough (Royal, Canterbury, Empress, and Princess), as well as two long term care facilities, and has both paid staff and volunteers.
Royal Gardens provides many services and programs for it’s residents, including bus excursions, guest speakers, concerts, live entertainment, local masses and services, art auctions, golfing, walking, dinner clubs, hobbies and crafts, card games, and shopping. Royal Gardens also provides services that address the primary health care principles for its residents, such as 24 hour nursing care, podiatry, physiotherapy, hair cutting and personal support (for bathing, dressing, and hygiene). Royal Gardens has a multidisciplinary team which includes medical care, fitness and wellness, and a pharmacy. Royal Gardens prides itself on it’s inclusivity, and adheres to principles of inclusivity in both hiring, and in patient care. They take a non-judgmental approach to employee and volunteer selection, and provide many multicultural activities, as well as host non-denominational services at their chapel.
The role of a community health nurse at Royal Gardens is slightly different, as they perform both basic nursing duties, as well as administrative duties. The role of a community health nurse, according to the RN at the facility, is to provide a complete medical spectrum of nursing to the residents, including medication administration, wound care, and continuing care. However, the community health nurse on site also played an administration role, where he takes over for the Director of Care when she is away, and creates information and workshops for the staff. Our role as community health nursing students will be to conduct surveys to find out the needs regarding palliative care at Royal Gardens, and to create a tea cart to enhance palliative care. We will also develop a volunteer network, and to create information regarding medication effects and side effects for staff and family members. Royal Gardens collaborates with many other professions to deliver service, such as podiatrists, denturists, physiotherapists, dietary staff, hair salon staff, and activities volunteers to carry out it’s multiple services. The team, as outlined by their mission statement, works together as a “family” to provide holistic care for the residents, with the satisfaction of the residents being their main priority. The clients who are served by the agency are seniors who are paying to live in the retirement home. According to The Public Health Agency of Canada, some social determinants related to this population are: income and social status (need to be able to pay for Royal Gardens), culture (need to have cultural demands met by the activities provided), social support networks (many residents lack social interaction from family and friends), and personal health practices and coping skills (especially important for those in independent living as they need to provide self-care) (Public Health Agency of Canada, 2014). The agency identified the need for physiotherapy, to maintain the health of the residents, socialization, and the palliative tea carts to better serve their residents. The agency has implemented private physiotherapy, and is working with the Trent Nursing students to provide socialization and the tea carts, to enhance the palliative care experience of the residents. The agency also identified that the residents had many personal strengths, such as wisdom and resilience, as well as the residents have the capacity to provide information if needed to conduct research. The methods that we will be using to collect data are the survey and interview methods, as we believe the survey (for the staff) is not overly time consuming, as they are busy. We believe that the interview will work best for the residents as some of them may lack the fine motor skills to fill out the survey, and we can prompt them with ideas if needed.
The most prominent barriers facing the target group in accessing and using the services provided is the prevalence of dementia, and the physical inability of some of the residents to participate in the activity (such as shuffleboard or dancing). Some strategies that can be implemented are to bring the activities to the patients who cannot physically get to the activity, or to incorporate activities that have less physical requirements so allow participation. For the patients with dementia, the activities can be made simpler with fewer steps involved, to ensure success. However, overall the residents seem satisfied with the activities, and Royal Gardens does well to gear their activities for their population.
Finally, although an outstanding retirement residence, Royal Gardens does have a few minor gaps in their service to their residents. First, their physiotherapy is individually funded, so many of the residents do not get the physiotherapy that they need as it is expensive. The agency is working hard to advocate for more physiotherapy to be provided for their residents, and have hired a full time physiotherapist to provide care for those who can pay for it. Also, the second gap is that there are no palliative care sitters, so people without family close by are often alone, and even dying alone. However, hopefully thorough this placement, the palliative care of Royal Gardens can be enhanced, alleviating this gap, allowing for optimal care for all of their residents. Overall, I am excited about the potential for this project to make a big difference in the lives of the families of palliative care patients. Hopefully, by the end of the project, there will no longer be palliative care patients being alone, or without proper comfort measures.
Reflective Analysis
The first few days at Royal Gardens have been eye opening in many ways. When I initially walked in the door, all I could think about was how beautiful the retirement home is, and how many wonderful amenities that they offer. I couldn’t get off my mind how lucky the residents were to be there. The staff that work there are fantastic, and are full of spirit and cheeriness, and overall, the first few days have been a welcoming experience.
However, with all positives, comes some critical thinking and analysis, which unfortunately in this case, leads to one glaring negative. For a retirement home, with lots of income, the palliative care at Royal Gardens is severely lacking. The residents’ families who visit them have no resources or comfort measures to help them through their tough time, and many of the staff and family members lack knowledge regarding the medication side effects of commonly used palliative care medications. Also, in my opinion, the most heartbreaking fact that I learned was that Royal Gardens do not have palliative sitters for those who have no nearby family, so residents, as recent as last Wednesday, are dying all alone.
This fact really has struck me and my partner Emily, and we both immediately knew the importance of our project to the patients and their families at the end of life care. We are fortunate to have a large budget, and many available resources to aid us in implementing our physical tea cart project. I believe that we are also going to focus on developing a volunteer network, which might be the most challenging part of the project, as volunteers are often hard to come by, especially ones willing to sit with those who are at the end of their lives.
Overall, the first few weeks have been exciting, and educational. I am both extremely motivated, and enthused to begin this project, to make a difference in the community.
Reference
Public Health Agency Of Canada. (2014, September 18). Social Determinants of Health. Retrieved September 20, 2014, from Canadian Best Practices Portal: http://cbpp-pcpe.phac-aspc.gc.ca/public-health-topics/social-determinants-of-health/
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Ethics Proposal
Complete package includes this checklist, the completed project protocol submission form (next page), consent form (if appropriate), survey or questionnaire form (if being used)
Nursing Research//Ethics committee via :
[email protected]
Project Protocol Submission Form
Student Names: Emma Cumming and Emily Rienstra
Course For Project: NURS 2020 Community Based Nursing Practice Fall 2014
Faculty Clinical Instructor: Susan Fairs [email protected]
Title of Project: Enhancing Palliative Care at Royal Gardens
Project Rationale: The students have undertaken this assignment under the supervision of Jeannette Larsen, to try to enhance the quality of palliative care at Royal Gardens retirement home. The director of care (Jeannette Larsen) identified the need for a tea cart for therapeutic and comfort measures for the palliative care families, and enhanced information regarding medications used for the staff of Royal Gardens. The project will also entail developing a volunteer network, under the supervision and policies outlined by Royal Gardens, to carry out the tea cart program and palliative sitting.
Anticipated Start and End Dates: October 2, 2014 (Pending Ethics Approval) à November 28, 2014
Methods: The students will be performing 10 staff surveys using cross section of different disciplines, with initial consent. The students will also be conducting 25-35 resident interviews, of residents of different genders and ages, ensuring that consent is initially obtained. The research will be conducted at Royal Gardens retirement residence, using pen and paper surveys. The data will analyzed using statistical analysis, and will be kept confidential. The final outcome data will be presented in poster form, with the participants remaining anonymous.
Anticipated Use of Research Findings: Create a tea cart that will enhance the experience of palliative patients and their families, as well as create a medication information booklet to assist staff and families.
Staff Tea Cart Survey
Project Overview
Trent nursing students Emily Rienstra and Emma Cumming will be conducting a survey investigating the needs of palliative patients and staff at Royal Gardens retirement home for their NURS 2020 Community Care placement. The information that they collect will be kept confidential. They will use the information to construct a tea cart that will enhance palliative care at Royal Gardens, as well as create a medications information sheet for staff and patient’s families. This project is supervised under Jeannette Larsen, Director of Care at the facility. Thank you in advance for your information.
Staff Questions
1. Of the following aspects of palliative care, which come up most frequently among patients and their families? Rank in order of importance.
Medications/ palliative pain management
Coping with loss
How to provide support to the patient
Which community services are available?
Other _____________
2. On a scale of 1-5 (1 being knowing little and feeling uncomfortable educating patients and their families and 5 feeling extremely comfortable educating the patients and their families), what is your knowledge regarding how the commonly used medications in palliative care work and their side effects?
1 2 3 4 5
Not Comfortable Somewhat Uncomfortable Undecided Somewhat Comfortable Very Comfortable
3. Rank each individual medication on the same scale of 1-5.
Hydrocodone 1 2 3 4 5
Morphine (subQ) 1 2 3 4 5
Fentanyl 1 2 3 4 5
Oxycodone 1 2 3 4 5
Hydromorphone (subQ) 1 2 3 4 5
Dimenhydrinate 1 2 3 4 5
Acetylsalicylic acid 1 2 3 4 5
Oxygen 1 2 3 4 5
Senna 1 2 3 4 5
Haloperidol 1 2 3 4 5
Diazepam 1 2 3 4 5
Trazodone 1 2 3 4 5
Midazolam (subQ) 1 2 3 4 5
Glycopyrrolate 1 2 3 4 5
4. Rank each resource in order of what would be most helpful to your knowledge of medications.
Booklet
Workshop
Online resources
Other ____________
5. If a tea cart was made, what could be put on the cart to benefit you and the staff most?
6. Please add any other comments you think would be helpful
Thank you for your time, your input is appreciated.
