Reflection, Liverpool Care Pathway

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I am a rehab support worker at level three of the skills for health (2009) framework, within a multidisciplinary team of nurses, therapy and healthcare. This reflective account looks at my involvement and contribution to the care of an elderly gentleman, nursed in his own home living with his wife who provided him with nursing care between his private carer visits. The gentleman was also receiving care from a private agency and had district nurse involvement, as his condition worsened he had been referred by his doctor to a specialist palliative care team who assessed the patient and put him on the Liverpool Care Pathway (LCP). The LPC is a best-practice model of care, supporting care in the last hours/days of life driving the quality of care we give to patients and relatives (Ellershaw and Wilkinson, 2011). The LCP was developed 1997 as an integrated care pathway enabling us to focus on the quality of care delivery, supporting the individual and family needs. Providing on-going assessment, care after death, clear documentation and covers physical, psychological, social and spiritual needs. (LCP Pocket Guide 2011). For this reflection I will be using the Gibb`s (1988) reflective cycle as a guide to focus on my actions, thoughts and involvement but also to help me reflect on the thoughts and actions of all the people; carers, family and the patient that were involved. I feel comfortable using the prompts in the Gibb`s cycle as they are clearly set out and follow a logical path I also feel it is an appropriate tool for this level of study. In line with; the NHS confidentially codes of practice (2003), the Data Protection Act (1998) and the NMC Code (2008) I have protected the patients confidentiality and renamed him John. It was agreed that we would supply support to the private agency care team that were already in place as Johns care needs increased. I have had experience nursing palliative patients from when I worked on an elderly care ward, but there I had the full support of the nursing staff and had not been a lone worker. I had not had experience caring for a patient on the LCP. I personally felt reassured to be doubled with agency carers as I felt they would have prior knowledge of the family and patient and have a relationship that would be valuable for me to learn from but also the familiarity would be reassuring for the family, making it easier to accept us as new carers in their home. Before my first visit with the patient I thought reflectively about my Fathers passing, about how, three years ago, he had died in a hospital assessment unit that was ill equipped to deal with our emotional or my father`s pain control needs, he was not on a palliative pathway and on reflection the nursing and caring staff didn`t have the communication skills or knowledge needed to facilitate a “good death.” My father’s death left me angry and confused and with a sense that I and the nursing staff should have done more. Jasper (2003) discusses that reflection should be taking our experiences as a starting point for learning. Therefore thinking about them in a purposeful way we can come to understand them differently and take action as a result. By doing this I identified that I needed to have knowledge of the LPC and also of palliative care to ensure that I provided the best quality care. The NMC code (2008) says that people in our care must be able to trust us with their health and wellbeing, using a high standard of practice at all times. That I must consult and take advice from colleagues when appropriate and I must deliver care based on the best available evidence or best practice, finally that I must recognise and work within the limits of my own competence. Without knowing John or his family I had decided not to let my personal experience influence my care, but that I would also do all that I could to support and care for John and not avoid what may be delicate and difficult conversations and questions. Deborah Murphy,...
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