ETHOS Project
Final report
May 2005
Table of Contents
Foreword
3
Executive Summary
4
Introduction
6
Objectives
6
Method
7
Input
7
Observations
8
Recommendations
10
Conclusion
15
Appendices
1. NHS Lanarkshire - “Picture of Health” Consultation
17
2. Steering committee
18
3. Project flow chart
19
4. Competencies
20
5. Framework of reflection
21
6. Patient and carer form
22
7. Student feedback
24
2
Foreword
Mrs. Marianne Rowan, Lanarkshire Stroke MCN, Patient & Carer Group
“I first heard of the ‘ETHOS’ Project when I attended a Spiritual Care Stakeholders meeting
about 2 years after I suffered a stroke. When the presenter Bob Devenny spoke of the ‘sacred
losses’ that can accompany a stroke, his words spoke directly to me. For I had been in the
middle of a masters degree in Community Education when it happened. I had a sudden
flashback to the traumatic time when, bewildered and frightened, I wondered if this new place
I had come to inhabit – a stroke patient in a busy general hospital ward – could ever be made
comprehensible never mind bearable. My grief for the life that I knew and what it might
become was profound.
My medical and physical needs were being attended to in an extremely professional – even
clinical way. But the part of me that encompassed my deepest fears, strung out emotions,
frustrations and desires, not to mention mere likes and dislikes, were not being addressed in
any meaningful fashion. I was becoming just another case, I felt, who would journey through
the system leaving not a trace of the individual person that was’ ME’. The danger inherent in
this approach, I feel, was that the part of me which was essential to my recovery – my spirit –
could be blunted in a depersonalisation process. This allowed me a minimal role in the sort of
change and adaptation needed to take control and restore a feeling of well being and quality of
life.
However, I was lucky in that my stroke happened at a time of recognition of a need to change
the approach to the recovery process for stroke patients within the health care profession. I
was transferred to a dedicated stroke unit at Coathill Hospital where the team of professionals
adopted a more holistic approach to their delivery of care. My family was involved in the
rehabilitation process through family meetings with staff, which allowed them to discuss their
concerns and distress and were a great reassurance for all of us.
The therapeutic value of the environment also helped in my recovery. From the feeling of
isolation in the clinical atmosphere of a ward that was 4 floors up with no view of the outside
world, to the informal ambience of the bungalow type ward that opened out on to a garden,
that the stroke unit provided, was the difference between two worlds. I got dressed; I sat
outside on my own or with my family and became part of the real world again. I had space to
think, to heal, to regain my spirit. I was still ‘ME’, with another set of priorities, but I was still
same old ‘ME’”.
Marianne Rowan
3
1.
Executive Summary
1.1
This report covers work completed and recommendations made from a short-term
project carried out within the Lanarkshire Managed Clinical Network for Stroke in
2004/2005. The goal of the project was to incorporate into service development, some
of the findings from research carried out on behalf of the Scottish Executive, which
examined spiritual issues associated with the sudden onset of stroke from the patient
and carer perspective. These spiritual issues were in connection with finding meaning
and purpose in life, in the face of sudden illness and were not necessarily held within a
religious framework. Bob Devenny, who carried out the original research, acted as
project manager for the project on a half time basis over a six-month period.
1.2
The project was based at Hairmyres, with some outreach and general training
in other locations. The approach to the project was:
ƒ
To develop and deliver specialised training programmes to meet identified
competencies, which would aid in the delivery of the goals of the project.
ƒ To pilot an in depth training module over an eight week period, with
participants coming from different disciplines and from primary and
secondary care and from the voluntary sector.
ƒ To listen to staff, patients and carers and with their input, suggest ways of
creating a service environment which would enhance the rehabilitation
process and minimise the spiritual distress of those dealing with the
sudden onset of stroke.
1.3
The ETHoS approach was well received by staff. The in-depth pilot course was very
well received and created a strong sense of teamwork across traditional organisational
boundaries as well as teaching new skills and approaches to patient care, including
supporting patient self-management.