Volunteer Interview
1. Are you able to provide us with a police check with a vulnerable screening sector?
2. Are you able to provide proof of a recent two-step Tb test?
3. Why are you interested in volunteering with palliative care patients?
4. What skills will you bring to this volunteer position?
5. Are you comfortable dealing with patients that are nearing the end of life?
6. What do you feel comfortable doing?
Palliative sitting
Bringing around tea cart
Reading
Overseeing volunteer activities
7. When are you available to volunteer? (Please circle all that apply)
Sunday- Morning/ Afternoon
Monday- Morning/ Afternoon
Tuesday- Morning/ Afternoon
Wednesday- Morning/ Afternoon
Thursday- Morning/ Afternoon
Friday- Morning/ Afternoon
Saturday- Morning/ Afternoon
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Praxis Note 2/ Reflection 2
Short Term Goal
Short Term Goal: To determine what comfort measures would benefit palliative residents the most, and identify common medications taken near end of life. This goal will be completed by October 17, 2014.
Using the Critical Assessment to Create a Logic Model
The critical assessment was performed the first two weeks that we were at placement. Upon doing our windshield survey and communicating with Jeannette Larsen, the Director of Care, it was determined that the main need of Royal Gardens was to enhance their palliative care unit. This included developing a palliative care cart, providing staff education (regarding medications) to enhance patient and family teaching, and through enlisting palliative care sitters for those who do not have family nearby.
From this information, we determined both a short term and a long term goal for this project. The short term goal was to determine what comfort measures would benefit palliative residents the most, and to identify common medications taken near end of life. The long term goal is to create a cart that has the comfort measures for palliative patients and their families identified in the needs assessment, as well as a booklet of medications for staff and families (to provide education about the pharmacology of medications). The resources that we are enlisting include the residents’ council, nursing and professional staff, Hospice Peterborough, and funding from Royal Gardens. The activities that we are doing to achieve these goals include creating a survey for the staff, creating and stocking a tea cart, and creating pamphlets for the staff. Through these, we hope to have the eventual outcomes of both residents and staff being more comfortable with the end of life care at Royal Gardens, and having no resident die alone.
We decided that the health promotion strategies of staff education, and enhanced health measures for the palliative care patients were most important in this project. We decided to use staff education through the use of pamphlets, because pamphlets are easily accessible, and are a form of health promotion that most staff are familiar with. We also decided to use the pamphlets because the staff can pass along them to the families of the palliative patients, to share the information regarding the medications. We also decided that enhanced health measures (such as providing lip balm, creams, dental hygiene devices, and wipes on the cart) would benefit the palliative residents most, as they would provide enhanced comfort for them during their final stage of life.
Two partnership agencies that Royal Gardens is connected to are: Hospice Peterborough, and Community Care Access Center (CCAC). For this community health project, the connection with Hospice Peterborough is being used, as we are enlisting palliative sitters for those who have no family nearby, to enhance their end of life experience. We are working closely with Paula, the Volunteer Coordinator at Hospice Peterborough, to provide a connection with the staff of Royal Gardens to educate them regarding the program that is available. CCAC is also connected to Royal Gardens, and is important in this project for the patients on the palliative care floor. If the patient has more care needs than the staff can handle, they enlist a CCAC professional to help with the care, provided that the person has the required funding. The vision of CCAC is for “outstanding care—every person, every day” (CCAC, 2014). This is shown through their community involvement, and commitment to care, trying to better the lives of others in need in the community. The relationship between both CCAC and Hospice to Royal Gardens is very underused, which is something that we are trying to change throughout this project.
Reflection
To this date, our project is going quite well. Although we have had a few minor set-backs, we are continuing to make progress towards developing our care cart, palliative sitter network, and medication information for the staff of Royal Gardens. We are working together with staff of Royal Gardens (Jeannette, Julie, and Heather), to ensure that the information about the project is being shared throughout the multiple layers of staff at the retirement residence. We are developing a presentation for the resident’s council to gather information for the development of the comfort care cart, and are creating a presentation with Paula for the professional staff meeting in November, regarding connecting with Hospice Peterborough.
We had a minor set-back with our ethics proposal, as it seemed to be confusing for the evaluator. This actually ended up with us taking a different direction with how we are going to gather our information (making a presentation at the resident’s council, rather than doing a survey), which we believe is going to be a better way to present the topic to the residents, and to gather the information. We had a very productive meeting with Paula from Hospice Peterborough, where we learned that Royal Gardens actually already had a connection to use the palliative sitters. This means that we just have to re-introduce this connection to the staff at Royal Gardens, to enlist the palliative sitters. This was wonderful news as it meant that we can start using the sitters immediately, so that no resident will have to die alone.
Overall we are satisfied with the progress that we are making this far in our project. Future short term goals for our project include gathering the surveys that we have distributed and creating the pamphlets, developing the care cart based on the needs expressed by the residents, and creating presentations for both the resident’s council, and professional staff meetings.
Reference
Community Care Access Center. (2014, October 15). Vision, Mission and Values. Retrieved October 16, 2014, from CCAC website: http://healthcareathome.ca/centraleast/en/Who-We-Are/Vision-Mission
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Praxis Note Three
Implementation Plan
Implementing our plan will require the collaboration of the RN students, the professional staff at Royal Gardens (RNs, RPNs, PSWs, Executive Director, Director of Care, and Assistant Director of Care), and Hospice Peterborough. The care cart, brochures, and palliative sitters will all be implemented by the completion of our project. The items on the care cart were determined by Jeannette, Julie, Barb, and us, along with the input of the residents from the resident’s council. We are planning on having the cart completed by week 9, based on funding provided to complete the hygiene packages, and small items on the cart. Based on the information provided by the staff surveys, we are developing a brochure for the staff and families, which will be completed by week 8, and distributed on weeks 9 and 10. Finally, the link with Hospice Peterborough has been established, and we are working towards implementing brochures from Hospice regarding grieving, as requested by the staff at Royal Gardens. We are looking to redirect the staff towards the hospice website regarding the palliative sitters, in order to increase adherence to using the volunteer network. The volunteers provide emotional support and practical help to people who are in palliative care, and provide relief time for those caring for them (Hospice Peterborough, 2014).
Finally, although we have been responsible for buying the cart and the items on it, developing the brochures, and re-establishing the link between Hospice Peterborough and Royal Gardens, the final implementation of the project will be how we pass it on to Royal Gardens to sustain it. We will have to develop an outline of how to sustain the care (examples of items on it), and provide a strong connection with Hospice Peterborough, to be maintained after we have left. We will develop an outline regarding what items to put on the cart, an electronic version of the brochure that can be printed, and resources and contacts for Hospice Peterborough, to try to ensure that the project is maintained after we have gone.
Ghantt Chart
Task Name
September
October
November
Wk 1
2
3
4
5
6
7
8
9
10
Windshield survey needs assessment
Outline Project
Create surveys for staff and resident input
Plan palliative sitters with hospice
Buy items for cart
Present at residents council
Create educational medications pamphlet
Create surveys for staff to evaluate effectiveness of cart
Create poster
Present poster
Inform staff on components of cart and how to maintain its use and the use of palliative sitters
Budget
Budget Items
Rationale for items
Cost (hypothetical if nec.)
Personnel
· Staff Salaries ($22/hr)
· Volunteer Hours ($10.00/hr)
- Professional Staff (Director of Care, Executive Director, and Assistant Director of Care are overseeing this project) are responsible for overseeing the volunteer and staff use of the care cart once the RN students are gone, and are responsible for stocking the cart with supplies when needed
- Professional Staff (Registered Nurses, Registered Practical Nurses, and Personal Support Workers) have access to the care cart if needed for their use
- Volunteers from Hospice Peterborough are providing their time for palliative sitting free of charge
- The project will be taken on by the staff as an added part of their workload at no extra pay, thus the costs will just be their general salaries (ex. Director of Care- $100,000 yearly; RN- $60,000 yearly)
- The volunteers from Hospice Peterborough are providing their time free of charge
Travel Costs
· Parking- Free, accessible parking is available for the staff and volunteers at Royal Gardens, as they will be needing to stay long hours and may not be able to rely on public transit to get around
· Transit - Transit fees reimbursed by Hospice Peterborough, and rides are also provided for the volunteers, by Hospice workers, if needed
· Mileage- ?
Program Costs
· Printing -Printing was required for the resident’s council handout, surveys, brochures, door signs, and evaluation forms
- Staff/ Family Brochures
- Door Signs
· Photocopying- Photocopying was also needed for all of the above
- Staff/ Family Brochures $5.98 (Printer Paper), $60.00 (Ink for Photocopier)
- Door Signs
· Purchase of Resources - All of the resources required were put onto the care cart, and were discussed prior to purchasing them by the RN students and the Executive Director. It was mutually agreed, between the Director of Care, Executive Director, Assistant Director of Care, and RN students, on the purpose of each object on the cart. The air purifier, lip balm, hygienic wipes, and non-scented lotions are comfort measures for the palliative patient. The journals are for staff recording of care, and the radio, CDs, Hospice booklets, hand sanitizer, alcohol swabs, hygiene kits, and tea set are for comfort measures for the family and Hospice volunteers
- Wooden tea cart- $78.00
- Radio- $30.00
- Journals (4)- $36.00
- Air Purifier- $58.00
- CDs-$0.00 (donated)
- Tea Set- $0.00 (donated)
- Hygiene Kits- $5.00 (x5)
- Lip Balm- $3.00
- Alcohol Swabs- $0.00 (provided)
- Hygienic Wipes- $10.00
- Non-scented Lotions- $5.00
- Hand Sanitizer - $0.00 (provided)
- Hospice Booklets re: Grief- $2.00
- Organizing Baskets- $5.00
Program Promotion
· Posters - The project was promoted by word of mouth at the resident’s council meeting, thus the only fees required are the ones associated with photocopying, mentioned previously
· Advertising - No advertising was needed, as was discussed through the team that worked on the project. It was inappropriate to advertise the care cart, as many residents have a hard time discussing palliative care.
