Jennifer Kirton

‘A bridge to the hospice’: The impact of a Community Volunteer Programme in Uganda

In Africa, the need for palliative care provision is escalating with an increasing number of people living with HIV/AIDS, coupled with rising cancer and AIDS-related cancer diagnoses. In Uganda there is a shortage of doctors, particularly in rural areas. To address this Hospice Africa Uganda developed a Community Volunteer Programme to train volunteers to help by providing support to patients in their own homes. The aim of this qualitative study was to evaluate the impact of the Community Volunteer Programme. Sixty-four interviews, with patients (21), community volunteer workers (CVWs) (32), and the hospice clinical teams (11) were conducted, using semi-structured digitally recorded individual, group and focus group interviews, at the Hospice Africa Uganda sites. The results reported the value of the Community Volunteer Programme, including the impact on patients and families, and how the CVWs acted as a ‘bridge to the hospice’ in identifying patients. Developing financial challenges that are emerging which could potentially impact on the programme were reported. The Community Volunteer Programme appears to be having a positive impact on patients, families and the hospice team, and is a model worthy of consideration by other developing countries to allow the expansion of palliative care.

The personal value of being a palliative care Community Volunteer Worker in Uganda: A qualitative study:

Background: Volunteers in palliative care play a key role, particularly in the hospice setting. The expansion of palliative care into developing countries has been accompanied by the emergence of volunteer workers, who are providing a main source of support and care for patients, many of whom never see a health professional. Aim: The aim of this study was to evaluate the motivation for becoming a volunteer and the personal impact of being a palliative care Community Volunteer Worker in Uganda. Design: A qualitative methodology using semi-structured individual and group digitally recorded interviews was adopted for the study. Data were analysed for emerging themes using thematic analysis. Setting/Participants: Forty-three interviews were undertaken, 32 with Community Volunteer Workers and 11 with the Hospice clinical teams, using semi-structured digitally recorded individual, group and focus group interviews at the Hospice Africa sites in Uganda. Results: The results identified the cultural wish to help people as a key motivator in becoming a volunteer. Additionally, the volunteers reported having a sense of pride in their volunteering role, and this role had a positive impact on their perceived status in their local community. Conclusion: This model of volunteering is clearly having an impact on the volunteers, both personally and also in terms of how they are treated in their communities. Further research to explore the long-term personal benefits of being a palliative care volunteer is recommended.

An investigation of the clinical experiences of dentists within the national dental foundation training programme in the North West of England

Objective To investigate the clinical experiences of foundation dentists (FDs) in the North West of England.Methods Three research methods were used: a questionnaire completed by FDs at the end of their training; an analysis of the clinical logs of experience recorded in the educational portfolios; and analysis of NHS Business Services Authority (NHSBSA) activity data for the 12 month period of training of FDs.Results A response rate of 100% (N = 50) was achieved for the questionnaire and complete data for 49 of the 50 FDs was available from the NHSBSA and clinical logs in the educational portfolios.Discussion Trainees were satisfied with the clinical experience and believed their workload and patient mix provided a broad experience of clinical conditions, although 40% felt there were gaps in their clinical experience. There were wide ranges in the number of individual clinical procedures performed by FDs with some providing very few endodontic treatments, crowns, bridges, metal dentures and fissure sealants. There was a statistically significant difference (P <0.0005) in self- reporting of procedures recorded in the portfolio log when compared to the NHSBSA data.Conclusion The results from this study suggest that there is satisfaction amongst FDs with FT, but there is wide range in the level of clinical experience amongst FDs with some gaps which need to be addressed. In order to provide a consistent, cost effective approach to the delivery of FT changes are required to ensure minimum levels of clinical procedures are achieved during FT. The information collected in the training portfolio must be robust in order to make valid judgements on progress.