1.4
The report recommends:
ƒ That the training programme be rolled out to the stroke service across Lanarkshire
and consideration should be given to its application across other long term
conditions. Training should be given at a general level to all staff and in-depth
training should be given to key staff across the service.
ƒ The role of discharge liaison and early support should be reviewed.
ƒ Adoption across the MCN of a Patient and Carer Form, designed with the
help of the Patient and Carers Group of the Managed Clinical Network, to
help to personalise care, identify support networks and involve patients
and carers in the care plan.
ƒ That the Multi-disciplinary Education, Research & Development Group of the
Managed Clinical Network investigate the development and use of self
help resources so that patients could work on certain aspects of
rehabilitation on their own initiative, while in hospital and at home.
ƒ Changes to the physical environment of the stroke unit at Hairmyres, to
create some less clinical spaces to aid patients and carers in coming to
terms with the impact of the stroke and to facilitate and encourage selfmanagement.
4
1.5
The project has raised awareness of the opportunities and advantages of developing a
positive patient centred ethos within healthcare and has developed and delivered
specialised training to support the ethos, enhance the rehabilitation process and improve
patient and staff satisfaction. The implementation of the recommendations in this report
will deliver significant improvements in the quality of stroke care within Lanarkshire.
While this project focused on the acute phase of stroke care, it is felt that this
programme will have a positive impact on the long-term holistic outcomes and selfmanagement of patients and carers. Training for community staff would be beneficial
in maintaining this approach. It is important that medical staff be involved in the
training and implementation of ETHoS because of the strong influence which they have
on the overall environment of care.
1.6
Finally, while this project was undertaken within the MCN for Stroke it is suggested
that a similar approach in other health areas would be beneficial. The next logical step
would be to implement the ETHoS approach within the MCN for CHD. The in-depth
training for the cardiac rehab team and liaison nurses would improve their active
listening skills, which in turn, as with stroke, would be beneficial in supporting selfmanagement for patients and carers and reducing stress. Research to determine the
impact of this approach on anxiety reduction, self-management and secondary
prevention would provide hard evidence of its effectiveness.
5
2.
Introduction
2.1
The general approach of the project comes from the findings of research into the
spiritual issues associated with stroke. The definition of spirituality used in the
research was the search for meaning and purpose in life through experience, in
relation to self, others, the natural world and the transcendent. This definition
identifies an intrinsic component of our humanity, which may or may not be framed
within a religious context. The research identified a process of spiritual recovery after
stroke, which involved transformational coping through the evolution of personal
meaning in the face of sudden onset disability. This process was an important element
for patients and carers in regaining their sense of well being in the context of dealing
with the impact of stroke. The research also identified several themes such as the
importance of the physical environment, what was labelled ‘sacred losses’, the
importance of vocation and maintaining personhood and the impact on family
systems.
2.2
The research used a qualitative methodology, which gave rise to a view of the stroke
service from the patient and care perspective. A presentation of the research findings
raised significant interest from staff as well as those who had experienced stroke
personally. It was decided to initiate a project in Lanarkshire, which would
incorporate some of the research findings into service development through the
Managed Clinical Network (MCN) for stroke.
2.3
The findings from NHS Lanarkshire’s “Picture of Health” consultation with staff and
the wider public (appendix 1), identified key areas for development which would be
facilitated and strengthened by the adoption of the main principles within the ETHoS
Programme.
3.
Objectives
3.1
The main objective of the project was to look at ways of service development, which
would enhance stroke patients’ and carers ability to undertake the kind of
transformational coping identified in the research and to minimise the stress created by
the impact of the stroke. The project was given the name ETHOS as the hope was to
create an ethos within the stroke service, which would recognise and respond to the
spiritual needs of patients and carers. Ethos stood for developing an Environment of
care, which would facilitate Transformational coping, through the Holistic approach
Of Service development and delivery. The environment of care was thought to be
both physical and relational. This environment should help patients maintain and
regain their sense of personhood, which can be affronted by the occurrence of stroke
and should also help patients and carers to regain a sense of balance within their
family systems. Physically this would mean minimising the effects of the
institutional, clinical environment, which has a tendency to take a person’s sense of
identity away. Relationally it would be important to create an environment of
mutuality, which would respect the individual needs and gifts of all, including
patients, carers and staff. It was felt that a cultural change within the healthcare
system would be needed to include more emphasis on creating this environment of
mutuality, health promotion, patient education and self-management along with the
traditional emphasis on repairing deficits. This increased emphasis on health
promotion would entail creating a healthy environment for staff so that patients and
carers would be brought into a healthy community to be cared for. This approach
6
meant that the project would engage with all levels of staff from domestics to
consultants as well as management.