· Other (specify)
]
Project Evaluation
· Cost of printing/copying -The costs associated with printing and photocopying the evaluations were listed previously in the budget. Since there are very limited numbers of evaluations being printed, the cost is nothing more than the cost mentioned previously.
· Other (specify)
TOTAL: $317.98
Reflection
So far, the project is advancing forward well, with few set-backs. I feel fortunate to be a part of such a cohesive, respectful team, which welcomes the opinions of everyone, and works together to problem solve. Overall, I believe that Emily and I are on track for completing the project within the timeline given, as long as we don’t hit any major speed bumps. We have started to put together the cart, and are working together to analyze the information from the surveys, to complete the staff and family brochure, and eventually the final poster.
One minor set-back that we had was adherence to completing the survey by the staff and the residents. We ended up getting 10/90 surveys back from the staff, and 5/30 back from the residents. Although the information we received was valuable, and will be implemented into our project, it would have been nice to have a larger cross-section of opinions to work from. We believe the poor adherence from the staff was due to them being busy, and the surveys being in a location that was not immediately in eye sight. We believe that the residents had a poor compliance rate due to some cognitive decline, and lack of motivation to discuss the palliative care topic. Next time, I would individually hand out the staff surveys, to put a face to the survey, to make it more personal, and would ask the residents to complete the surveys before leaving the council meeting (if possible), to enhance compliance. Although the return rate was low on the surveys, we were able to pull some ideas, and to brainstorm with Jeannette, Julie, and Barb, to allow us to move forward towards completing the care cart and brochures.
Overall, the project is going well, and I am looking forward to finally implementing the cart and brochures to enhance the palliative care at Royal Gardens. I am excited to see the final product of this project come together, and to share our experience through the poster presentation at the end of the month.
Reference
Hospice Peterborough. (2014, October 10). Volunteer Visiting. Retrieved October 30, 2014 from Hospice Peterborough website: http://www.hospicepeterborough.org/volunteer-visiting
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Praxis Note Four/ LEARN Reflection
Praxis Note 4
The main evaluation strategies that we used to evaluate our progress were to monitor that we were staying on time with our work and assignments, Likert scales to monitor the quality of information of our pamphlet, and asking our preceptor how we were doing on the project. These are appropriate strategies because they kept us on time with all of our objectives, made sure that our outcome of the pamphlet was effective, and ensured that we were meeting the expectations of our preceptor.
For the process evaluations, we needed to make sure that they were appropriate for the short term goals of getting information from the residents regarding what items they would like on the care cart, having the staff complete a survey regarding medications, and developing a palliative sitters network. The strategy used was to have all of the information gathered and analyzed by a certain deadline, with a strong cross section of research. This was evaluated the development of the palliative sitters by by our forming of connections with Hospice, and our maintenance of this connection (via weekly email) with Hospice over the time we spent at Royal Gardens. We know this was achieved because all of the information was handed in on time, analyzed, and formed into brochures and items being bought for the cart.
We needed to make sure that our outcome objective was appropriate for the assessment of whether the introduction of our cart meets the long term goal of satisfying a palliative care need took after our long term goal of no resident dying alone. For the process for this goal, we the Hospice phone number at nursing station, for people to call if someone is dying alone. To evaluate this, we are expecting staff to report that no one has died alone, after our implementation, and asked the staff to evaluate the evaluation on a five point Likert scale.
LEARN Reflection
Look Back
This community placement was truly unlike any other nursing placement I’ve experienced. My placement was at Royal Gardens, with another nursing student, enhancing the palliative care unit at Royal Gardens. The whole experience of planning and implementing a project was completely different from anything that I have done thus far in nursing. The whole experience of working independently, without having the guidance of a preceptor over my shoulder, was quite different from my previous placement experiences. Being in charge of my own hours, own progress on the project, including my own deadlines and expectations, was a struggle, and a weakness for me. I am so used to answering to preceptors, and having others set limitations and expectations on me, that setting them on myself was difficult. However, I feel like I developed self-efficacy and confidence in my project developing skills, which is a strength. Not being able to work with the population that I was creating the project for, was a struggle. We developed a palliative care cart, medication pamphlet, and developed a volunteer palliative sitters network, all without ever dealing with the palliative population at Royal Gardens, which was a struggle as well.
Evaluate
Overall, the project in my mind went well. Emily and I were satisfied with our cart that we developed, and are excited to see how it is implemented in the palliative care at Royal Gardens. We were satisfied with the quality of information that we had on our medication brochure, and feel like it is a valuable, informative resource for the staff and families to have. We were satisfied with the creation of the pamphlet, in that it is easy to read, and has lots of information on it. Finally, we were satisfied with the connection that was re-established with Hospice Peterborough. Hospice Peterborough volunteers provide emotional support and practical help to people who are facing a life threatening illness and relief time for those caring for them (Hospice Peterborough, 2014). We are content that the palliative sitter network is now in place, with ultimately solved our long-term goal of no resident dying alone. Two downfalls that we found were that there were a poor return of surveys, which resulted in having a smaller stream of information to pull from, when developing our medication pamphlet. The other downfall was, as previously mentioned was the lack of interaction with the population of interest, which in my mind, didn’t allow us to develop a phenomenological perspective when developing the project. This, in my mind, was a difference between theory and practice, as we developed this entire project, based on a population in our mind, due to the lack of access we had to interact with the population.
Analyze
Upon analysis, I believe that this project, overall was successful, both personally, and for the palliative care population at Royal Gardens. Although there were some areas of weakness, personally, as a nurse I developed my self-confidence in organizing and developing a project, and working effectively with a partner and independently. I struggle with confidence, and often rely on working under someone else as a “boss” for a security or comfort blanket. This placement truly challenged me to come out of my comfort zone, and to develop some confidence in my self-directed practice, which I think was greatly needed.
This project was also successful for the palliative care unit at Royal Gardens. Although a wonderful retirement residence, with many amenities for their population, their palliative care floor was lacking comfort measures. By the creation of the comfort care cart, medication pamphlet, and palliative sitters network, the palliative care provided at Royal Gardens was enhanced. These measures will provide enhanced comfort to the palliative care patients, their families, and the staff at Royal Gardens, providing a more comfortable experience, for all.
Revise
If I was to undertake this project again, I would do many things the same, such as use the Ghantt chart, create deadlines, and create a budget, to keep on track both with time and with finances. However, upon analysis, I would change some things with the project. I would like to increase the adherence to the survey completion next time, to allow for a more adequate cross-section of information gathered for the surveys. This would ensure that we were accessing the needs of more of the staff and the residents, making our project more fair overall. I would do this by personally handing out the surveys to the different health care workers and residents. This way they could have a face to the survey, and would be inclined to fill it out, instead of having to take it upon themselves to pick up the survey to do so. I would also make more notices regarding survey completion, via word of mouth, emails, and flyers, to enhance adherence.
I would also take the time, next time, to work with the population of interest, and to work with the people from the front lines of that population, to develop the program. Although I tried to do this, with the surveys, this population was not necessarily a part of the project planning and implementation, which was indeed a downfall. Next time, I would try to include the population, no matter how marginalized they are, via information sessions, flyers, or word of mouth, to keep them up to date on the project, and to ask for their input.
New Perspectives
I have learned many new things from this project that I will bring forward into my future practice as a nurse. I learned the very valuable skills of developing, implementing, and evaluating a project effectively, which I can bring forward into any aspect of both my personal, and professional life. I have developed some self-confidence in myself, which I will need going forward into my career. Finally, through this project, I have learned how important it is to empower populations who cannot empower themselves. I learned that the palliative care population is very vulnerable, and should not be overlooked, and that comfort is essential for this population. These things will come forward with me, in my future career of being a nurse.
Reference
Hospice Peterborough. (2014, November 9). Volunteer Visiting. Retrieved October 30, 2014- from Hospice Peterborough website: http://www.hospicepeterborough.org/volunteer-visiting
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Good evening Ms. Fairs,
This week at clinical, at Royal Gardens, I did research for the project that was outlined in the initial contact email from Jeanette Larsen. Since I worked from home on Thursday, as requested by Jeanette, I brainstormed with my partner regarding the email and what we thought Jeanette wanted us to do regarding the project. We read into the email, believing that Jeanette wanted us to increase the palliative care experience, and that our topic was open-ended. Jeanette suggested that we start a tea-cart, and on Thursday, we literally thought that she meant a cart, just for tea (which was clarified for us on Friday). Emily and I came up with the idea to use skype, and email to allow palliative care patients who were not able to see their families to have communication with them, to enhance the last days of their lives. We researched the idea and came up with many journal articles outlining the successes and complications associated with communication with elderly individuals who were in palliative care.
