Shaw Vanessa, Davies Alison, Ong Bie Nio
End of Life Partnership, Sandbach, UK.
BMJ Support Palliat Care. 2019 Mar;9(1):e3. doi: 10.1136/bmjspcare-2017-001340. Epub 2017 Jul 22.
Breathlessness is a major problem for people in their last weeks of life. Breathlessness is considered to be multidimensional with physical, psychological, emotional, social and spiritual factors all playing a part. It has been recognised that specific training to health professionals is beneficial in order to improve the care for patients with breathlessness.Breathlessness courses have tended to focus on senior nurses. A new flexible and collaborative training course was designed to include a wider range of nurses and other health professionals in hospital, hospice, primary care and community settings. The aim of the 'Practical Skills to Support the Breathless Patient' programme was to make patients and carers feel better supported in their breathlessness, for health professionals to develop confidence and skills in using proven interventions, and to adopt a flexible educational design that could be adapted to different contexts.
The course is learner-centred and teaching methods encourage interaction and participation via a mix of lectures and discussions with practical skills-focused, experiential workshops in smaller groups. Case study work was included to integrate learning with participants' practice environment. Evaluation is built in during the course, so adaptations can be made throughout to respond to changing learner needs.
Participants reported increased confidence in terms of knowledge and applying this within everyday practice. The theory-practice dynamic worked well within each participant' specific work context in particular through the case study approach.
The course developed a number of innovative approaches, such as multi-disciplinary learning groups, regular feedback loops, reflexive learning about putting theory into practice and long-term follow-up. Combining these elements increases professionals' confidence and sustains new clinical practice.
呼吸困难是临终患者面临的一个主要问题。呼吸困难被认为是多维度的,身体、心理、情感、社会和精神因素都在其中发挥作用。人们已经认识到,对健康专业人员进行特定培训有助于改善对呼吸困难患者的护理。呼吸困难课程往往侧重于高级护士。一个新的灵活且协作性的培训课程旨在让医院、临终关怀机构、初级保健机构和社区环境中的更多护士及其他健康专业人员参与进来。“支持呼吸困难患者的实用技能”项目的目标是让患者及其护理人员在应对呼吸困难时得到更好的支持,让健康专业人员在使用经过验证的干预措施方面培养信心和技能,并采用一种可适应不同环境的灵活教育设计。
该课程以学习者为中心,教学方法通过讲座、讨论以及以实践技能为重点的小组体验式工作坊相结合的方式鼓励互动和参与。纳入案例研究工作以将学习与参与者的实践环境相结合。课程过程中设有评估环节,以便能随时做出调整以满足学习者不断变化的需求。
参与者报告称在知识以及将知识应用于日常实践方面信心有所增强。理论与实践的动态结合在每个参与者的特定工作环境中效果良好,尤其是通过案例研究方法。
该课程开发了一些创新方法,如多学科学习小组、定期反馈循环、关于将理论付诸实践的反思性学习以及长期随访。将这些要素结合起来可增强专业人员的信心并维持新的临床实践。