3.2
Along with this general approach to the environment of care, an objective was to
develop more in depth training for some staff to improve their skills in active listening
and the facilitation of transformational coping.
4.
Methods
4.1
A steering committee was set up to oversee the project (see appendix 2). The steering
committee met regularly as per the flow chart in appendix 3. The steering committee
not only oversaw the progress of the project but also contributed to its direction and
development through their individual expertise and experience. Steering committee
meetings began with a short time of quiet reflection and meditation and so the
approach of the project was integrated into its management.
4.2
Although the hope was that the project would have influence across Lanarkshire, it
was decided to concentrate efforts at Hairmyres in the first instance. The project
manager was employed on a half time basis over a six-month period and joined the
team at Hairmyres stroke unit. The approach to the project came from a spiritual care
model, which emphasises active listening and being with people in order to support
and facilitate change. The project manager began by meeting with small groups of
staff on the stroke unit to inform them about the project and to get their feedback.
5.
Inputs
5.1
Involvement on the ward
The project manager participated in the weekly multi-disciplinary meetings, which
helped staff to get to know him and provided the opportunity to raise issues and offer
input from an ETHOS perspective. Staff began to refer patients to the project
manager for support, which provided the opportunity to work with different members
of staff on specific cases and for staff to gain a sense of the practical application of
integrated spiritual care. The project manager was restricted in how much patient
support could be undertaken because of being available on a part time basis and other
priorities within the project.
5.2
Training
Spiritual care competencies were identified and these were integrated into the overall
core competencies for stroke in Lanarkshire (see appendix 4). A training programme
was then developed to meet some of these competencies.
5.2.1
Training took place on two levels:
¾ The project manager held some general training sessions at the three stroke
unit locations, which provided the opportunity to spread the project out
beyond Hairmyres. These were well received and requests for more and
individual training were received.
¾ An in depth pilot course was run at Hairmyers with three nurses from the
stroke unit, a CHSS liaison nurse and a community based physiotherapist and
physiotherapy assistant from the early supported discharge team participating.
This course ran for one morning per week over eight weeks.
7
5.2.2
The in depth pilot course took a reflective practice approach with a framework for
reflection being developed for the course (see appendix 5). Each student presented
three reflections to the group over the length of the course. Along with the reflective
practice, didactic sessions were given and two guest speakers were invited to present.
These were Teresa MacIntosh, from the Department of Nursing at Bell College, who
presented her MSc research on the psychological issues faced by young stoke
survivors and Hina Sheikh, diversity and equality coordinator for NHS Lanarkshire,
who talked to the group about diversity and minority ethnic considerations. On
another occasion, a young stroke patient from the ward joined the group to give them
her personal feelings at that time. In a later session, when it was reported that this
patient was going through a rough time, one of the students offered to lead the group
in a prayer for the patient, which the group felt was appropriate and felt comfortable
with.
5.3
Management
The project manager, the stroke unit sister, the manager of the stroke MCN, the
clinical director and the service manager met to discuss ideas from the project about
making alterations to the physical environment of the ward. The ideas from this
meeting were tabled at the next meeting of the Hospital Management Committee
meeting. The project manager was invited to address a meeting of the Local Area
Group (discharge planning). He was asked to open the meeting with a short time of
meditation and then invited to present the background and approach of the ETHOS
project. This committee really engaged with ideas of the project and offered some
worthwhile feedback.
5.4
Patient/carer form
Through the steering committee the idea of developing a patient and carer form arose
and was pursued with the help of the patient and carer group of the MCN. The idea of
the form is to facilitate self management and personalised care. This form is being
piloted at Wishaw and Hairmyres (see appendix 6).