On Friday, we went to Royal Gardens to meet with Rob, who is an RN at the retirement home. We sat down with Rob and filled out a whole bunch of paperwork and did some quizzes regarding occupational health and safety. After, we discussed with Rob what we thought Jeanette was saying in her email, and Rob clarified to us that the “tea cart” was not merely just a cart with tea, but rather that Jeanette wanted us to do many mini projects regarding palliative care. She wants us to develop a cart for families of the patients in palliative care, to provide comfort measures (such as warm towels, radios for soft music, Kleenex, snacks, tea, and coffee). She also wanted us to develop staff, family, and patient information brochures regarding the end of life transition and palliative care information. This clarification from Rob, although unfortunately making the work that we did the day before essentially useless, was wonderful in that it gave us the ideas on which to form our community health placement research on. We went on a tour of the beautiful facility, and learned what information packages they already had in place for families with loved ones in palliative care (which wasn’t much). We then helped Rob to design a poster regarding flu season, and information for staff and residents regarding upcoming flu clinics. Finally, at the end of the day, Emily and I sat down and brainstormed a list of questions that we would like to start asking the staff and residents of the facility regarding what they wanted to see in the palliative care, following ethics approval.
Thanks,
Emma Cumming
Clinical Note Two
This week at placement, Emily and I got to meet our preceptor, Jeannette Larsen, who is the Director of Care at Royal Gardens. She is an absolutely lovely person, who is outgoing, and funny, but is also one of the busiest people I think I’ve ever seen. Ms. Larsen met us on Thursday morning, and briefly outlined the project before she was rushed away to a meeting, and we didn’t see her until lunch. The good thing is that Emily and I have a lot of freedom, and also many of the staff at Royal Gardens are willing to help in any way, so we never really feel out of place.
On Thursday, we worked on developing and finalizing our interview questions for the residents and the staff. We also discussed about having volunteers come to do palliative sits with the residents, and discussed what kind of volunteers we would like to have. We brainstormed a list of interview questions for the volunteers, and then put together our ethics package and submitted it.
We also began to look up the prices for putting together palliative carts. We discussed going local vs. big box store, medical vs. homey looking, and the cost. We discussed the importance of trying to prevent a stigma of “the cart” being associated with death, and came up with some ideas to make the cart quaint and comfortable looking, rather than medical looking. We brainstormed some ideas of the types of things that we wanted on the cart, and then we met up with Julie, who is the Assistive Director of Care and also an RN, to discuss the questions that we had regarding Royal Gardens for our Praxi Note One.
On Friday we came to Royal Gardens for 9am, and worked on piecing together the bits and pieces of information that we have learned and researched so far. We had a meeting with Susan and Jeannette at 10, and discussed the placement. After, Emily and I went out into the community to look at prices of carts and objects that we were for sure going to put on the carts. We found that many of the basic objects were actually pretty pricey, along with the carts. After, we discussed looking for volunteers or community organizations to donate for the carts, and discussed the draw backs (in that maybe people don’t think that they need to volunteer time or resources since people in retirement homes pay so much to be there). However, we decided to look into community resources for quilts and other amenities for the carts.
We emailed Jeannette regarding the cart that we found, and she responded saying that it looked wonderful. Emily and I ended our day by visiting the Hospice of Peterborough to try and gather information regarding their palliative sitters program. We ended up leaving an email address for them, and hopefully we can set up a meeting for next week.
Clinical Note Week 3
October 2nd
Today Emily and I decided to tidy up some loose ends of our project, in hopes of starting to get more of a direction towards what we are doing for it. We were waiting to meet with Susan (since we start at 9 and we were meeting with her at 10), so we discussed the LOGIC model regarding our project. We found that we were slightly confused, but luckily when we met with Susan, she clarified that she would go over the LOGIC model in seminar. We met with Susan, and discussed revamping our ethics proposal. We also discussed resending our ethics proposal to her and Cyndi Gilmour, and chatted about the Hospice lack of community connections that Royal Gardens have. After meeting with Susan, Emily and I revamped our proposal, eventually cutting out the residents survey, and then emailed Susan back with the proposed new ethics submission.
Next, we emailed Jeannette about changing our project from using surveys to gather information from the residents, to bringing the questions to the residents council. Emily and I discussed what we should do, and how we should approach the topic with the residents at the resident’s council, and decided that we should just be brutally honest, and discuss the “palliative care cart”, even though discussing end of life may be difficult for some of the residents. We also emailed Hospice to try and gather information on palliative care (and ended up arranging to meet Friday at 9:30am),and we also emailed Trent Health Services to look into information regarding therapeutic touch services for the volunteers to be trained in. Finally, we looked online for more therapeutic touch training options and worked on developing a presentation for the resident’s council.
October 3rd
Today we met with Paula at Hospice Peterborough. Our meeting with her was extremely informative and helpful to our information gathering. We initially met with her to ask her about recruiting volunteers for the potential volunteer sitters program, and about how to train the volunteers that we would recruit. We actually found out during our meeting that Royal Gardens already had a letter of understanding between them and Hospice Peterborough, from four years previously. This basically means that Royal Gardens has access to the Hospice volunteers for Palliative sitting. We also found out that the palliative sitters are vastly underused, and that actually they only responded to four calls in the last year. We found out that all of the Gardens Residences have access to these volunteers, so Emily and I discussed potentially sending emails out to the other retirement residences re-orienting them with this service. We learned about the speak up service as well. We also met with Jeannette for a while, and discussed the project in depth, and then made some signs for her and laminated them, to provide comfort measures for families of the deceased.
Clinical Week 4
October 9th and 10th
This week at clinical we really got rolling on the staff surveys and the tea cart. Emily and I began our day by hashing out the LOGIC model for our Praxis Note 2 together. We then decided to work on pricing out the cart, and the basic necessities that we are going to be putting on it. We decided to build a budget (even though initially Jeannette said there was no budget), just so that we would have a ball park figure of what we were going to spend. We put together the budget (for the cart, wipes, care products, air purifiers, books, radio, CDs, etc.), and then actually went out to the Brick and bought the cart. We will be picking it up and assembling it next week. We also finalized our surveys today, and double checked them with Barb (the Executive Director at Royal Gardens). We finally printed of 100 copies of them, and made completion envelopes, and a brief flyer regarding the survey information. We distributed the surveys between the two nursing stations and the front desk.
Today we also decided to plan a meeting with Heather, which will take place tomorrow morning at 10:30am, regarding the resident’s council and the volunteer network with Hospice, and how to present that to the staff. We worked on developing a presentation for the resident’s council, and worked on finishing distributing the surveys. We also created a presentation outline and sent it to Heather for approval. We discussed prices with Barb (the Executive Director) and discussed how we would go about paying and being reimbursed for it. The flu clinic was going on, and we were glad that our poster was being used to promote getting a flu shot.
Clinical Week 5
October 16th and 17th
Our placement started a day early this week, as we went into Royal Gardens on Wednesday to present at the Resident’s council regarding our community care project. We wanted to try and get some input from the residents regarding the palliative care cart. We made our presentation to the resident’s council, and it appeared to be well-received. We were worried after the presentation about the feedback that we will be receiving, but we are hoping for the best. We printed out the presentation and the surveys and they were distributed to the residents following the resident’s council.
We also got our praxis note back and fixed it, as we had to add in a reference and to fix some errors in our logic model. We resubmitted it to Susan on Thursday. On Thursday we also picked up the cart from the Brick, and spent a large amount of time attempting to put it together. We finally managed to put it together, and went out to buy a radio and an air purifier for it. We budgeted $100 for the two things in total, and ended up spending less than our budget. We put the instructions and the two devices on the cart, along with the donated tea set. We are excited about actually having a physical cart now, and with further money allotted, we will be able to put more things on the cart. We also collected some of the staff and residents surveys, and began to look for common themes.
We went to Chapters and Staples to price compare some journals. We ended up going with journals from Chapters, as they were nicer and slightly more affordable. We ended up actually putting together the care journals, following an outline of a journal that was previously used in Royal Gardens many years ago. We implemented a nice poem regarding grieving, and implemented pages for both the family and the staff to fill out. We put in different pages, such as a page for medications that the patient is on, and any changes to them, and a page for contact numbers of their close family and friends, so that they can be contacted. We also put the number for Hospice Peterborough, and the toll free number for it, on the inside cover, with the hours that they are available to take calls between. This is for the staff to use the volunteer palliative sitters network, and for the family to have access to the services available from Hospice. We also contacted Hospice Peterborough regarding their information brochures for staff about grieving and addressing the dying process with the family and patient, and we are waiting back on prices for those.
Finally, we met with Jeannette and invited her and Julie to the poster presentation, and were emailed our midterm evaluations from her.
Clinical Week 6
October 30th and 31st
At our placement this week, it was a little slow and disappointing since our preceptor was not present, and we could not move forward with our project in the way that we wanted to. We had our midterm evaluation with Susan and Julie on Thursday, where we received nice praise from both Julie and Barb, the executive director. It was nice to hear that our work was so appreciated, especially since our project is so individual based, and we feel sometimes as if we are unnoticed when we are at clinical. It was nice to hear that our work was appreciated, and that we were making a difference at Royal Gardens.
We worked on creating the medication pamphlet, which actually took a surprisingly long time. It was hard to summarize the information that we needed in such little space, and to configure it the way that we wanted it to be. We also tried to use simple language for the families and staff to be able to communicate with together.
Emily and I also worked on the budget and Ghantt chart for our project. Since it has been all over the place, and much of our project relies on funding provided spontaneously whenever there is “petty cash”, it was hard to piece together when everything was put into place. We worked on the planning component of Praxis Note 2 as well.