Improving end of life care in care homes; an evaluation of the six steps to success programme

BackgroundThere are approximately 426,000 people residing within care homes in the UK. Residents often have complex trajectories of dying, which make it difficult for staff to manage their end-of-life care. There is growing recognition for the need to support care homes staff in the care of these residents with increased educational initiatives. One educational initiative is The Six Steps to Success programme.MethodIn order to evaluate the implementation of Six Steps with the first cohort of care homes to complete the end-of-life programme in the North West of England., a pragmatic evaluation methodology was implemented in 2012–2013 using multiple methods of qualitative data collection; online questionnaire with facilitators (n = 16), interviews with facilitators (n = 9) and case studies of care homes that had completed the programme (n = 6). The evaluation explored the implementation approach and experiences of the programme facilitators and obtain a detailed account of the impact of Six Steps on individual care homes. Based upon the National Health Service (NHS) End of Life Care (EoLC) Programme, The Route to Success in EoLC – Achieving Quality in Care Homes.ResultsThe programme was flexibly designed so that it could be individually tailored to the geographical location and the individual cohort requirements. Facilitators provided comprehensive and flexible support to care homes.Challenges to programme success were noted as; lack of time allocated to champions to devote to additional programme work, inappropriate staff selected as ‘Champions’ and staff sickness/high staff turnover presented challenges to embedding programme values.Benefits to completing the programme were noted as; improvement in Advance Care Planning, improved staff communication/confidence when dealing with multi-disciplinary teams, improved end-of-life processes/documentation and increased staff confidence through acquisition of new knowledge and new processes.ConclusionsThe findings suggested an overall positive impact from the programme. This flexibly designed programme continues to be dynamic, iteratively amended and improved which may affect the direct transferability of the results to future cohorts.

THE IMPACT OF BEING PART OF A THET LINKS PARTNERSHIP TO DEVELOP A PALLIATIVE CARE DEGREE PROGRAM IN SUB SAHARAN AFRICA

Background In Sub-Saharan Africa the need for palliative care provision is escalating with rising cancer rates and non-communicable disease burden. The shortage of trained health care professionals has highlighted the need for increasing the palliative care workforce. A THET Links Health Partnership was established between a UK Faculty comprising clinical and academic palliative care staff from across the UK and Hospice Africa Uganda, to support the development of a palliative care degree in Uganda. UK Faculty supported the Ugandan Faculty in the development and delivery of the degree programme. Aim To identify the impact on the UK Faculty of participating in the partnership. Methods A pragmatic evaluation methodology was adopted for the study and data were collected in November 2012, using a confidential descriptive electronic survey, comprising open ended and closed questions. A total population sample approach was used and all 17 UK Faculty invited to participate. Data were analysed using thematic analysis and descriptive statistics for the closed questions. The project was reviewed by West London Research Ethics Committee and considered service evaluation. Result 82% (n=14) UK Faculty participated, and no negative points were raised by any respondent. Several themes emerged from the data including the impact on their UK clinical practice. This included examples of improving their team working and leadership and enhanced diagnostic skills with reduced reliance on technology. The improvement in their teaching skills was widely reported. The personal impact of the experience was also noted including providing personal growth, influencing lifestyle choices and changing their perspectives on life. Conclusion the impact of being part of this volunteer programme has shown multiple benefits for the participants, not only relating to their clinical work in the UK, but also the personal impacts on their lives. As well as the overarching goal of improved access to palliative care.

‘Me I feel proud in my uniform’: the personal value of being a palliative care community volunteer

Background Approx 27 000 new cases of cancer are reported in Uganda in each year affecting 1.5% of the population. A shortage of Doctors, wide geographical distribution, and poor transport systems lead to many patients experiencing severe uncontrolled symptoms. Hospice Africa Uganda developed a community volunteer worker programme where local villagers are trained to identify patients with palliative care needs. The volunteers refer patients to the hospice and provide basic care and support for patients and families. A training course with ongoing support has resulted in 85 volunteers practicing out of the hospice in Kampala (40) and Hoima (45).The volunteers receive no payment, except for a bicycle enabling them to reach remote areas. Aim To explore personal impact of being a palliative care community volunteer. Methodology A qualitative methodology using semi structured individual and group tape recorded interviews was adopted for the study. Data was collected from the volunteers based in two sites (Hoima and Kampala). A purposive sample of 32 volunteers participated in the study. Data was analysed for emerging themes using thematic analysis. Results The volunteers all reported how they found the role to be of great value to themselves, including having an increased knowledge and satisfaction at helping the dying in their villages. Interestingly they all commented on the pride of being a volunteer, how they felt when they put on their uniform and the resulting respect they received. Discussion This paper will discuss these findings as well as the challenges that the volunteers are finding regarding language barriers and old bicycles.