6.
Observations
6.1
Physical environment
Hairmyres is a fairly new hospital built in 2001 under the private funding initiative.
The stroke unit is a 24 bed unit with a 6 bed mixed sex acute receiving room, three
four bed rooms which are managed as single sex rooms and 6 single side rooms. The
unit is efficient for bed management but there is a lack of facilities for staff and for
patients and carers, separate from the clinical environment. There is a day room
which also serves the adjoining ward and there is a room at the opposite end of the
ward which was designed as a bathing room but which is currently being used for
storage. The day room is being used part of the time for occupational therapy sessions
and is also used for staff meetings including the weekly multi-disciplinary meeting.
There is a room for physiotherapy on the ward but patients are often brought down
two levels, to the rehab unit for various types of assessment and therapy.
Occupational Therapy offer relaxation therapy and hand massage in a small room in
the rehab centre. This service is appreciated by patients, but the room is quite confined
and a long distance from the ward.
8
6.2
Relational environment
The stroke unit at Hairmyres benefits from a very competent and dedicated team.
They welcomed the project manager into their midst and showed a genuine interest in
the project. As they got to know the project manager they began to refer patients to
him for added support. The referrals came from the different disciplines including
consultants. The pressures of healthcare in Scotland today were palpable on the ward
with bed occupancy and delayed discharge, causing stress for the multi-disciplinary
team as they sought to fulfil their remit to the best of their abilities.
6.3
Training
The presentations, which the project manager has given in various locations across
Lanarkshire, have been very well received. Articulating the deeper emotions of stroke
patients and their carers and placing this within a health care framework seems to
touch a chord with stroke survivors and staff. The general reaction from staff has been
an expressed desire to learn how to integrate spiritual care into their practice. Because
of shift work, rotation of staff and the time limits of the project, a significant number
of staff have not received this training.
6.3.1
The participants in the in depth pilot course, engaged in the course fully and found it
to be very worthwhile (see appendix 7 for comments). There was a noticeable shift in
how participants related to those in their care as was demonstrated through the
reflective practice presentations. A significant change was that participants learned to
stop trying to fix or brush over the deep feelings of patients and carers and learned the
art of active listening and just being with people and offering them genuine
compassion. The compassion was already present in the students, it was a case of
allowing it to be offered in a way that was helpful to those in their care and learning to
listen to their own deeper feelings for their own care. This new way of relating to
patients lead to enabling patients and carers to better self-manage their situation and to
set more personalised and meaningful goals in their rehabilitation programme.
Another important aspect of this pilot course was that it created a very strong sense of
teamwork, which cut across professional and primary/secondary care boundaries.
Because of the timeframe of the project the pilot course ran for 8 weeks only. It was
felt by participants that they could have used more time and it is recommended that
any future courses be 12 weeks in duration. Participants were keen to get more of this
kind of training and it would be possible to develop more advanced training in the
future. One idea would be to include chaplains in this multi-disciplinary training.
9
7. Recommendations
1. Training: Incorporate the general ETHOS training into overall training and induction
programmes for stroke.
Offer in-depth training courses to selected staff in all locations.
Recommendation
Rationale
Actions
Outcomes
1.1 Rollout general
training programmes
developed under the
project to other
locations and
integrate this training
into professional
development through
the core competency
framework.
This training will
raise awareness of
spiritual issues
associated with
stroke and help staff
at all levels to
integrate a sense of
mutuality into their
caring relationships.
Training for stroke
awareness
coordinator
Increased awareness
of the spiritual
dimension of health
Improved patient
satisfaction
Improved ethos of
the service.
1.2 In-depth training
should be delivered
to a cross section of
staff within the stroke
service and
developed for other
services such as CHD
The pilot course was
very well received by
the participants (see
appendix 7) and
proved successful in
not only developing
active listening skills
but also proved to be
an excellent vehicle
for building good
team relationships
across professional
and primary
/secondary care
boundaries. The
skills learned in this
course demonstrated
the ability of staff to
improve their ability
to provide selfmanagement support
to patients and carers.
