Parasol Service produces champions in end of life care

They are among the most difficult conversations facing health professionals, but a growing number of Swansea Bay staff are being trained to give patients coming to the end of their life additional care and comfort when they need it most.

Patients who are in the last months of their life often have questions they want to ask, along with feelings of anxiety, stress and the fear about what happens to those they will leave behind.

To ensure more staff can help ease those worries, the health board’s End Of Life Care team is training staff to become End of Life Champions by recognising when a patient is dying, understanding more about end of life care, and being comfortable about having difficult conversations with patients.

The Champions Days training sessions, held monthly, are open to all staff, to give everyone an opportunity to better support this vulnerable group of patients. More than 200 members of staff have become champions over the past year.

They range from health care support workers to admin staff, and registered nurses to members of the Patient Advice and Liaison Service team.

The sessions explain the terminology of the end of life and what is meant by it. They  also discuss palliative care, recognising dying, the importance of clear communication and ethics, as well as being confident in explaining the roles of the care after death service team, the mortuary and chaplaincy.

The training is delivered across the health board’s sites as part of the End of Life Care team’s Parasol Service, based in Tŷ Olwen in the grounds of Morriston Hospital.

It is the first and only team of its kind in Wales.

End of Life Parasol Clinical Nurse Specialists Glenda Morris and Philippa Bolton deliver the training, while support worker Sarah Romano is also a key part of the team.

PICTURED: The Parasol service teams comprises of End of Life Parasol Clinical Nurse Specialists Philippa Bolton and Glenda Morris along with support worker Sarah Romano.

Glenda said: “Death is still very much a taboo subject for many people, which is understandable, but it’s something we all have to prepare for.

“For anyone who is coming to the end of their life, it is a very sensitive time.

“What we want to do is make sure that anyone working in the health board is confident enough to deal with patients who are at the end of their lives in the right way.

“We take the end of life care delivered in Tŷ Olwen out into the health board. We try to upskill other healthcare professionals in delivering that care.

“It is for anyone who comes into contact with patients - healthcare support workers, junior doctors, registered nurses, consultants and anyone else within the health board.

“We are trying to be quite diverse by training health professionals and also non-clinical staff because end of life care is everyone’s business.

“Being able to recognise when someone is dying is hugely important, and by putting plans in place in a timely manner means the patient and family are prepared for what is to come.

“Our champions now have the confidence and knowledge in this particular area.”

Philippa joined the team in January, and she feels the Champions Days are already having the desired effect.

Philippa said: “We’ve recently been asked to attend a ward where staff have recognised a patient is dying and found the situation very challenging. We were on hand to support them having the conversations with other health professionals, looking at the plan to put in place, making sure they have the right medications prescribed and have support with the symptoms.

“Identifying the patient was coming to the end of their life was a key part from the staff’s behalf. It meant we could step in and advise with certain things.

“We hope the champions will take a bit of what we feel is in their role and apply it in their area.

Developed in July 2021, the Parasol Service is evidence of further investment into end of life care throughout the health board.

Its objectives include:

Person-Centred Approach: being proactive in early identification and acknowledgment of uncertainty of individuals in the last year to six months of their life.

Assessment: holistic assessment from multidisciplinary team which include physical, social, psychological and spiritual needs of the individual.

Recognition: possibly a person may die within days/hours is recognised, communicated and documented clearly.

Approach: multidisciplinary team commence All Wales Care Decisions for the last days of life and use the Symptom Control Guidance and have an individual plan of care which is tailored to the individual.

Sensitive: communication between staff, the person that is dying and those important to the individual.

Observe: assess for symptoms using Symptom Assessment Sheet. Ensure anticipatory medications are prescribed and then consider contacting Specialist Palliative Care team if input and support is required.

Lastly: continue to regularly review, re-assess and discuss with the multidisciplinary team.

Philippa added: “The Parasol team works with any department across the health board that needs its help.

“Communication skills are a big part of our framework. It is a hugely emotional time for patients, so it’s essential they are dealt with in a sensitive and appropriate manner.

“We’ve recently worked with the mental health learning disabilities service, along with paediatric therapists, about advance and future care planning so they can talk to parents of the children.

“We’ve recently held a public awareness event recently focusing on advance and future care planning, which is so important.

“People can be quite cagey at first when they see what we’re discussing, but this is something we should all talk about.

“Don’t wait to look into it when you are ill – do it when you’re healthy and are clear in the decisions you make.”