All together, this week was kind of disappointing at clinical, hopefully next week will be better.
Clinical Week 7
November 6th and 7th
This week at placement, Jeannette was back from holidays, which we thought would be beneficial for us to get some of the work for our project done. However, since she is the Director of care, catching up from being on holidays is actually pretty difficult, and it was almost as if she wasn’t there again since she was so busy. We barely got to see her, as she was catching up with the multiple levels of staff about the week she was away.
Emily and I worked on completing and editing the pamphlets, and got it approved to hand out. We handed out the pamphlet to the different nursing stations, explaining to them that this was the finalized project, and that it was for them to use. We explained how they could use it with the patient’s families, and the importance of the patient’s families knowing what medications they were on, in order to have everyone on the same page. We explained why we simplified the language that we used, and explained why not all of the contraindications, side effects, and interactions were on the pamphlet (due to lack of space).
Emily and I took Friday to work on our poster, as I was sick as a dog on Thursday and Jeannette kindly suggested that we work from home (since I’ve been sick and have been unable to get a flu shot). We worked on the poster, making some headway in this final stretch of our project, which was rewarding to start to put everything together.
Clinical Week 8
November 10th & 11th
This week at clinical we worked on completing our poster, and submitted it to Susan for approval. We created a cart procedure so that items on the cart can be restocked and properly used in the future once we are gone. We finally finished purchasing the cart items, and finalized the cart, putting together all of the items. We discussed the process and outcome evaluations for Praxis Note 4, and discussed how we met these evaluations and expectations. We finalized the pamphlets, and put them on the care cart, to be used in the future. We also discussed with the staff, asking them to use a 5 Point Likert scale, to provide feedback on the quality of information on the pamphlets. We were a little worried that the staff wouldn’t appreciate the simplified language used, and not having massive amounts of information on the pamphlets, however the staff seemed to greatly appreciate the pamphlets. We received a lot of positive feedback, regarding the pamphlet, cart, and palliative sitter network, which was nice to hear.
We decided to use the face-to-face method when asking for feedback this time, due to our lack of success with the survey return previously in the project. This provided useful, as people gave their opinions, and it didn’t take up much of their time. We also got personalized feedback, something that a basic 5 Point Likert scale on paper wouldn’t have received.
Finally, this week we emailed Paula regarding volunteer list for Jeannette. Hospice Peterborough is only open between 9-5 to answer phone calls on week days. This isn’t necessarily beneficial for Royal Gardens to access the palliative sitter network, on weekends or weekdays after 5pm. Thus, we emailed Paula asking if we could have the phone number information for the volunteers, to keep in confidentiality with Jeannette alone, so that she could call the volunteers if they were needed at other times. We also went to Hospice Peterborough to pick up pamphlets for the cart, but they were closed for an education day, so we will have to go back next week for those.
Complete package includes this checklist, the completed project protocol submission form (next page), consent form (if appropriate), survey or questionnaire form (if being used)
Nursing Research//Ethics committee via :
[email protected]
Project Protocol Submission Form
Student Names: Emma Cumming and Emily Rienstra
Course For Project: NURS 2020 Community Based Nursing Practice Fall 2014
Faculty Clinical Instructor: Susan Fairs [email protected]
Title of Project: Enhancing Palliative Care at Royal Gardens
Project Rationale: The students have undertaken this assignment under the supervision of Jeannette Larsen, to try to enhance the quality of palliative care at Royal Gardens retirement home. The director of care (Jeannette Larsen) identified the need for a tea cart for therapeutic and comfort measures for the palliative care families, and enhanced information regarding medications used for the staff of Royal Gardens. The project will also entail developing a volunteer network, under the supervision and policies outlined by Royal Gardens, to carry out the tea cart program and palliative sitting.
Anticipated Start and End Dates: October 2, 2014 (Pending Ethics Approval) à November 28, 2014
Methods: The students will be performing 10 staff surveys using cross section of different disciplines, with initial consent. The students will also be conducting 25-35 resident interviews, of residents of different genders and ages, ensuring that consent is initially obtained. The research will be conducted at Royal Gardens retirement residence, using pen and paper surveys. The data will analyzed using statistical analysis, and will be kept confidential. The final outcome data will be presented in poster form, with the participants remaining anonymous.
Anticipated Use of Research Findings: Create a tea cart that will enhance the experience of palliative patients and their families, as well as create a medication information booklet to assist staff and families.
Staff Tea Cart Survey
Project Overview
Trent nursing students Emily Rienstra and Emma Cumming will be conducting a survey investigating the needs of palliative patients and staff at Royal Gardens retirement home for their NURS 2020 Community Care placement. The information that they collect will be kept confidential. They will use the information to construct a tea cart that will enhance palliative care at Royal Gardens, as well as create a medications information sheet for staff and patient’s families. This project is supervised under Jeannette Larsen, Director of Care at the facility. Thank you in advance for your information.
Staff Questions
1. Of the following aspects of palliative care, which come up most frequently among patients and their families? Rank in order of importance.
Medications/ palliative pain management
Coping with loss
How to provide support to the patient
Which community services are available?
Other _____________
2. On a scale of 1-5 (1 being knowing little and feeling uncomfortable educating patients and their families and 5 feeling extremely comfortable educating the patients and their families), what is your knowledge regarding how the commonly used medications in palliative care work and their side effects?
1 2 3 4 5
Not Comfortable Somewhat Uncomfortable Undecided Somewhat Comfortable Very Comfortable
3. Rank each individual medication on the same scale of 1-5.
Hydrocodone 1 2 3 4 5
Morphine (subQ) 1 2 3 4 5
Fentanyl 1 2 3 4 5
Oxycodone 1 2 3 4 5
Hydromorphone (subQ) 1 2 3 4 5
Dimenhydrinate 1 2 3 4 5
Acetylsalicylic acid 1 2 3 4 5
Oxygen 1 2 3 4 5
Senna 1 2 3 4 5
Haloperidol 1 2 3 4 5
Diazepam 1 2 3 4 5
Trazodone 1 2 3 4 5
Midazolam (subQ) 1 2 3 4 5
Glycopyrrolate 1 2 3 4 5
4. Rank each resource in order of what would be most helpful to your knowledge of medications.
Booklet
Workshop
Online resources
Other ____________
5. If a tea cart was made, what could be put on the cart to benefit you and the staff most?
6. Please add any other comments you think would be helpful
Thank you for your time, your input is appreciated.
Volunteer Interview
1. Are you able to provide us with a police check with a vulnerable screening sector?
2. Are you able to provide proof of a recent two-step Tb test?
3. Why are you interested in volunteering with palliative care patients?
4. What skills will you bring to this volunteer position?
5. Are you comfortable dealing with patients that are nearing the end of life?
6. What do you feel comfortable doing?
Palliative sitting
Bringing around tea cart
Reading
Overseeing volunteer activities
7. When are you available to volunteer? (Please circle all that apply)
Sunday- Morning/ Afternoon
Monday- Morning/ Afternoon
Tuesday- Morning/ Afternoon
Wednesday- Morning/ Afternoon
Thursday- Morning/ Afternoon
Friday- Morning/ Afternoon
Saturday- Morning/ Afternoon
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Praxis Note 2/ Reflection 2
Short Term Goal
Short Term Goal: To determine what comfort measures would benefit palliative residents the most, and identify common medications taken near end of life. This goal will be completed by October 17, 2014.
Using the Critical Assessment to Create a Logic Model
The critical assessment was performed the first two weeks that we were at placement. Upon doing our windshield survey and communicating with Jeannette Larsen, the Director of Care, it was determined that the main need of Royal Gardens was to enhance their palliative care unit. This included developing a palliative care cart, providing staff education (regarding medications) to enhance patient and family teaching, and through enlisting palliative care sitters for those who do not have family nearby.
From this information, we determined both a short term and a long term goal for this project. The short term goal was to determine what comfort measures would benefit palliative residents the most, and to identify common medications taken near end of life. The long term goal is to create a cart that has the comfort measures for palliative patients and their families identified in the needs assessment, as well as a booklet of medications for staff and families (to provide education about the pharmacology of medications). The resources that we are enlisting include the residents’ council, nursing and professional staff, Hospice Peterborough, and funding from Royal Gardens. The activities that we are doing to achieve these goals include creating a survey for the staff, creating and stocking a tea cart, and creating pamphlets for the staff. Through these, we hope to have the eventual outcomes of both residents and staff being more comfortable with the end of life care at Royal Gardens, and having no resident die alone.
We decided that the health promotion strategies of staff education, and enhanced health measures for the palliative care patients were most important in this project. We decided to use staff education through the use of pamphlets, because pamphlets are easily accessible, and are a form of health promotion that most staff are familiar with. We also decided to use the pamphlets because the staff can pass along them to the families of the palliative patients, to share the information regarding the medications. We also decided that enhanced health measures (such as providing lip balm, creams, dental hygiene devices, and wipes on the cart) would benefit the palliative residents most, as they would provide enhanced comfort for them during their final stage of life.
