An Overview of the impact of Cognitive Behavioural Skills in Clinical Practice

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An Overview of the impact of Cognitive
Behavioural Skills in Clinical Practice

• Presented by Ms Clare Gadd
• 4th September, 2009

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Contents

• The Benefits of the Cognitive Behavioural
  Approach and its impact upon
• Me
• Patients
• Colleagues
• Group Feedback
• Challenges/Costs
• Overcoming Challenges
• Clinical Examples

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Benefits/Impact 1/2

• Clinician
• Skills
• Confidence
• Fears

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Benefits/Impact 2/2

• Reduced anxiety
• Less medication used
• Improved quality of life sustained by shift in
  perception
• Able to pace themselves more
• Able to relax more
• Improved independence
• Improved symptom control
• More control over their life

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Interventions helped with

• Anxiety
• Fear
• Panic
• Despair
• Pain
• Breathlessness
• Weakness

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Impact on colleagues

• Empowering staff
• Giving them tools to use
• Improving awareness
• Challenging practice
• Bringing psychological care alongside medical/
  nursing issues and linking it to symptom control
• Open up thinking
• Allaying fears
• More confidence in handling difficult situations
• Increased awareness of the impact of disease upon
  the whole person

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Challenges/Costs 1/2

• Time
• All training time meant time away from patients,
  increased workload, guilt, covering unit
• Difficult to get set time with patients on IPU
  due to the nature of the area

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Challenges/Costs 2/2

• Not suitable for everyone
• Being the 1st trained Group
• CBA can appear formulaic
• Awareness of missed opportunities
• Discomfort putting own practice under scrutiny

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Overcoming Challenges

• ACST/Connected
• Regular Clinical/Case Supervision
• Safety
• Specific and Constructive Feedback
• Encouragement
• Developing Understanding, Confidence Skills
• Learning from others
• Departmental Support

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Clinical example 1

• Judy, 83, admitted for nausea
• Tearful Anxious
• Lorazepam PRN x4
• Mini-MAC Mental Adjustment to Cancer
• Thoughts
• Alternatives
• Coping style
• Outcome No Lorazepam

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Clinical example 2

• Sheila, 76 Shortness of Breath
• Declined FAB group
• Couldnt go home high dependency
• Hot Cross Bun
• Activity Planning Relaxation Pacing
• Transfer
• Helped fellow patient
• Discharged. Then Lived and Died at Home

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Questions and answers
Many thanks!