Change Proposed in NSF - Research Proposal Example

Change Proposed in NSF Palliative care provided for the essential children is the sign of a civilised and socially responsible society. It should reach the children in need. The children along with their families should be addressed according to their needs. Both short term and long term goals were set and reached. Palliative care is also part of Child hospice. In cases of palliative care and palliative care along with child hospice needs timely and careful application. All the agencies offering the services need to work with coordination to attain the goals and to give relief to the victims of depression, physical and mental torture and those who are knocking the doors of death. The nurses, managers and doctors should make their services easily accessible to the victims by working with coordination with various agencies and developing network with them. Change Proposed in NSF The changes that can be proposed are: Government must include hospice and palliative care as part of all governmental health policy, as recommended by the World Health Organization (WHO), make access to hospice and palliative care a human right, make resources available for hospice and palliative care programs and services, establish clear, informed and self-standing policies with action plans for preparation. To make the above things more effective in execution following changes are necessary in NSF for children, young people and maternity services; include hospice and palliative care in their national cancer control programs national ids strategies along with looking after disabled children. Thus the aim of putting children and young people at the centre of care, building services around their needs can be fulfilled up to a large extent Disabled children should get not only care but support to participate in daily life and to compete with others. Disabled children and their families must be encouraged and supported to make them capable of making informed choices of their own assessments, treatment and care, and in the planning and development of services that affect them. The families in need of high level of care should have access to a key worker or a care manager, i.e. some one who argues on their behalf and who have a word in the activities of taking care. Families of disabled children should receive affective care along with their children in time. If a child is 14 years or older the agencies that are taking care of him/her must take care of transferring him/her into young people care and try to minimizing the negative affects of transformation. The services must be culturally sensitive and responsible regarding blacks and ethnic minorities. For this purpose health, care and education services should work together. If not, the child cared without education may turn into a stubborn and irresponsible personality. Disabled children should have access to GPs, dentists and others providing primary cares as soon as possible, say less than 24 hours. This can include booking system that is sensitive to the particular difficulties certain children have with long waiting periods before appointments. If the long waiting makes the child more disabled the care taken will be void. It should also cover the needs of disabled children when the surgery and care centres were modernised. Authorities should ensure that existing laws about disability and special education needs are applied in letter and spirit. The inclusion of disabled children's assessment and action plans must be a part of transport, housing and leisure services also. The hospital booking services must be disabled child friendly. Schools can be termed as extended schools when they take care about health needs of disabled and death time bound children. Action plan 1 To make my commitment more reasonable I suggest the following action plan for senior nurse in child hospice and disabled child care. Action 1 Goal: To make policy makers know about the need of including hospice and palliative care as part of health policy, and to include the children suffering from cancer and AIDS into the NSF network. Steps necessary for achieving goal Time expected to be taken Resource Preparing the records and needs of the children suffering from cancer and AIDS and submitting to higher authorities. 5-6 months Getting access to the records of health department, keeping contacts and taking help of supervisors, managers and director of health Attending and seeking the meetings with higher authorities to understand the need of the goal you want to achieve 1 year Meeting supervisors, managers, and mentors of palliative care team. Creating awareness on necessity of achieving your goal 1-2 years Liaison with voluntary organisations working on the same type of goals and conveying the message to the policy makers and philanthropists. Action Plan 2 Goal: putting suffering children and young people at the centre of care, building services around their needs. Disabled children should get not only care but support to participate in daily life and to compete with others. Steps necessary Time expected Resources needed Liaise with management to produce awareness about your goal 1 year Senior management team, training and education director. Developing communication with multi disciplinary teams cascade information through various levels. On going Line manager, multi disciplinary team and myself. Motivating the team members by making them know about the critical developments in hospice and palliative care. On going Association with the families of children and the agencies offering services. Liaise with management to provide direct link on hospice and palliative care web pages to health department and other departments. On going Fund raising, directors of education, training, health. Negotiating with managements to present an analysis of the need of