The course also
provided participants
with the opportunity
to examine and build
on their own spiritual
strengths and so is a
useful tool for selfdevelopment.
Allocate resources
for in-depth training
programme
New competencies in
spiritual and holistic
care
Set up 12 week
modules and release
the appropriate staff
Improved job
satisfaction for staff
Improved patient
self-management
support
Improved patient
satisfaction
Deeper
understanding and
appreciation of the
roles of other staff
members
Improved working
relationships
10
2. Discharge Liaison & Support: Review the discharge liaison and support process in light
of the other recommendations including the in-dept
training.
Rationale
Actions
Outcomes
Recommendations of Chair of the Local
this project will help Area Group
in the preparation and
ETHoS team.
support of patients
and carers as they are
discharged out of the
hospital environment,
back into the
community.
Discharge liaison and
early support in the
community are
crucial to this
transition. The
CHSS liaison nurse
and two members of
the early supported
discharge team took
part in the in-depth
training course and
found that this
benefited their
practice. It is felt
that a review of how
the training and other
recommendations
could impact on
discharge planning
and early support
would be beneficial.
It was not possible
within the scope of
this project to
properly investigate
the opportunities.
Intentional
integration of ETHoS
into discharge
planning and early
support
11
3. Patient & Carer Form: Implement the use of a patient & carer form across Lanarkshire
through a randomised control trial.
Rationale
Actions
Outcomes
This form will
facilitate a more
personalised care
plan and help identify
support networks. It
will help the
healthcare system to
take the more holistic
approach to patient
care that it is striving
for and help to create
an environment of
mutuality between
staff and those in
their care. It will
allow patients and
carers to take a more
active role in care
and discharge
planning.
Introduce in three
locations, through
nursing, as a RCT
research project.
Improved patient
satisfaction.
Personalised care
planning.
Improved
staff/patient/carer
relationships.
4. Personalised Self-Management Resources:
Develop personalised self-management resources, through the multi-disciplinary protocol
group of the MCN, to be used by patients on the ward and to be taken home.
Rationale
Actions
Outcomes
Patients are often
keen to work on their
rehabilitation as
much as possible and
can feel restricted by
the lack of healthcare
resources. Computer
based programmes
such as those which
help to regain
communication
skills, would allow
patients to work on
their rehab on their
own initiative and
during times when
staff are unavailable.
Multi-disciplinary
protocol group
Introduced in three
locations by AHPs as
a RCT research
project
Encouraged and
supported selfmanagement
Improved
rehabilitation
progress
Improved patient
satisfaction
12
5. Physical Environment: Make Improvements to the physical environment, which will
enhance recovery.
5.1 Change the bathroom into home-style kitchen area.
5.2 Create computer-based resource centre in day room.
5.3 Create relaxation area in day room.
Rationale
Actions
Outcomes
5.1 Change the
bathroom, which
is being used for
storage into a
home-style
kitchen area.
5.2 Create
computer-based
resource centre in
day room.
This space will help
to offset the clinical,
institutional
environment of the
ward. It will provide
an area where
patients and carers
can be together in
privacy, to support
each other and begin
to work on how they
will deal with the
affects of the stroke.
It could also be used
for O.T. assessment
and training by
dietetics.
Approval of hospital
management team.
More control for
patients and carers.
Patients spend
considerable time
waiting in between
appointments with
rehab staff and it
could be possible to
develop resources so
that they could work
on some aspects of
their rehabilitation on
their own initiative.
An example of such a
resource is computerbased programmes
for relearning
communication
skills. Access to the
internet would also
allow patients to
access information
on stroke and would
allow them to
perform tasks such as
internet banking.
Approval of hospital
management
committee
Encouragement and
support of selfmanagement
IT department input
Improved
rehabilitation
Fundraising by stroke Facilitate family
unit staff.
systems adjustments
to new situation post
stroke.
Easier transition from
hospital to home.
13
5.3 Create
relaxation area in day
room.
