A manager at a care home in Newport, South Wales, who came to the country from the Philippines 10 years ago, is doing his bit to raise nursing standards in the social care sector after completing a ground-breaking training programme that has just been shortlisted for an NHS Wales Award.
Edgar Bautista is Clinical Lead and Deputy Manager at Capel Grange in Newport, a 72 bed purpose-built nursing home owned by Linc Cymru Housing Association and operated by its health and social care division, Linc Care. Mr Bautista recently received a commendation from Aneurin Bevan University Health Board after completing a five-month NHS Improving Quality Together (IQT) Silver programme, as part of which he conducted a study on how nurses are trained and supported in delivering “end of life” care.
Aneurin Bevan University Health Board has been running the IQT programme with NHS staff for just over two years but is the first health board in Wales to open up the programme to nursing home managers working outside the NHS. The initiative is one of three shortlisted in the Improving Quality category of the high-profile NHS Wales Awards scheme, with the winner being announced in September. Melanie Laidler, Assistant Director of ABCi, Aneurin Bevan University Health Board’s Continuous Improvement Team, explained;
“The not-for-profit sector has such an important role to play in the overall delivery of care for the elderly in Wales that we felt it was important to build on our experience of delivering IQT in the NHS and open it up to a wider audience. There is so much knowledge and experience that can be shared between managers and care providers in the two different arenas and when we talk about continuous improvement there are real benefits in ensuring that we are all talking the same language.”
The programme lead Rachel Fletcher, Improvement Advisor, was instrumental in developing the collaboration and inspiring people to complete their projects.
IQT uses a combination of monthly workshops and work-based assessments to bring about innovative, positive and practical changes that enhance the quality of services and, ultimately, improve healthcare outcomes for patients. Mr Bautista’s programme focused around one of the most sensitive areas of nursing, advance care planning. Sometimes referred to as palliative care, or end of life care, advance care planning has been the subject of much debate both inside and outside the NHS, and Mr Bautista looked to America for inspiration.
“As part of my project I came across a validated questionnaire that had been used in the United States to measure the perception of nurses towards advance care planning,” he explained. “It looked at the four areas of knowledge, attitude, level of comfort and organisational support; and measured the relative strength of these different factors. Using an adapted version of the questionnaire, I ran a study with some of our own nurses and found some very interesting results.”
Mr Bautista’s study found that, while nurses at Linc’s Capel Grange nursing home scored highly against knowledge, attitude and understanding of the organisational support structure in place to support advance care planning, it was the ‘comfort’ score that came out lowest in most cases. Sensitivities of discussing end of life care with family members, concerns around religious beliefs and the mental capacity of elders and the implications of legal issues lasting power of attorney were all highlighted as factors that could make some nurses uncomfortable when dealing with advance care planning.
His findings led him to the assertion that, rather than spreading training and other interventions across the broad spectrum of advance care planning (as many institutions do currently), the majority of resources and strategies should be focused around addressing the issue of comfort. As part of the programme, he then introduced a new mentoring programme involving tailored supervision, one-to-one sessions where sensitive issues were discussed openly and ideas exchanged, and the development of case scenarios to highlight potential solutions.
At the end of the five-month programme, Mr Bautista presented his findings to a team of IQT assessors. Melanie Laidler on the panel that witnessed the presentation and commented;
“The whole panel was really impressed with Edgar’s excellent and in-depth presentation. The way he grasped the nettle in identifying an opportunity for improvement and communicating it back through his colleagues in the care home was really inspiring and you could also tell that the other participants on the course could identify with his approach and recommendations and drew their own confidence from it.
“Opening up the IQT programme to nursing home staff has been such a positive experience, as well as giving us an appreciation of the different approaches to learning that are held inside and outside the NHS. We have entered this pilot programme for an NHS Wales Award and hope to expand the rollout of both the Bronze and Silver level programmes to nursing home staff across the region.”
Mr Bautista has also drawn further inspiration from the experience of taking part in the IQT programme and remains passionate about the role he can play in driving up standards of nursing care and tackling the challenges associated with advanced care planning.
“Getting involved in the IQT programme has been a great experience for me and the opportunity to support our own nursing team on what can be a very stressful part of their jobs has been very rewarding, said Mr Bautista. “To think that work started at Linc could also have a positive impact on the way nurses are trained and supported to deliver better advance care planning in other parts of Wales is something that makes me very proud.”
Executive Director of Linc Care, Anne Thomas, added;
“Edgar is so passionate and dedicated to providing high quality care to the elders at Capel Grange that when the opportunity came to put forward one of our managers for the IQT programme there was no hesitation. With the full support of Linc, Edgar has thrown himself into the challenge of completing the five-month programme and delivered an excellent research project in one of the most difficult areas of nursing care. It is so important that families can be assured that the person they love is cared for with dignity and respect at the end of their life. We are also grateful to Aneurin Bevan University Health Board for the opportunity to engage with this programme and hope that it will continue to flourish.”