achieving your goal. 1 year Management team, director of training and education and health. Action Plan 3 Goal: Taking care in transforming children of age 14 and above to young people care. Necessary steps to be taken Time expected Resources supposed to be needed Liaising with Young people care units On going Senior management of children care and young people care. Transferring the required data of the child at the time of transformation and maintaining contacts with them till they adjust to new atmosphere. On going Senior management of children care and Young People care. Retaining the child if he need some more time in child care though he crossed 14 years age. On going Senior management of child care and young people care Maintaining the relationship with the parents of children being transferred and advising them accordingly On going Contacts with parents The part of the essay from now onwards constitutes the rationale of the changes proposed and the action plans presented. If the children and parents did not receive help automatically it develops depression in family members and lack of support and help in case of child. If the child hospice, care and palliative movement was included in health policy it is easy to consult the families and plan about the child care and future. Skilled workers' services can be made available to more extent if the network was extended and necessary inclusions were done. It will be easier to patient advice and liaison services and independent complaints advocacy services to ensure that they are known to the disabled children's families. Interpretation and advocacy can be made in case of all service settings. The rural families of minority groups can be consulted easily and NSF can make them to avail the care and facilities if offers with the extension of network and broader view of the problem. It is now recognized that national associations have a key role in supporting care of the dying around the world. The key issues to be addressed are; the development of a core curriculum, development of standards in education and training, Evaluation methods to assess knowledge, skills and feedback to learners, palliative care as a separate discipline, further palliative care development for clinicians, validity of education/training programs, organise an expert interactive discussion group coordinated through Help the Hospices according to the world level conference organised in Seoul in 2005, where doctors, child hospice, care and palliative movement advocates attended from all over the world. Another problem is fund raising. It can be minimised by Government extending more support. There are varying definitions about palliative care and this poses a problem in raising funds from funds as each donor is particular about his known definition and the movement has to deliver accordingly. With less government support and not including the childcare in health policy another particular concern was the difficulty and resource implications of completing funding applications while delivering services. Here training for both donors and recipients is required which can be made quite easy by including the network in health policies of the governments. It is not reliable to depend more and more on external funding as it may affect the sustenance of the movement. It may raise the concern about sustainability of the care in the minds of parents of problematic children. There is a chance that some services might not have any choice about the situation as there might be a danger that the community ownership of services would be undermined by the expectations of donor organisations. If the donor funding is done directly to at the level of policy making then these type of pressures and dangers can be avoided. Another difficulty regarding fund raising was that it relied on the internal capacity of a community; it might not be the culture of all communities to give to charitable organisations. Marketing was highlighted as an essential aspect of income generation for hospice and palliative care services and it would be easier by including the thing into health policy. The messages used to generate funds were fraught with difficulties, for example photographs of death might be culturally inappropriate and there was a need to think creatively about how to present palliative care provision. Children and adolescents with life-limiting conditions have very specific palliative care needs which are often different to those of adults. The people who take care of the children facing life limiting conditions must have specific knowledge and skills, lest these children's physical, emotional, spiritual and developmental needs are to be met. We ask that the voice of these children and adolescents is heard, respected and acknowledged as part of the expression of palliative care. Objectives that can be outlined were: to establish a steering group to develop the following: to launch the National ( if possible international) Children's palliative Care Network, to pilot and review a programme of expertise-sharing, to ensure that children's palliative care is included in national and international meetings, journals and the work of national associations, to develop a permanent fund to support these activities, to carry out a basic survey of existing children's hospice and palliative care services and from this to identify gaps in provision. The process towards establishing national paediatric standards should begin and these results of this work will help to respond to the needs of children and their families when accessing palliative and end-of-life care services for children across the country. There is a need that the volunteers available to provide care and support services to patients and family should be full members of the palliative care interdisciplinary team. The Education for Formal Caregivers should