PALLIATIVE CARE
Palliative care in the community and the friends and family test Brian Nyatanga
Senior Lecturer in Allied Professional Studies and Lead for The Centre for Palliative Care, University of Worcester
© 2014 MA Healthcare Ltd
T
he NHS friends and family test (FFT) introduced in 2013 by the Prime Minister, David Cameron, seemed a desperate response to poor care in the NHS. However, guidance on how to implement the test is currently being revised and expanded to commence in GP practices in December 2014 and mental health and community services from April 2015 (NHS England, 2014). The FFT was sold as a simple, single question of whether people would recommend the services they had received to their friends and family. More work and expansion has now been carried out to ensure that this test is applied to all settings. Following an in-depth review of existing practice, NHS England has published new implementation guidance, aimed at supporting the expansion of FFT across the NHS (see http://tinyurl.com/ofc83yb for more details). While this is happening, nurses delivering palliative care in the community can ask themselves how likely their service is to be recommended to friends and family. Expanding FFT into palliative care in the community could be an opportunity to understand in more depth how the service is received and perceived as a basis for making improvements. The FFT involves questioning someone who has used or experienced the service to ascertain whether they are satisfied enough to encourage their own family and friends to access the service. However, because the nature of palliative care means that the exit point from care is dignified death, the FFT may be more useful if conducted while the patient is receiving the care. Indeed, timing can be crucial as the patient condition may fluctuate towards the end of life. Furthermore, in conjunction with patient validation of care received, it would be desirable for health professionals themselves to give feedback on the service they offer, and whether they would recommend their family and friends. This would serve as introspective analysis that could be compared with feedback obtained from patients. However, proponents of objectivity may argue that only the patients’ feedback is valid.What is important, though, is the context of such feedback, as events immediately before the feedback is given (e.g. an inability to control vomiting or a stabilisation of pain) are crucial in influencing the validation. When this is considered, patient feedback would be an objective way of validating the service (third-party validation) as our own judgements might be biased, subjective and inwardlooking. However, for any assessment to be valid it should not restrict answers to ‘yes’ and ‘no’, but should explore in more depth what was good and bad about the services used. Such information would benefit poor services as they set out to improve.
Email: [email protected]
Palliative care in the community The practice of palliative care is centred on the human, regardless of where the patient is being cared for. The community uses or employs the same ethos, which can be summarised by the 6Cs of care. The 6Cs (compassion, care, competence, communication, courage and commitment) provide a platform on which to build ‘good’ palliative care. It is important to reiterate that, in palliative care and community nursing in general, communication should be the blanket that covers all the other Cs—or the glue necessary to make the other Cs possible. With poor communication, even the best intended care might be received negatively. For example, compassion, courage and commitment are all communicated to patients and those important to them (either verbally or non-verbally), who then make interpretations of the care based on how staff communicated with them. It is also crucial to vary how we communicate in order to meet the needs and concerns of the different patients we care for. This may help us help the patient to feel respected, achieve dignity in their dying and be treated empathically. To do all this properly means engaging with the fundamental principles of communication (Fisher, 2014), that is, active listening and doing something about what patients tell us.This helps to build a positive relationship (rapport) with patients and those important to them. When this happens, patients are more likely to feel cared for. The FFT then becomes easy to pass. Close scrutiny of care delivered in the community suggests that it will not only be the patient who feels satisfied or disapproving of the care but the whole family unit, including friends. Given this scenario, when palliative care is delivered properly according to its guiding principles (World Health Organization, 2012), family and friends are also satisfied. Therefore, there may sometimes not be a need for the FFT in palliative care, since the family are often present, experiencing the care for themselves together with the patient. Instead of asking whether palliative care in the community can be recommended to family and friends, we may need to ask whether the FFT has a place in palliative care in the community. Readers no doubt have their own thoughts about this. Please share them through this journal. BJCN Fisher J (2014) Communication in palliative and end of life care. In: Nicol J, Nyatanga B, eds, Palliative and End-of-life Care in Nursing. Sage, London NHS England (2014) High Quality Care for All, Now and for Future Generations: Transforming Urgent and Emergency Care Services in England. http://tinyurl.com/ k6qetfs (accessed 5 August 2014) World Health Organization (2012) WHO definitions of palliative care. http:// tinyurl.com/5228js (accessed 28 July 2014)
British Journal of Community Nursing September 2014 Vol 19, No 9
463
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 130.237.122.245 on November 15, 2015. For personal use only. No other uses without permission. . All rights re
