Monday 21st December 2015
Mac Voice, the magazine for Macmillan professionals: Winter 2015
In part six of our Sharing Good Practice issue on psychological support, Rachel Criddle outlines the importance of supporting staff who deliver psychological care.
Supporting cancer and palliative care staff to deliver psychological care through consultation, supervision, teaching and training is important.
A large and important part of the Macmillan clinical psychologist’s role within cancer and palliative care services is to work alongside the multidisciplinary cancer and palliative care teams, to promote psychologically-informed care, and to support the psychological well-being of staff.
The NICE guidelines for improving supportive and palliative care for adults with cancer highlight this when it states that ‘all staff providing psychological support within the recommended model will require training and ongoing supervision’. The guidelines suggest that ’those working at the higher levels of the model should normally provide training, supervision and opportunities for continuing professional development for those operating at the lower levels’ and that ’psychological specialists should also play a significant role in the development and maintenance of communication skills through teaching and training’.
Based on this, the psychologist’s role aims to offer consultation, supervision, team formulation and reflective practice to all nurses and therapists in cancer and palliative care services.
Supervision at Cwm Taf UHB
At Cwm Taf University Health Board (UHB), supervision is delivered mainly on a group basis (with a maximum of 10–12 members of staff but typically 4–6 attend). However, occasionally it is delivered on an individual basis, either face-to-face or over the telephone. The consultation sessions are delivered once a month for an hour and a half in a setting away from their immediate work space.
The psychologist draws on a variety of psychologically-informed consultation/reflective practice models to do this. These models can include cognitive behavioural, systemic and solution-focused therapies.
Staff members are encouraged to set their own agenda for the sessions. The purpose of the session is to provide the staff with a safe reflective space to explore and discuss some of the following topics:
- A case of a patient experiencing psychological distress/difficulties
- Space for reflective discussions of patient work
- Discussion and reflection on a psychological difficulty that the consultee may be struggling with and/or want more knowledge on. For example, anxiety, low mood, risk, trauma or grief
- Organisational issues
- Discussions that may arise on any topic, but with a psychological focus
The psychologist can also offer debrief sessions individually or as a group after a serious incident or event. To ensure staff members feel comfortable and safe to reflect on their clinical practice, the sessions are kept confidential among those attending the session. The only time information would be shared was if the psychologist was concerned that harm may come to a staff member or the patients they are working with.
Another crucial part of the psychologist’s role is to provide teaching and training to staff members to develop their level one and two psychological care.
Below is a list of some of the teaching topics that have been provided. The majority of the teaching is delivered by the psychologist, but one of the teaching topics has been provided by an external facilitator using the Macmillan Group Learning and Development Grant:
- Psychological impact of cancer
- Assessing risk (e.g. suicide and self-harm)
- The psychological impact of cancer on relationships/couple/families
- Self-care for staff
- Breaking bad news
- Anxiety and cancer
- Cancer-related fatigue
- Loss and grief models
- Introduction to cognitive behavioural therapy concepts
- Brief solution-focused therapy (external facilitator)
- Feedback from staff
Staff members have provided the following feedback on the consultation and on the teaching sessions:
'This has been a forum for education and, peer support, and has been extremely beneficial to our practice.’
‘As a lone specialist nurse, I have found great benefit in the regular meetings for CNSs. They have provided me with education, as well as a forum for peer discussion on difficult cases/situations. The two-day session on solution-focused therapy was invaluable and really does work when used with patients. Between meetings, having the opportunity to discuss patients/situations with the clinical psychologist over the telephone has been very helpful and I feel that this has actually taken some stress out of the job.’
‘Since attending the psychology workshops, I have felt more reassured that I am giving the right support and that I am acknowledging their distress, saying the right things and listening to patients … I am much more able to identify those that may need specialist psychological support. Therefore, the psychology workshops have been a valuable resource to me and the team.’
'As well as a valuable learning resource, the workshops have enabled us (i.e. specialist nurses) to discuss difficult situations that we have encountered in our work, and then as a group, discuss how we could have best handled the situation. We have learned from each others’ experience.’
Email Dr Rachel Criddle, Macmillan Clinical Psychologist, Cwm Taf University Health Board.