Two partnership agencies that Royal Gardens is connected to are: Hospice Peterborough, and Community Care Access Center (CCAC). For this community health project, the connection with Hospice Peterborough is being used, as we are enlisting palliative sitters for those who have no family nearby, to enhance their end of life experience. We are working closely with Paula, the Volunteer Coordinator at Hospice Peterborough, to provide a connection with the staff of Royal Gardens to educate them regarding the program that is available. CCAC is also connected to Royal Gardens, and is important in this project for the patients on the palliative care floor. If the patient has more care needs than the staff can handle, they enlist a CCAC professional to help with the care, provided that the person has the required funding. The vision of CCAC is for “outstanding care—every person, every day” (CCAC, 2014). This is shown through their community involvement, and commitment to care, trying to better the lives of others in need in the community. The relationship between both CCAC and Hospice to Royal Gardens is very underused, which is something that we are trying to change throughout this project.
Reflection
To this date, our project is going quite well. Although we have had a few minor set-backs, we are continuing to make progress towards developing our care cart, palliative sitter network, and medication information for the staff of Royal Gardens. We are working together with staff of Royal Gardens (Jeannette, Julie, and Heather), to ensure that the information about the project is being shared throughout the multiple layers of staff at the retirement residence. We are developing a presentation for the resident’s council to gather information for the development of the comfort care cart, and are creating a presentation with Paula for the professional staff meeting in November, regarding connecting with Hospice Peterborough.
We had a minor set-back with our ethics proposal, as it seemed to be confusing for the evaluator. This actually ended up with us taking a different direction with how we are going to gather our information (making a presentation at the resident’s council, rather than doing a survey), which we believe is going to be a better way to present the topic to the residents, and to gather the information. We had a very productive meeting with Paula from Hospice Peterborough, where we learned that Royal Gardens actually already had a connection to use the palliative sitters. This means that we just have to re-introduce this connection to the staff at Royal Gardens, to enlist the palliative sitters. This was wonderful news as it meant that we can start using the sitters immediately, so that no resident will have to die alone.
Overall we are satisfied with the progress that we are making this far in our project. Future short term goals for our project include gathering the surveys that we have distributed and creating the pamphlets, developing the care cart based on the needs expressed by the residents, and creating presentations for both the resident’s council, and professional staff meetings.
Reference
Community Care Access Center. (2014, October 15). Vision, Mission and Values. Retrieved October 16, 2014, from CCAC website: http://healthcareathome.ca/centraleast/en/Who-We-Are/Vision-Mission
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Praxis Note Three
Implementation Plan
Implementing our plan will require the collaboration of the RN students, the professional staff at Royal Gardens (RNs, RPNs, PSWs, Executive Director, Director of Care, and Assistant Director of Care), and Hospice Peterborough. The care cart, brochures, and palliative sitters will all be implemented by the completion of our project. The items on the care cart were determined by Jeannette, Julie, Barb, and us, along with the input of the residents from the resident’s council. We are planning on having the cart completed by week 9, based on funding provided to complete the hygiene packages, and small items on the cart. Based on the information provided by the staff surveys, we are developing a brochure for the staff and families, which will be completed by week 8, and distributed on weeks 9 and 10. Finally, the link with Hospice Peterborough has been established, and we are working towards implementing brochures from Hospice regarding grieving, as requested by the staff at Royal Gardens. We are looking to redirect the staff towards the hospice website regarding the palliative sitters, in order to increase adherence to using the volunteer network. The volunteers provide emotional support and practical help to people who are in palliative care, and provide relief time for those caring for them (Hospice Peterborough, 2014).
Finally, although we have been responsible for buying the cart and the items on it, developing the brochures, and re-establishing the link between Hospice Peterborough and Royal Gardens, the final implementation of the project will be how we pass it on to Royal Gardens to sustain it. We will have to develop an outline of how to sustain the care (examples of items on it), and provide a strong connection with Hospice Peterborough, to be maintained after we have left. We will develop an outline regarding what items to put on the cart, an electronic version of the brochure that can be printed, and resources and contacts for Hospice Peterborough, to try to ensure that the project is maintained after we have gone.
Ghantt Chart
Task Name
September
October
November
Wk 1
2
3
4
5
6
7
8
9
10
Windshield survey needs assessment
Outline Project
Create surveys for staff and resident input
Plan palliative sitters with hospice
Buy items for cart
Present at residents council
Create educational medications pamphlet
Create surveys for staff to evaluate effectiveness of cart
Create poster
Present poster
Inform staff on components of cart and how to maintain its use and the use of palliative sitters
Budget
Budget Items
Rationale for items
Cost (hypothetical if nec.)
Personnel
· Staff Salaries ($22/hr)
· Volunteer Hours ($10.00/hr)
- Professional Staff (Director of Care, Executive Director, and Assistant Director of Care are overseeing this project) are responsible for overseeing the volunteer and staff use of the care cart once the RN students are gone, and are responsible for stocking the cart with supplies when needed
- Professional Staff (Registered Nurses, Registered Practical Nurses, and Personal Support Workers) have access to the care cart if needed for their use
- Volunteers from Hospice Peterborough are providing their time for palliative sitting free of charge
- The project will be taken on by the staff as an added part of their workload at no extra pay, thus the costs will just be their general salaries (ex. Director of Care- $100,000 yearly; RN- $60,000 yearly)
- The volunteers from Hospice Peterborough are providing their time free of charge
Travel Costs
· Parking- Free, accessible parking is available for the staff and volunteers at Royal Gardens, as they will be needing to stay long hours and may not be able to rely on public transit to get around
· Transit - Transit fees reimbursed by Hospice Peterborough, and rides are also provided for the volunteers, by Hospice workers, if needed
· Mileage- ?
Program Costs
· Printing -Printing was required for the resident’s council handout, surveys, brochures, door signs, and evaluation forms
- Staff/ Family Brochures
- Door Signs
· Photocopying- Photocopying was also needed for all of the above
- Staff/ Family Brochures $5.98 (Printer Paper), $60.00 (Ink for Photocopier)
- Door Signs
· Purchase of Resources - All of the resources required were put onto the care cart, and were discussed prior to purchasing them by the RN students and the Executive Director. It was mutually agreed, between the Director of Care, Executive Director, Assistant Director of Care, and RN students, on the purpose of each object on the cart. The air purifier, lip balm, hygienic wipes, and non-scented lotions are comfort measures for the palliative patient. The journals are for staff recording of care, and the radio, CDs, Hospice booklets, hand sanitizer, alcohol swabs, hygiene kits, and tea set are for comfort measures for the family and Hospice volunteers
- Wooden tea cart- $78.00
- Radio- $30.00
- Journals (4)- $36.00
- Air Purifier- $58.00
- CDs-$0.00 (donated)
- Tea Set- $0.00 (donated)
- Hygiene Kits- $5.00 (x5)
- Lip Balm- $3.00
- Alcohol Swabs- $0.00 (provided)
- Hygienic Wipes- $10.00
- Non-scented Lotions- $5.00
- Hand Sanitizer - $0.00 (provided)
- Hospice Booklets re: Grief- $2.00
- Organizing Baskets- $5.00
Program Promotion
· Posters - The project was promoted by word of mouth at the resident’s council meeting, thus the only fees required are the ones associated with photocopying, mentioned previously
· Advertising - No advertising was needed, as was discussed through the team that worked on the project. It was inappropriate to advertise the care cart, as many residents have a hard time discussing palliative care.
· Other (specify)
]
Project Evaluation
· Cost of printing/copying -The costs associated with printing and photocopying the evaluations were listed previously in the budget. Since there are very limited numbers of evaluations being printed, the cost is nothing more than the cost mentioned previously.
· Other (specify)
TOTAL: $317.98
Reflection
So far, the project is advancing forward well, with few set-backs. I feel fortunate to be a part of such a cohesive, respectful team, which welcomes the opinions of everyone, and works together to problem solve. Overall, I believe that Emily and I are on track for completing the project within the timeline given, as long as we don’t hit any major speed bumps. We have started to put together the cart, and are working together to analyze the information from the surveys, to complete the staff and family brochure, and eventually the final poster.
One minor set-back that we had was adherence to completing the survey by the staff and the residents. We ended up getting 10/90 surveys back from the staff, and 5/30 back from the residents. Although the information we received was valuable, and will be implemented into our project, it would have been nice to have a larger cross-section of opinions to work from. We believe the poor adherence from the staff was due to them being busy, and the surveys being in a location that was not immediately in eye sight. We believe that the residents had a poor compliance rate due to some cognitive decline, and lack of motivation to discuss the palliative care topic. Next time, I would individually hand out the staff surveys, to put a face to the survey, to make it more personal, and would ask the residents to complete the surveys before leaving the council meeting (if possible), to enhance compliance. Although the return rate was low on the surveys, we were able to pull some ideas, and to brainstorm with Jeannette, Julie, and Barb, to allow us to move forward towards completing the care cart and brochures.
Overall, the project is going well, and I am looking forward to finally implementing the cart and brochures to enhance the palliative care at Royal Gardens. I am excited to see the final product of this project come together, and to share our experience through the poster presentation at the end of the month.
Reference
Hospice Peterborough. (2014, October 10). Volunteer Visiting. Retrieved October 30, 2014 from Hospice Peterborough website: http://www.hospicepeterborough.org/volunteer-visiting
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Praxis Note Four/ LEARN Reflection
Praxis Note 4
The main evaluation strategies that we used to evaluate our progress were to monitor that we were staying on time with our work and assignments, Likert scales to monitor the quality of information of our pamphlet, and asking our preceptor how we were doing on the project. These are appropriate strategies because they kept us on time with all of our objectives, made sure that our outcome of the pamphlet was effective, and ensured that we were meeting the expectations of our preceptor.