Occupational
Therapy offer
relaxation therapy,
which is appreciated
by patients and helps
them to deal with the
emotional upheaval
associated with
stroke. At present
this is offered in a
small room down in
the rehabilitation
centre, which is not
as conducive for this
type of therapy as it
could be. With some
minor adjustments
the day room could
accommodate this
type of therapy, with
the added benefit of
being on the ward
and would allow
patients to access this
kind of resource on
their own initiative
Approval of hospital
management
Occupational
Therapy Department
Reduction in
emotional stress of
patients
Improved patient
satisfaction
14
8. Conclusions
8.1
The qualitative, person centred research into spiritual issues associated with stroke,
articulated the deep human reaction to the sudden onset of stroke and the struggle to
regain personhood and a feeling of well-being in the face of disabilities. The ETHOS
project sought to facilitate change in the stroke service, to better support families
dealing with the impact of stroke from a spiritual care perspective. Spiritual care has a
strong health promotion component to it and this project followed the principles set
out in the Ottawa Charter for Health Promotion 1 , which defines health promotion as
“the process of enabling people to increase control over, and to improve, their health”.
Spiritual care supports people who are undergoing spiritual distress by offering
companionship, mutuality and compassion. In order to be most effective in offering
this kind of support it is important that the environment which staff work in is
conducive to their own spiritual well being, so that those who have to use the service
come into a healthy caring environment. Spiritual care then links together the working
conditions of staff and promoting their own health with the effective clinical care of
patients.
8.2
The work completed in the ETHOS project and the recommendations made in this
report will facilitate the cultural changes required to create a healthier environment for
patients, carers and staff. There is a danger with this kind of project that once it has
finished, any gains made will be lost through the inertia of the large health care
system. It is felt that the training will have longevity, especially with those who
participated in the in depth course. If the recommendations for the changes to the
physical environment are carried out and if the patient and carer form becomes
embedded into practice then these changes will not only have an immediate positive
return but will also facilitate the deeper cultural shift, which the project seeks. The
long term results will lead to a more cost effective, person centred service with
improved outcomes and satisfaction. It is hoped that a further small project using case
studies to bring staff together from different professional perspectives and at different
points on the patient journey, will help to round off the project.
8.3
The final recommendation of this report is that this successful project should be
built on, and expanded, within the stroke service through implementing the
recommendations specific to Hairmyres, incorporating the ETHoS approach in
the other locations and by setting up a training programme throughout the
service. It is recommended that as specific changes are made that a research
approach should be taken to the implementation, to assess impact and provide
hard evidence to support the changes. It is the vision of this project, that through
the writing up of the research, that the advances made in stroke rehabilitation in
Lanarkshire will be recognised and adopted by the wider stroke care community.
The National Framework Long Term Conditions Action group has highlighted
the need for improved interdisciplinary training for collaborative patient centred
care to support self management. The ETHoS approach is transferable to other
long term conditions and could prove an important tool for Community Health
Partnerships delivering chronic illness care.
1
World Health Organization. Ottawa Charter for Health Promotion
(http://www.who.int/hpr/NHP/docs/ottawa_charter_hp.pdf). Ottawa, WHO, 1986
15
APPENDICES
16
Appendix 1.
NHS Lanarkshire, Picture of Health and Public Values Consultation – Issues in Keeping with ETHoS Project Principles.
ISSUE
DETAIL
Better cooperation between agencies and more coordinated care.
There is existing good partnership working and effective partnerships.
Need to develop courses and programmes to support new roles.
Appropriate levels of well-qualified staff providing care and treatment in a
caring way (mutual respect). Access to the right person with the
qualifications to provide quicker treatments.
ƒ Streamline services and link together to provide continuity of care including
after care.
Improved Services
ƒ
ƒ
ƒ
ƒ
Improved provision of information
ƒ
ƒ
Improved communications with patients and carers (clear, consistent, user
friendly, at the right time and two way)
Good communications between professionals and departments
Delayed Discharge
ƒ
ƒ
Improved communication with social work department
Start planning discharges from early in admissions
Value staff
ƒ
Address specialist shortages through improved terms and conditions and
environment. Extend roles and development of centres of excellence.