Palliative care in the community and the friends and family test Brian Nyatanga
Senior Lecturer in Allied Professional Studies and Lead for The Centre for Palliative Care, University of Worcester
© 2014 MA Healthcare Ltd
T
he NHS friends and family test (FFT) introduced in 2013 by the Prime Minister, David Cameron, seemed a desperate response to poor care in the NHS. However, guidance on how to implement the test is currently being revised and expanded to commence in GP practices in December 2014 and mental health and community services from April 2015 (NHS England, 2014). The FFT was sold as a simple, single question of whether people would recommend the services they had received to their friends and family. More work and expansion has now been carried out to ensure that this test is applied to all settings. Following an in-depth review of existing practice, NHS England has published new implementation guidance, aimed at supporting the expansion of FFT across the NHS (see http://tinyurl.com/ofc83yb for more details). While this is happening, nurses delivering palliative care in the community can ask themselves how likely their service is to be recommended to friends and family. Expanding FFT into palliative care in the community could be an opportunity to understand in more depth how the service is received and perceived as a basis for making improvements. The FFT involves questioning someone who has used or experienced the service to ascertain whether they are satisfied enough to encourage their own family and friends to access the service. However, because the nature of palliative care means that the exit point from care is dignified death, the FFT may be more useful if conducted while the patient is receiving the care. Indeed, timing can be crucial as the patient condition may fluctuate towards the end of life. Furthermore, in conjunction with patient validation of care received, it would be desirable for health professionals themselves to give feedback on the service they offer, and whether they would recommend their family and friends. This would serve as introspective analysis that could be compared with feedback obtained from patients. However, proponents of objectivity may argue that only the patients’ feedback is valid.What is important, though, is the context of such feedback, as events immediately before the feedback is given (e.g. an inability to control vomiting or a stabilisation of pain) are crucial in influencing the validation. When this is considered, patient feedback would be an objective way of validating the service (third-party validation) as our own judgements might be biased, subjective and inwardlooking. However, for any assessment to be valid it should not restrict answers to ‘yes’ and ‘no’, but should explore in more depth what was good and bad about the services used. Such information would benefit poor services as they set out to improve.
Email: [email protected]
Palliative care in the community The practice of palliative care is centred on the human, regardless of where the patient is being cared for. The community uses or employs the same ethos, which can be summarised by the 6Cs of care. The 6Cs (compassion, care, competence, communication, courage and commitment) provide a platform on which to build ‘good’ palliative care. It is important to reiterate that, in palliative care and community nursing in general, communication should be the blanket that covers all the other Cs—or the glue necessary to make the other Cs possible. With poor communication, even the best intended care might be received negatively. For example, compassion, courage and commitment are all communicated to patients and those important to them (either verbally or non-verbally), who then make interpretations of the care based on how staff communicated with them. It is also crucial to vary how we communicate in order to meet the needs and concerns of the different patients we care for. This may help us help the patient to feel respected, achieve dignity in their dying and be treated empathically. To do all this properly means engaging with the fundamental principles of communication (Fisher, 2014), that is, active listening and doing something about what patients tell us.This helps to build a positive relationship (rapport) with patients and those important to them. When this happens, patients are more likely to feel cared for. The FFT then becomes easy to pass. Close scrutiny of care delivered in the community suggests that it will not only be the patient who feels satisfied or disapproving of the care but the whole family unit, including friends. Given this scenario, when palliative care is delivered properly according to its guiding principles (World Health Organization, 2012), family and friends are also satisfied. Therefore, there may sometimes not be a need for the FFT in palliative care, since the family are often present, experiencing the care for themselves together with the patient. Instead of asking whether palliative care in the community can be recommended to family and friends, we may need to ask whether the FFT has a place in palliative care in the community. Readers no doubt have their own thoughts about this. Please share them through this journal. BJCN Fisher J (2014) Communication in palliative and end of life care. In: Nicol J, Nyatanga B, eds, Palliative and End-of-life Care in Nursing. Sage, London NHS England (2014) High Quality Care for All, Now and for Future Generations: Transforming Urgent and Emergency Care Services in England. http://tinyurl.com/ k6qetfs (accessed 5 August 2014) World Health Organization (2012) WHO definitions of palliative care. http:// tinyurl.com/5228js (accessed 28 July 2014)
British Journal of Community Nursing September 2014 Vol 19, No 9
463
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 130.237.122.245 on November 15, 2015. For personal use only. No other uses without permission. . All rights re