be mandated to identify educational needs for formal caregivers delivering palliative care. This includes reviewing and influencing curricula for palliative and end-of-life care in undergraduate, post-graduate and continuing professional development. Formal caregivers are members of an organization and therefore accountable to defined norms of conduct and practice. Initiatives are needed to help ensure optimal education and training for formal caregivers in palliative and end-of-life care. Following an overview of palliative care education of undergraduate and post-graduate physician, nursing, social work, pharmacy and chaplaincy training programs, it can be established that core discipline competencies for formal caregivers (under-graduate and post-graduate physicians, nursing, social work, pharmacy and chaplaincy), can be achieved through national consensus via a Professional Competencies Consensus Survey. There is a need to bring palliative and end-of-life care medical education to all undergraduate medical students and clinical postgraduate trainees at medical schools, so that they will graduate with core competencies in this area. This collaborative initiative of professional organizations, which can be led by Government health policy will also help shape the development of parallel programs in nursing, social work, pharmacy, child care, hospice and palliative care. It should be made mandatory to cover issues related to information sources, tools and dissemination relative to the full range of hospice, palliative and end-of-life care for the country's population with attention given to ethical and spiritual considerations, community-based and cultural sensitivities, and language. The network should capitalize on current awareness raising communication activities. It is intended that the plan be used by the stakeholder community and other interested parties to help increase people's understanding of palliative care and where to access information services or programs when needed. It is time to work on to establish benchmarks of peoples' awareness, understanding and use of palliative care and to capture understanding and views on advance care planning. As part of its work to promote dialogue and discussions on dying and planning for end-of-life, the network through the Best Practices and Quality Care should ensure that the accreditation standards under development include advance care planning. The managements of communities should form a Coordinating Committee to address the informational needs of informal caregivers (family, friends and loved ones) in actual or anticipated palliative and end-of-life situations. Informational needs can be identified and defined from both service providers' and informal caregivers' perspectives. The results of this work and other related work will inform future action to ensure those primary caregivers, their patients, and families and loved ones have timely access to appropriate information. To assist informal caregivers with some of their immediate information needs, the communities and network should develop an inventory of information tools for informal caregivers who are currently in, or who are anticipating they may be involved in, palliative care. The inventory must be made available on the NSF's Web site. All the above mentioned were achieved by Canadian government and it is possible even here by including NSF for children, young people and maternity services in health policy of Government. In case of the children of age 14 or above who are to be transferred to young people care, there is a need to recognize signs of stress that lead to self-exhaustion and identify strategies for dealing with stress. The nurses and authorities should demonstrate knowledge of the current principles and practices of palliative care, identify personal values, beliefs, and reactions related to life, death, spirituality, culture, ethnicity, and religion. There is a need to acknowledge how personal values and beliefs impact/influence practice. They have to recognize personal values and beliefs and ensure that they do not interfere with the provision of care. The value of practicing self care must be demonstrated. Appropriate measures are needed to cope with multiple losses and grief reactions. Strategy needed to make balance own self-care needs with the complexities and intensities of dying and death. The ongoing educational activities related to hospice palliative nursing and hospice palliative care must see that every body participate in them. By making appropriate changes in practice the knowledge gained in education and experience must be helpful in child transforming into young. The research activities appropriate to the individual's position education and environment must be taken up regularly. Engagement in discussions and identifying strategies to resolve ethical concerns related to end of life are needed as the young people are more emotional than children. A comprehensive, compassionate and coordinated care should be taken by both child care and young people care agencies while transferring the child from child care to young people care. By recognising that the excellent palliative care the loss of loved one creates intense grief integrates palliative care as a health promotion activity at the person, family and at community level. More support is needed at this junction for the family care givers along with the child. The signs of stress that lead family care giver exhaustion must be recognised and assisted in dealing with the stress. Services need to be offered as near to home as possible and in a number of settings to take account of the different needs of children, young people and their parents and carers. They should include locations such as schools, homes and family centres, which may be perceived as less stigmatising, as well as traditional clinic settings. The