For the process evaluations, we needed to make sure that they were appropriate for the short term goals of getting information from the residents regarding what items they would like on the care cart, having the staff complete a survey regarding medications, and developing a palliative sitters network. The strategy used was to have all of the information gathered and analyzed by a certain deadline, with a strong cross section of research. This was evaluated the development of the palliative sitters by by our forming of connections with Hospice, and our maintenance of this connection (via weekly email) with Hospice over the time we spent at Royal Gardens. We know this was achieved because all of the information was handed in on time, analyzed, and formed into brochures and items being bought for the cart.
We needed to make sure that our outcome objective was appropriate for the assessment of whether the introduction of our cart meets the long term goal of satisfying a palliative care need took after our long term goal of no resident dying alone. For the process for this goal, we the Hospice phone number at nursing station, for people to call if someone is dying alone. To evaluate this, we are expecting staff to report that no one has died alone, after our implementation, and asked the staff to evaluate the evaluation on a five point Likert scale.
LEARN Reflection
Look Back
This community placement was truly unlike any other nursing placement I’ve experienced. My placement was at Royal Gardens, with another nursing student, enhancing the palliative care unit at Royal Gardens. The whole experience of planning and implementing a project was completely different from anything that I have done thus far in nursing. The whole experience of working independently, without having the guidance of a preceptor over my shoulder, was quite different from my previous placement experiences. Being in charge of my own hours, own progress on the project, including my own deadlines and expectations, was a struggle, and a weakness for me. I am so used to answering to preceptors, and having others set limitations and expectations on me, that setting them on myself was difficult. However, I feel like I developed self-efficacy and confidence in my project developing skills, which is a strength. Not being able to work with the population that I was creating the project for, was a struggle. We developed a palliative care cart, medication pamphlet, and developed a volunteer palliative sitters network, all without ever dealing with the palliative population at Royal Gardens, which was a struggle as well.
Evaluate
Overall, the project in my mind went well. Emily and I were satisfied with our cart that we developed, and are excited to see how it is implemented in the palliative care at Royal Gardens. We were satisfied with the quality of information that we had on our medication brochure, and feel like it is a valuable, informative resource for the staff and families to have. We were satisfied with the creation of the pamphlet, in that it is easy to read, and has lots of information on it. Finally, we were satisfied with the connection that was re-established with Hospice Peterborough. Hospice Peterborough volunteers provide emotional support and practical help to people who are facing a life threatening illness and relief time for those caring for them (Hospice Peterborough, 2014). We are content that the palliative sitter network is now in place, with ultimately solved our long-term goal of no resident dying alone. Two downfalls that we found were that there were a poor return of surveys, which resulted in having a smaller stream of information to pull from, when developing our medication pamphlet. The other downfall was, as previously mentioned was the lack of interaction with the population of interest, which in my mind, didn’t allow us to develop a phenomenological perspective when developing the project. This, in my mind, was a difference between theory and practice, as we developed this entire project, based on a population in our mind, due to the lack of access we had to interact with the population.
Analyze
Upon analysis, I believe that this project, overall was successful, both personally, and for the palliative care population at Royal Gardens. Although there were some areas of weakness, personally, as a nurse I developed my self-confidence in organizing and developing a project, and working effectively with a partner and independently. I struggle with confidence, and often rely on working under someone else as a “boss” for a security or comfort blanket. This placement truly challenged me to come out of my comfort zone, and to develop some confidence in my self-directed practice, which I think was greatly needed.
This project was also successful for the palliative care unit at Royal Gardens. Although a wonderful retirement residence, with many amenities for their population, their palliative care floor was lacking comfort measures. By the creation of the comfort care cart, medication pamphlet, and palliative sitters network, the palliative care provided at Royal Gardens was enhanced. These measures will provide enhanced comfort to the palliative care patients, their families, and the staff at Royal Gardens, providing a more comfortable experience, for all.
Revise
If I was to undertake this project again, I would do many things the same, such as use the Ghantt chart, create deadlines, and create a budget, to keep on track both with time and with finances. However, upon analysis, I would change some things with the project. I would like to increase the adherence to the survey completion next time, to allow for a more adequate cross-section of information gathered for the surveys. This would ensure that we were accessing the needs of more of the staff and the residents, making our project more fair overall. I would do this by personally handing out the surveys to the different health care workers and residents. This way they could have a face to the survey, and would be inclined to fill it out, instead of having to take it upon themselves to pick up the survey to do so. I would also make more notices regarding survey completion, via word of mouth, emails, and flyers, to enhance adherence.
I would also take the time, next time, to work with the population of interest, and to work with the people from the front lines of that population, to develop the program. Although I tried to do this, with the surveys, this population was not necessarily a part of the project planning and implementation, which was indeed a downfall. Next time, I would try to include the population, no matter how marginalized they are, via information sessions, flyers, or word of mouth, to keep them up to date on the project, and to ask for their input.
New Perspectives
I have learned many new things from this project that I will bring forward into my future practice as a nurse. I learned the very valuable skills of developing, implementing, and evaluating a project effectively, which I can bring forward into any aspect of both my personal, and professional life. I have developed some self-confidence in myself, which I will need going forward into my career. Finally, through this project, I have learned how important it is to empower populations who cannot empower themselves. I learned that the palliative care population is very vulnerable, and should not be overlooked, and that comfort is essential for this population. These things will come forward with me, in my future career of being a nurse.
Reference
Hospice Peterborough. (2014, November 9). Volunteer Visiting. Retrieved October 30, 2014- from Hospice Peterborough website: http://www.hospicepeterborough.org/volunteer-visiting
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Good evening Ms. Fairs,
This week at clinical, at Royal Gardens, I did research for the project that was outlined in the initial contact email from Jeanette Larsen. Since I worked from home on Thursday, as requested by Jeanette, I brainstormed with my partner regarding the email and what we thought Jeanette wanted us to do regarding the project. We read into the email, believing that Jeanette wanted us to increase the palliative care experience, and that our topic was open-ended. Jeanette suggested that we start a tea-cart, and on Thursday, we literally thought that she meant a cart, just for tea (which was clarified for us on Friday). Emily and I came up with the idea to use skype, and email to allow palliative care patients who were not able to see their families to have communication with them, to enhance the last days of their lives. We researched the idea and came up with many journal articles outlining the successes and complications associated with communication with elderly individuals who were in palliative care.
On Friday, we went to Royal Gardens to meet with Rob, who is an RN at the retirement home. We sat down with Rob and filled out a whole bunch of paperwork and did some quizzes regarding occupational health and safety. After, we discussed with Rob what we thought Jeanette was saying in her email, and Rob clarified to us that the “tea cart” was not merely just a cart with tea, but rather that Jeanette wanted us to do many mini projects regarding palliative care. She wants us to develop a cart for families of the patients in palliative care, to provide comfort measures (such as warm towels, radios for soft music, Kleenex, snacks, tea, and coffee). She also wanted us to develop staff, family, and patient information brochures regarding the end of life transition and palliative care information. This clarification from Rob, although unfortunately making the work that we did the day before essentially useless, was wonderful in that it gave us the ideas on which to form our community health placement research on. We went on a tour of the beautiful facility, and learned what information packages they already had in place for families with loved ones in palliative care (which wasn’t much). We then helped Rob to design a poster regarding flu season, and information for staff and residents regarding upcoming flu clinics. Finally, at the end of the day, Emily and I sat down and brainstormed a list of questions that we would like to start asking the staff and residents of the facility regarding what they wanted to see in the palliative care, following ethics approval.
Thanks,
Emma Cumming
Clinical Note Two
This week at placement, Emily and I got to meet our preceptor, Jeannette Larsen, who is the Director of Care at Royal Gardens. She is an absolutely lovely person, who is outgoing, and funny, but is also one of the busiest people I think I’ve ever seen. Ms. Larsen met us on Thursday morning, and briefly outlined the project before she was rushed away to a meeting, and we didn’t see her until lunch. The good thing is that Emily and I have a lot of freedom, and also many of the staff at Royal Gardens are willing to help in any way, so we never really feel out of place.
On Thursday, we worked on developing and finalizing our interview questions for the residents and the staff. We also discussed about having volunteers come to do palliative sits with the residents, and discussed what kind of volunteers we would like to have. We brainstormed a list of interview questions for the volunteers, and then put together our ethics package and submitted it.
We also began to look up the prices for putting together palliative carts. We discussed going local vs. big box store, medical vs. homey looking, and the cost. We discussed the importance of trying to prevent a stigma of “the cart” being associated with death, and came up with some ideas to make the cart quaint and comfortable looking, rather than medical looking. We brainstormed some ideas of the types of things that we wanted on the cart, and then we met up with Julie, who is the Assistive Director of Care and also an RN, to discuss the questions that we had regarding Royal Gardens for our Praxi Note One.
On Friday we came to Royal Gardens for 9am, and worked on piecing together the bits and pieces of information that we have learned and researched so far. We had a meeting with Susan and Jeannette at 10, and discussed the placement. After, Emily and I went out into the community to look at prices of carts and objects that we were for sure going to put on the carts. We found that many of the basic objects were actually pretty pricey, along with the carts. After, we discussed looking for volunteers or community organizations to donate for the carts, and discussed the draw backs (in that maybe people don’t think that they need to volunteer time or resources since people in retirement homes pay so much to be there). However, we decided to look into community resources for quilts and other amenities for the carts.
