Occupational Therapists guiding volunteers in palliative care

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1 Occupational Therapists guiding volunteers in palliative care results of a qualitative research. Maryke Moens (3rd year student Artevelde University College Ghent, Belgium)

2 Contents workshop Introduction: palliative homecare and the volunteer What s the problem? (results of the qualitative research) PDL a solution? (practicing + discussion) Conclusion and final statement.

3 Introduction: palliative homecare and the volunteer Palliative homecare includes: Pain- and symptom reduction, emotional, spiritual and social care. Palliative homecare-team: GP, physiotherapist and nurse. (Volunteers are supplementary) (http://www.palliatief.be)

4 Introduction: palliative homecare and the volunteer Profile volunteer: Sex (n=354) 85% 15% Age (n=354) < 30 years years years years years > 70 years Still working or not? (n=354) professionally occupied not professionally occupied 62% 38% (Baerten, 2005)

5 Task of volunteer: o o Available 4-8 hours/week; emotional, social and spiritual guidance of palliative person; o o o o o substitute partner or family members; night watch; administration and organizing activities; mourning care for relatives and accompany the relatives after the decease. (Baerten, 2005)

6 Current basic-education of the volunteer: Communication lessons; mourning care and ethics; theoretical background about pain- and symptom reduction; comfort care; privacy and lift-techniques. (Baerten, 2005)

7 Results Motivation to do voluntary work: 3 main reasons of internal motivation: 1. Opportunity of personal growth; 2. Meaningful occupation to spend time on; 3. Have wide interests in life and end of life. How to cope with psychological burden? 1. A semi-structered interview (sample of 12 volunteers) following results emerged: compensation and psychological help from the organization. 2. Extra result : lack of ergonomic education for the volunteer itself and for the patient during the care. => 7/12 volunteers said the basic education was sufficient but it was too philosophic. The practical side was sometimes overlooked. (Moens, 2011)

8 Teaching PDL a solution? PDL = Passivity's of Daily Living 7 factors: 1. To lie; 2. To sit (position the person); 3. To wash (to be washed); 4. To dress (to be dressed); 5. To change (to be changed); 6. To transfer (to be transferred) and 7. To feed (to be fed). (Loudon & Jelier)

9 Principles of PDL and the haptonomical approach: 1. Prepare the person to the touch. 2. Do not lose physical contact, using a warm touch. 3. Stay continuously in contact with the person by eyecontact and conversation. 4. The approach has to be caring and gentle but not childish. 5. The approach has to be a sensory focused approach with matching emotions. (Loudon & Jelier)

10 Why OT? (MOR-model) Person who is palliative Environment: the volunteers Activities of daily living. e.g. getting dressed.

11 person who is palliative Environment: the volunteers + OT Activities of daily living. e.g. Getting dressed. Activities of daily living. e.g. Getting dressed.

12 Techniques To lie, to sit and to be transferred Techniques that need proper ergonomic explanation are : Rolling the person over. Lifting the person higher or lower into the bed. Shift the person to the side of the bed. Helping the person to get seated from a lying position and reverse. the use of a passive or active lift (for example the Arjo Sara): when possible

13 (film: positioning person higher into bed using the Multi glide )

14 Active lift Passive lift

15 Techniques to wash, change and position (to sit and to lie). Problems that could emerge: Spasms in the hand and arms. Spasms in the feet and legs.

16 Solution: Use of Key points Spasm hand: Envelope-technique Wrist palmary flexion with corresponding hand. Opposition of the thumb with other hand. Extension of fingers Give full hand with corresponding hand. Combine key points with swinging-movements away from the body.

17 Bend Knee with Extension spasm : Use thumb to put big toe in plantar flexion. Place 4 fingers in hollow of the foot. Place a hollow hand in the knee cavity. Bent the knee and place the foot on a flat surface. (do the same thing with the other leg) One hand holds both feet. Swing both legs gently to become an abduction of the legs. Put your arm under the legs and support the knees.

18 Strengthen knees with flexion spasm : Take the heel with one hand Push with the other hand gently above the knee to strengthen the leg. Why these techniques? Bending and strengthening legs, holding hands, are all necessary to put on clothes, to wash the person, etc.

19 Techniques to be dressed in bed Film PDL (to be undressed)

20 Solution: a good technique and adjusted clothing. Necessary for good comfort for the person is extra heating. Make sure your hands are warm. Explain what you are going to do. Chose clothes the person wants to wear / likes!

21 PDL requires a full education! Before you can teach PDL to someone, you d have to take PDL-courses. Problems: PDL isn t known out of the Netherlands and Belgium. Expensive course: +/- 870 Information / contact: Mobicare PDL-consult Mariniersweg VE OUDE-TONGE Telefoon: +31 (0)

22 Time to put it in practice

23 Discussion PDL + use OT Do you find an OT as a coach/mentor useful? Is the role as a coach part of an OT s job description? Do you find it important that OT s could participate within palliative care? Would you use PDL?

24 Conclusion

25 References Baerten, H., Clicteur, B., Helaers,A.-S.,& van Iersel,T.(2005, april). De onzichtbare kracht vrijwilligers in de palliatieve thuiszorg Kinébanian, A. (2009). Grondslagen van de Ergotherapie. In A. Kinébanian, & M. Le Granse (Ed.), Grondslagen van de Ergotherapie (2e editie ed., pp ). Maarsen: Elsevier Gezondheidszorg. Loudon, S., & Jelier, B. (n.d.). Retrieved 10 29, 2011, from Moens, M., De Muynck, S., De Backer, C., Defloo, S.,& Dewandel, J.(2011) Wie is hij? De persoon achter de vrijwilliger in de palliatieve thuiszorg : drijfveren, stimulans, emotionele belasting en voldoening Ryckbosch, J., Pâquet, G., Tassent, R., & Thomas, N. (2011). Tussen komen en gaan ligt een heel verhaal. Schelfhout, P., Noyez, E., Stevens, A., Schaep, C., Schouteden, J., & Rasschaert, S. (2011). Vrijwilligerswerk in het palliatieve netwerk. Van Autrijve, K., Vandaele, B., Van Driessche, L., Van Gansbeke, E., & Wolfs, F. (2011). Vrijwilligers in een palliatief dagcentrum: de manier waarop zij emoties ervaren. Website: (n.d.). Retrieved 10 29, 2011, from

26 Thank you for your attention and cooperation.

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