Skip to 0 minutes and 8 secondsThe Step 2 was introduced after Step 1, of course. And in step one all the nursing care staff got an introduction in palliative care. And during this introduction the graphs of different illness trajectories was presented. So the trajectory where a sudden declining condition occurred, which often happens with patients with cancer. And the trajectory with exacerbations and improvement was presented, as is the case with heart failure and COPD. And the dwindling trajectory for frail, elderly people and patients suffering from dementia. It worked well to discuss the graphs.

Skip to 1 minute and 7 secondsJust making a graph without discussing with colleagues why the line was going up or why the line was going down and what could be done to prevent further deterioration or to adjust the care-- If you just draw the line it's not changing the care you can provide, but if you discuss it, then it works well. What went really well was that the care staff who filled it out, together with the residents, was that they were really aware of why a resident was doing well or not, and that also you have documented this. And you can use this during conversations with a GP or during a multidisciplinary meeting. So it is clear how the trajectory is.

Skip to 2 minutes and 7 secondsWell, sometimes it is difficult to see where you start a graph and how much you go up or down. And some clients were afraid that when the line went down that they were already dying. So you really have to communicate that this graph is an indication, and for us we were also still finding out how to fill it out. It was a test for us, how we would use it, and we also explained that. but some residents also found it reassuring that when the line went down we could have other discussions with them. You may face some challenges in starting to implement Step 2. Here are some possible barriers you might face, with some solutions.

Skip to 2 minutes and 58 secondsYou have now completed Step 2 and are ready to implement it in your care home. You're now ready to move on to Step 3.

Mapping changes in condition - example

Now that you have had an opportunity to try using Step 2, you may like to hear about the experience of others.

In this video we will hear from a group of care workers in the Netherlands about their experiences of using the ‘Mapping changes in condition’ chart in their care home.

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This video is from the free online course:

Improving Palliative Care in Care Homes for Older People

Lancaster University