We emailed Jeannette regarding the cart that we found, and she responded saying that it looked wonderful. Emily and I ended our day by visiting the Hospice of Peterborough to try and gather information regarding their palliative sitters program. We ended up leaving an email address for them, and hopefully we can set up a meeting for next week.
Clinical Note Week 3
October 2nd
Today Emily and I decided to tidy up some loose ends of our project, in hopes of starting to get more of a direction towards what we are doing for it. We were waiting to meet with Susan (since we start at 9 and we were meeting with her at 10), so we discussed the LOGIC model regarding our project. We found that we were slightly confused, but luckily when we met with Susan, she clarified that she would go over the LOGIC model in seminar. We met with Susan, and discussed revamping our ethics proposal. We also discussed resending our ethics proposal to her and Cyndi Gilmour, and chatted about the Hospice lack of community connections that Royal Gardens have. After meeting with Susan, Emily and I revamped our proposal, eventually cutting out the residents survey, and then emailed Susan back with the proposed new ethics submission.
Next, we emailed Jeannette about changing our project from using surveys to gather information from the residents, to bringing the questions to the residents council. Emily and I discussed what we should do, and how we should approach the topic with the residents at the resident’s council, and decided that we should just be brutally honest, and discuss the “palliative care cart”, even though discussing end of life may be difficult for some of the residents. We also emailed Hospice to try and gather information on palliative care (and ended up arranging to meet Friday at 9:30am),and we also emailed Trent Health Services to look into information regarding therapeutic touch services for the volunteers to be trained in. Finally, we looked online for more therapeutic touch training options and worked on developing a presentation for the resident’s council.
October 3rd
Today we met with Paula at Hospice Peterborough. Our meeting with her was extremely informative and helpful to our information gathering. We initially met with her to ask her about recruiting volunteers for the potential volunteer sitters program, and about how to train the volunteers that we would recruit. We actually found out during our meeting that Royal Gardens already had a letter of understanding between them and Hospice Peterborough, from four years previously. This basically means that Royal Gardens has access to the Hospice volunteers for Palliative sitting. We also found out that the palliative sitters are vastly underused, and that actually they only responded to four calls in the last year. We found out that all of the Gardens Residences have access to these volunteers, so Emily and I discussed potentially sending emails out to the other retirement residences re-orienting them with this service. We learned about the speak up service as well. We also met with Jeannette for a while, and discussed the project in depth, and then made some signs for her and laminated them, to provide comfort measures for families of the deceased.
Clinical Week 4
October 9th and 10th
This week at clinical we really got rolling on the staff surveys and the tea cart. Emily and I began our day by hashing out the LOGIC model for our Praxis Note 2 together. We then decided to work on pricing out the cart, and the basic necessities that we are going to be putting on it. We decided to build a budget (even though initially Jeannette said there was no budget), just so that we would have a ball park figure of what we were going to spend. We put together the budget (for the cart, wipes, care products, air purifiers, books, radio, CDs, etc.), and then actually went out to the Brick and bought the cart. We will be picking it up and assembling it next week. We also finalized our surveys today, and double checked them with Barb (the Executive Director at Royal Gardens). We finally printed of 100 copies of them, and made completion envelopes, and a brief flyer regarding the survey information. We distributed the surveys between the two nursing stations and the front desk.
Today we also decided to plan a meeting with Heather, which will take place tomorrow morning at 10:30am, regarding the resident’s council and the volunteer network with Hospice, and how to present that to the staff. We worked on developing a presentation for the resident’s council, and worked on finishing distributing the surveys. We also created a presentation outline and sent it to Heather for approval. We discussed prices with Barb (the Executive Director) and discussed how we would go about paying and being reimbursed for it. The flu clinic was going on, and we were glad that our poster was being used to promote getting a flu shot.
Clinical Week 5
October 16th and 17th
Our placement started a day early this week, as we went into Royal Gardens on Wednesday to present at the Resident’s council regarding our community care project. We wanted to try and get some input from the residents regarding the palliative care cart. We made our presentation to the resident’s council, and it appeared to be well-received. We were worried after the presentation about the feedback that we will be receiving, but we are hoping for the best. We printed out the presentation and the surveys and they were distributed to the residents following the resident’s council.
We also got our praxis note back and fixed it, as we had to add in a reference and to fix some errors in our logic model. We resubmitted it to Susan on Thursday. On Thursday we also picked up the cart from the Brick, and spent a large amount of time attempting to put it together. We finally managed to put it together, and went out to buy a radio and an air purifier for it. We budgeted $100 for the two things in total, and ended up spending less than our budget. We put the instructions and the two devices on the cart, along with the donated tea set. We are excited about actually having a physical cart now, and with further money allotted, we will be able to put more things on the cart. We also collected some of the staff and residents surveys, and began to look for common themes.
We went to Chapters and Staples to price compare some journals. We ended up going with journals from Chapters, as they were nicer and slightly more affordable. We ended up actually putting together the care journals, following an outline of a journal that was previously used in Royal Gardens many years ago. We implemented a nice poem regarding grieving, and implemented pages for both the family and the staff to fill out. We put in different pages, such as a page for medications that the patient is on, and any changes to them, and a page for contact numbers of their close family and friends, so that they can be contacted. We also put the number for Hospice Peterborough, and the toll free number for it, on the inside cover, with the hours that they are available to take calls between. This is for the staff to use the volunteer palliative sitters network, and for the family to have access to the services available from Hospice. We also contacted Hospice Peterborough regarding their information brochures for staff about grieving and addressing the dying process with the family and patient, and we are waiting back on prices for those.
Finally, we met with Jeannette and invited her and Julie to the poster presentation, and were emailed our midterm evaluations from her.
Clinical Week 6
October 30th and 31st
At our placement this week, it was a little slow and disappointing since our preceptor was not present, and we could not move forward with our project in the way that we wanted to. We had our midterm evaluation with Susan and Julie on Thursday, where we received nice praise from both Julie and Barb, the executive director. It was nice to hear that our work was so appreciated, especially since our project is so individual based, and we feel sometimes as if we are unnoticed when we are at clinical. It was nice to hear that our work was appreciated, and that we were making a difference at Royal Gardens.
We worked on creating the medication pamphlet, which actually took a surprisingly long time. It was hard to summarize the information that we needed in such little space, and to configure it the way that we wanted it to be. We also tried to use simple language for the families and staff to be able to communicate with together.
Emily and I also worked on the budget and Ghantt chart for our project. Since it has been all over the place, and much of our project relies on funding provided spontaneously whenever there is “petty cash”, it was hard to piece together when everything was put into place. We worked on the planning component of Praxis Note 2 as well.
All together, this week was kind of disappointing at clinical, hopefully next week will be better.
Clinical Week 7
November 6th and 7th
This week at placement, Jeannette was back from holidays, which we thought would be beneficial for us to get some of the work for our project done. However, since she is the Director of care, catching up from being on holidays is actually pretty difficult, and it was almost as if she wasn’t there again since she was so busy. We barely got to see her, as she was catching up with the multiple levels of staff about the week she was away.
Emily and I worked on completing and editing the pamphlets, and got it approved to hand out. We handed out the pamphlet to the different nursing stations, explaining to them that this was the finalized project, and that it was for them to use. We explained how they could use it with the patient’s families, and the importance of the patient’s families knowing what medications they were on, in order to have everyone on the same page. We explained why we simplified the language that we used, and explained why not all of the contraindications, side effects, and interactions were on the pamphlet (due to lack of space).
Emily and I took Friday to work on our poster, as I was sick as a dog on Thursday and Jeannette kindly suggested that we work from home (since I’ve been sick and have been unable to get a flu shot). We worked on the poster, making some headway in this final stretch of our project, which was rewarding to start to put everything together.
Clinical Week 8
November 10th & 11th
This week at clinical we worked on completing our poster, and submitted it to Susan for approval. We created a cart procedure so that items on the cart can be restocked and properly used in the future once we are gone. We finally finished purchasing the cart items, and finalized the cart, putting together all of the items. We discussed the process and outcome evaluations for Praxis Note 4, and discussed how we met these evaluations and expectations. We finalized the pamphlets, and put them on the care cart, to be used in the future. We also discussed with the staff, asking them to use a 5 Point Likert scale, to provide feedback on the quality of information on the pamphlets. We were a little worried that the staff wouldn’t appreciate the simplified language used, and not having massive amounts of information on the pamphlets, however the staff seemed to greatly appreciate the pamphlets. We received a lot of positive feedback, regarding the pamphlet, cart, and palliative sitter network, which was nice to hear.
We decided to use the face-to-face method when asking for feedback this time, due to our lack of success with the survey return previously in the project. This provided useful, as people gave their opinions, and it didn’t take up much of their time. We also got personalized feedback, something that a basic 5 Point Likert scale on paper wouldn’t have received.
Finally, this week we emailed Paula regarding volunteer list for Jeannette. Hospice Peterborough is only open between 9-5 to answer phone calls on week days. This isn’t necessarily beneficial for Royal Gardens to access the palliative sitter network, on weekends or weekdays after 5pm. Thus, we emailed Paula asking if we could have the phone number information for the volunteers, to keep in confidentiality with Jeannette alone, so that she could call the volunteers if they were needed at other times. We also went to Hospice Peterborough to pick up pamphlets for the cart, but they were closed for an education day, so we will have to go back next week for those.