17
Appendix 2.
`
Steering Committee Members
David Hume
General Manager of Hairmyres with responsibility for MCN
Anne Hendry
Lead clinician for stroke
Moira Forsyth
Manager of Managed Clinical Network for Stroke
Maureen Carroll
Manager of Managed Clinical Network for CHD
Bob Devenny
ETHOS Project manager
18
Appendix 3.
Project Flow Chart
STEERING COMMITTEE
HAIRMYRES
LANARKSHIRE
Initial meeting
Assessment and
introduction
Progress report
Planning
meeting
Meeting with
main players
Core
competencies
Training
development
Person
centred
care
Role out to unit
Documentation
Progress report
Planning
meeting
Adjustments
Evaluation
Progress report
Final meeting
Final report
19
Appendix 4.
Spiritual Care Competencies
Spiritual Care Core Competencies for Stroke
Novice
2
3
4
Awareness of
Sensitivity to
Pt. vulnerability
Carer anxiety
Mutuality
Self awareness
Multifaith
multicultural
awareness
Spiritual assessment Integration of
personal spirituality
into care approach
spiritual issues
5
knowledge of
Psychology
6
Delivery of symbolic
experiential interventions
to individuals, families, groups
(as in religious practices)
In depth spiritual assessment
And specialist spiritual care
20
Appendix 5.
Framework for Reflective Practice
FRAMEWORK FOR REFLECTION
Setting
This section identifies where and when the interaction took place and who was
present.
Background
This section is used to provide information about pt/carer situation, the relationship
between self and participants to date and what was going on in your own life.
Transcript
This is a word for word transcription of the encounter as best as can be remembered.
It is presented in the form of a play with the characters identified as they speak and
also includes a note of things such as body language or external interruptions.
Analysis of Transcript
This section is used to go through the transcript line by line and analyse what was
going on in the participants and in yourself. You look at what the participants said
and how you responded. You suggest why you responded as you did and if there
might have been a more helpful way to respond.
Spiritual Insights
This section provides the opportunity to examine and articulate some of the spiritual
issues that might have been present for both the participants and yourself. It is used to
identify themes that might come up again in other situations. It may be helpful to
draw on other sources of literature to help to explain the themes. This will be helpful
in identifying these kinds of themes when they arise in the future.
Plan
This section is used to formulate a plan for how you might help the pt/carer in the
future and how you might address any concerns that surfaced within yourself.
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Appendix 6.
CONFIDENTIAL
PERSONAL INFORMATION FORM
We would be grateful if you could complete this questionnaire.
This form can be filled out by yourself or a relative/friend.
The information will provide relevant personal and family details that will be useful in their care.
FULL NAME_____________________ PREFERRED NAME_______________
ADDRESS______________________
DATE OF BIRTH__________________
_______________________________ MARITAL STATUS_________________
PLEASE LIST BELOW CLOSE FAMILY AND FRIENDS
(wife/husband/partner/children/grandchildren/friends/neighbours)
NAME
AGE
RELATIONSHIP
WHERE THEY LIVE…
PLEASE GIVE DETAILS OF YOUR WORKING EXPERIENCES AND ANY
INVOLVEMENT YOU HAVE IN THE COMMUNITY
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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HAVE YOU OR YOUR FAMILY FACED OTHER TIMES OF ILLNESS
_______________________________________________________________________________
_______________________________________________________________________________
PERSONAL DETAILS/INTERESTS
NEWSPAPERS
SPORTS (including teams)
READING
HOBBIES
TELEVISION
HOLIDAYS
MUSIC
PETS
ADDITIONAL INFORMATION
PLEASE GIVE DETAILS OF ANY FURTHER INFORMATION YOU FEEL WOULD BE OF
BENEFIT OR IMPORTANCE
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
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Appendix 7
Comments from ETHoS Training Participants
¾ Learning not to “fix it” (all participants)
¾ Enjoyable experience.
¾ Brilliant learning of each other’s role in health care.
¾ Emotional at times.
¾ Not “spiritual care” as we first thought.
¾ Improved my communication skills in my professional and private life.
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