care of seriously disturbed children and young people (Tier 4) should be provided by a network of services that include NHS, social care and youth justice provision, voluntary sector and the private sector, offering in- patient/residential, day-patient, in- and out-reach and therapeutic foster care. These services should be closely linked to the local community CAMHS. In many parts of the country and for some groups of children, for example those who are learning disabled, this will require a significant investment in, and development of, new staffing, additional buildings and refurbishment of current facilities. Work is in hand to support the development of the NSF and, in particular, to assess the strength of evidence for the interventions set out for each standard. The EWGs have also been asked to consider the longer term strategy for research in the children's field and set some priorities to improve the evidence base to find out what really works. The evidence base underpinning the standards has to be published. Optimising clinical outcomes for children, young people and expectant mothers is one of the most important aspects of this NSF. The NSF has to highlight opportunities for promoting and implementing all aspects of clinical governance in these areas. This includes promoting clinical effectiveness. The aim of the NSF is not to develop or promulgate clinical guidelines or appraisals itself - these can be commissioned from NICE to complement the NSF. Further relevant guidelines and appraisals are under development (eg an appraisal of drug treatments for epilepsy in children, guidelines for the management of depression in children and for the diagnosis and management of epilepsy, children suffering with cancer and AIDS) or under consideration for referral to NICE (eg appraisals on parent training programmes for behavioural disorders in children, appraisals of drug treatments for asthma and for eczema, cancer and AIDS). The soon to be established Office for Health Care Information within the Commission for Health Improvement should have a remit to develop a programme of national clinical audits. An adequate and competent workforce is fundamental to the successful delivery of The NHS Plan and the NSF. New national workforce planning and development structures have to be set up to meet the challenge of delivering a multi-professional and integrated health and social care workforce to support service improvement. If local funding and training capacity is available, increasing training places for these groups will go some way towards bridging the gap, but in it self is unlikely to be sufficient to meet demand. There fore there is an urgent need to support innovative solutions to develop more staff working in new ways across health, social care and education agencies. These include freeing up the training system, improving recruitment, retention and return of staff, exploring new ways of working and mixing different skills together maximising opportunities from innovative service configuration and increasing productivity. This framework can identify what people need to know and be able to do to deliver high quality, child-centred care to the standards defined in the NSF. Information management and technology The NSF can achieve the proposed changes and goals if high quality information is available to support services, professionals, carers and, most of all children, young people and expectant mothers. The development of a supporting information strategy for the NSF is, therefore, key to its successful delivery. The strategy will cover information: for children, parents and expectant mothers on how to keep healthy; about services and access to services; about individuals' care and to support the 'care pathway'; to support practice; and for monitoring and continual improvement of services. The individual care record should be developed as an integral part of the developing Integrated Care Records Service currently under development. The health professional must be in a position to ensure that the criteria known as the 'Fraser guidelines' are met. Where the young person is not judged competent to consent to his or her own treatment, the consultation should still remain confidential, in line with professional codes. References: The references were given in Harvard which is stated as follows: Name of the author, date or year, title of publication, Publisher, edition if it is periodical, type of publication, date retrieved, website. 1. DH Team, 2004, emerging findings, Department of Health, Electronic, 20-07-06, www.doh.gov.uk/nsf/children/gettingtherightstart 2. CHPCA committee, 2002, Hospice Palliative Care Nursing Standards of Practice, Way mire foundation, electronic, 20-07-06, CHPCA.org. 3. Elizabeth McDermott, 2005, Advocating hospice and palliative care: challenges, contexts and changes, 2nd Global Summit of National Hospice and Palliative Care Associations, electronic, 20-07-06, NHPCA.org. 4. Bernard Hannah and Jim McManus, 2005, Children, Young, People, and families, NHPCA, electronic, 20-07-06, www.eolc-observatory.net/global/pdf/NHPCA_2.pdf 5. Claire Phillips, 2005, education and skills, DH, electronic, 20-07-06, www.dh.gov.uk. 6. CHIC team, 2006, Guide lines, CHIC, electronic, 20-07-06, http: www:// dfes. Gov. uk. 7. CCTG, 2006, The East Sussex Children and Young People's Plan Families, East Sussex Children's Trust Executive Group, electronic, www.everychildmatters.gov.uk 8. Coordinating Committee, 2006, Canadian Strategy on Palliative and End-of-Life Care, coordinating committee, electronic, 20-07-06, http://www.hc-sc.gc.ca/hcs-sss/pubs/care-soins/2005-strateg-palliat/index_e.html. 9. Staff of NPR, 2005, not dying yet, NPR, electronic, 20-07-06, http://www.acils.com/NotDeadYet/ 10. HCFA team, 2006, HCFA manual, HCFA, electronic, 20-07-06, http://www.hospicefoundation.org. Read More