Unified Do Not Attempt Cardiopulmonary Resuscitation (uDNACPR) An Introduction to the Training Programme.
Post on 17-Dec-2015
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Unified Do Not Attempt Cardiopulmonary Resuscitation
(uDNACPR)
An Introduction to the Training Programme
Direction from the NMC
The Nursing Midwifery Council recognises that in certain cases it will be appropriate for appropriately trained Senior Nurses to
fulfil this role
Aim of Training
To increase confidence and competence in decision making
regarding DNACPR and communicating these decisions
with patients +/- relatives
Why?
• Benefits to patients/carers skilled communication in a timely discussion and less inappropriate resuscitation attempts
• Facilitates more, natural and dignified deaths• Avoids repeated and sometimes distressing discussions
if senior nurse can complete the process• Benefits to organisations – part of skilled advance care
planning, greater user satisfaction and less complaints• Benefits to senior nurses – increased job satisfaction • Potential to influence improved bereavement outcomes
“I let him down
I didn’t know what else to do
And when the ambulance . . . .”
Died in ambulance despite attempting CPR
Mrs G, his wife
We don’t have any choice, Unless we have a DNACPR or an Advance Decision we have to follow protocols
Default is to attempt CPR
Any healthcare setting
“We’re not covered, Unless
we have a DNACPR we have to take them to
A&E”Terminally ill patient diverted to emergency department despite wife’s protestations
Patient transport for hospice admissions
Compliance
• The Training Programme and Competency Framework is the agreed guide to support the South Central SHA Unified Do not Attempt Cardiopulmonary Resuscitation (DNACPR) Policy 2010.
• The overarching principles are compliant with the Joint Statement on DNACPR by the BMA, RCN and Resuscitation Council, and the NMC advice statement
Organisational responsibility
The South Central SHA makes no obligation for individualorganisations to train senior nurses to undertake this rolehowever –
• There are senior nurses who have the right competency and skills to enable them to have these discussions, to the benefit of their patients and organisations.
• The decision to train senior nurses in this extended role lies with individual organisations that retain accountability for the clinical governance for DNACPR decisions that originate within their operational jurisdiction. This allows for the portability of the decision making and the completed DNACPR form.
The processSenior Nurse checks competencies against framework
Senior Nurse fulfils criteria and seeks recommendation by their manager using SHA competency assessment signing off form
Senior Nurse may undertake training programme which is facilitated by a senior practitioners / educators with an appropriate skill set
Following this process if the senior nurse feels confident and an organisational agreement is in place, the senior nurse can practice this
extended skill
Competencies practitioners need for discussions around DNACPR decision making
Organisational Skills
HigherLevel
DecisionMaking
AdvancedCommunication
Skills
KnowledgeAnd
Skills
The training
This extended role will only be offered to senior nurses who fulfil all of the competencies, therefore, the training programmes should be able to be completed in 4 -5 hours.
The Booklet Contents (Pre course reading!)
The booklet covered• Introduction• Pre Course explanation• Explanation of role rehearsal• Review of facilitative communication skills• Review of the communication process• The SHA uDNACPR policy….in context of the Mental
Capacity Act• When to have discussions – pivotal or transition points• References and further reading prompts
The training
• The training will include watching and reflecting on 3 DVD’s which represent 1a, 1b and 1 c decision making
• There will be an opportunity during the training programme for role play to engage in simulated real life scenarios
• These scenarios will relate to predominantly 1a and 1b decisions
Expectation of Role Play
• Agree Ground Rules• Avoiding triggers/connection
to own experiences• Telephones / Bleeps• Give constructive feedback• Non judgemental attitude• Confidentiality• Any others
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