Provision of Patient Centred Care Within Vancouver, Canada and Two UK Hospice Settings.

The purpose of this study was to observe patient centred care within three hospice settings funded by differing health care providers within the province of Vancouver British Columbia, and also to visit two UK hospice settings. My study will briefly summarise the concept of patient centred care, make references to current research on this subject, detail my observations and recommend changes in my current practice setting. It is a narrative review of patient centred care using an ethnographic approach.

I was hoping to see models of care embracing a holistic patient centred approach, which could be implemented within the Inpatient unit where I am employed as a Staff nurse. I observed care given within the Inpatient units that I visited, spoke to nursing/medical staff, social workers, community nurses, hospital chaplains, kitchen staff and day hospice care staff where applicable.

I collected paperwork pertaining to hospice admission in Canada and UK hospice settings, for comparison with those used within my own workplace, and those of the two UK hospices I visited: Sue Ryder Hospice, Nettlebed Oxford UK, and St Columba’s hospice Edinburgh UK. I was hoping to find models of holistic patient centred care that were being used within the admission process.

I chose Canada for my overseas study as their hospice funding is similar to ours within the UK, a combination of government funding and charitable donations from public fund raising.

It is my intention to disseminate my findings to other hospice organisations, and I am hoping that positive changes in patient care may result from the information collated from my study.

It became evident very quickly during my study of Canadian Hospices that their philosophy of care for patients and family focuses on enhancing comfort and quality of life. Any active treatment is administered within palliative care units which are attached to large general hospitals.

But this difference did not have any impact on my observation that the giving of controlled drug medication by a single Registered nurse within Canadian hospice settings enabled medication to be given promptly and calmly in a patient centred manner, resulting in pain being alleviated quickly, and avoiding the time wasting practice of searching for the single set of keys held by any one Registered nurse within the unit.

Also, trying to locate an additional nurse to double check controlled medication is often time consuming and involves disturbing colleagues who are perhaps undertaking clinical procedures or having difficult or sensitive conversations with patients and their relatives and friends.

Inevitable delays in delivering break through medication using the system of double nurse checking cannot be considered a patient centred procedure at present within my workplace, and other hospice settings within the UK.

On return to the UK I visited a hospice where single nurse administration of drugs (SNAD) is in operation, obtained their nurse training package and observed nurses using the SNAD process of drug administration. I am presently working with my Inpatient nurse manager to implement SNAD within my work place.

My study concluded with a visit to St Columba’s hospice in Edinburgh where I met Dr Verna Haraldsdottir (Director of Education & Research/Senior Lecturer) who is implementing a patient centred care programme with Professor Brendan McCormack in October 2015 in Edinburgh. This programme has been offered to my workplace, and my Inpatient nurse manager and education department are excited about this opportunity.

Jane Eades (Clinical Effectiveness) Marie Curie is interested in the results of my study, with a view to implementing SNAD in the future within Marie Curie.