FINE trial nurse training materials

Dolphin

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Tate Mitchell posted the following to Co-Cure https://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind1311b&L=co-cure&F=&S=&P=10014 :

Note: More materials from the FINE trial have been released by the authors, including the 'Pragmatic Rehabilitation' therapist's manual and slides from training sessions provided to FINE nurse therapists.


FINE trial website-

http://www.fine-trial.net/gparea.asp?loggedin=1


Nurse induction and training slides-

http://www.fine-trial.net/downloads/PR induction and training (all).pdf


FINE TRIAL Pragmatic Rehabilitation Therapist Manual 07/01/05 http://www.fine-trial.net/downloads/Therapist PR manual.pdf

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Note: Description of training session materials from the FINE trial paper published in the BMJ.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859122/


Outline of training sessions provided to FINE nurse therapists


Introduction (2 hour sessions)


Induction.

Understanding CFS/ME, reading lists.

How to read research papers.

Randomised controlled trials, ethical issues, informed consent.

The structure of the FINE trial


Pragmatic rehabilitation training (half day sessions, delivered approximately weekly)


Overview of therapy and outcomes. The pragmatic rehabilitation model and the importance of providing rationales.

Deconditioning: the physiology.

Deconditioning: the rationale for treatment, designing an activity programme, and goal setting.

Sleep, cortisol, circadian rhythms: the physiology.

Sleep, cortisol, circadian rhythms: the rationale for treatment, regularising sleep patterns, and goal setting.

Anxiety: the physiology.

Anxiety: the rationale for treatment, learning to relax, and goal setting Shadowing group delivery of pragmatic rehabilitation in a hospital over eight weeks The structure of treatment—how to use the visits and phone calls.

Delivering the rationale. Agenda setting.

Overcoming impediments to change.

Using techniques from motivational interviewing.

Psychosocial issues—helping people to look to the future, termination of therapy.

Summary, overview and getting ready to start working with practice patients. Supervision contracts.

Rehabilitation issues (back to work).

Practice patients started. Pragmatic rehabilitation supervision sessions (group and individual) started Relapse prevention Follow up 1—Learning from practice.

Follow up 2—Learning from practice.


Supportive listening training (half day sessions, delivered approximately weekly)


Introduction to supportive listening, diary keeping, confidentiality, codes of conduct, and use of supervision.

Background to person centred listening, core conditions, and listening skills. What counselling is not.

Qualities of the listener. Beginning therapy, engagement, and the patient’s frame of reference. Stages of the listening relationship.

Helping the patient to tell a story. Attending and listening, body language, and non-verbal messages. Reflecting back.

Open questions and role plays.

Films/discussion. Skills exercises (for example, using silence).

Barriers to listening. Directed reading

Group discussion of learning and insights. Challenge and specificity.

Skills practice.

Practice patients started. Supportive listening supervision sessions started.

Creating an emotional and physical environment conducive to the helping relationship.

Telephone counselling skills.

Telephone counselling skills—review and practice.

Review of progress, identification of further training needs.

Group work. Taking action. Endings.

Endings. Listening skills practice.

Follow up 1—Reviewing practice. Boundaries.

Follow up 2—Reviewing practice. Transference issues.


Training sessions used a mixture of presentations by the trainers, discussion, group activities, role play, videos, and review of case material. Reading lists were given. Homework was set in some sessions and reviewed at the next session.
 

Dolphin

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Here's what one person said, which might give people an idea of what was involved:
Gee, I had not realised that the FINE nurse therapists were following such a course which is almost totally deconditioning/anxiety/ motivationally based.

If I was an ME patient given such a course I would be thinking:-" why on earth are they treating me like this, when it has nothing to do with the illness that I have"
 

Firestormm

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Must admit that I thought the FINE Trial failure would have prevented further training for nurses - not that I have ever come across a nurse in my time with ME. Nurses are hard enough to come by when in hospital emergency departments let alone ME Services. Still, I'll have a read of the manuals. Does anyone know who exactly receives this training?
 

alex3619

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One of the slides: "Try not too rest too much on a bad day (a gentle walk can help reduce symptoms)"

:eek:

:confused:

:rofl:
Well I do get fewer symptoms if I have a gentle walk on my favourite computer game. My avatars can walk whole miles! In real life, sadly, even getting out of bed is near impossible on a really bad day.

FINE advice was for mild patients though, and I wonder if the nurses even know about severe ME? Aside from occasional one line indoctrinations?
 

Firestormm

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I've not read it yet, but I think that it was training related to the FINE trial.
I haven't either - probably wont bother now. I think this has been circulated before but might be wrong. If it was a manual from the Trial it would make sense - but it's on the 'net now as being a current diktat applicable to nurses today.

Not sure that's correct. Hence my query. There are 'training' videos and resources elsewhere for the medical profession, but I hadn't seen anything for nurses particularly: hard to know when/where nurses feature in ME-world of NHS...
 

Esther12

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I haven't either - probably wont bother now. I think this has been circulated before but might be wrong. If it was a manual from the Trial it would make sense - but it's on the 'net now as being a current diktat applicable to nurses today.

Not sure that's correct. Hence my query. There are 'training' videos and resources elsewhere for the medical profession, but I hadn't seen anything for nurses particularly: hard to know when/where nurses feature in ME-world of NHS...
I think that FINE has only just released these now, so have not been seen before (they're not familiar to me), and they're just written in that diktat style as that's the way the researchers involved are.
 

kaffiend

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and they're just written in that diktat style as that's the way the researchers involved are.
I glanced through the slides and was really struck by the certainty, without reference to any study, with which they make statements about what patient responses will be.

It's creepy - they're indoctrinating, rather than training, a fleet of workers who are not encouraged to think critically about the information.
 

Esther12

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I glanced through the slides and was really struck by the certainty, without reference to any study, with which they make statements about what patient responses will be.

It's creepy - they're indoctrinating, rather than training, a fleet of workers who are not encouraged to think critically about the information.
And if you don't like that then you're antipsychiatry or stigmatising mental health issues!

They have a really disturbing faith in their right to decide what thoughts are appropriate for others to hold, without being concerned with what the evidence actually shows.
 

Dolphin

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FINE advice was for mild patients though, and I wonder if the nurses even know about severe ME? Aside from occasional one line indoctrinations?
The FINE Trial was initially envisaged just for severe patients. It expanded who it included. But did include severe patients (it was done in people's homes).
 
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biophile

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Some of this stuff is bordering into malpractice. Nothing really new that we have not seen in other similar materials.

CFS patients more emotionally distressed and impaired than all patients except depressed patients (c.f. MS, diabetes, MI, CHF etc).
They certainly would be more more emotionally distressed and impaired after reading this training material and/or having to endure some of the advice in practice.

Social and emotional factors [...]
– unhelpful advice (e.g. to rest excessively [much of this FINE training manual])
Although underlying disease processes have been ruled out, there are physiological changes which come about as the result of disturbed rest-activity cycles, disturbed sleep, somatic symptoms of anxiety.
No references of course, just assumptions about CFS symptoms.

Fears about exercise in CFS
• Many CFS patients are fearful about exercise through their own experience of symptoms following exercise.
• It is no use denying their experience of symptoms after exercise.
• Many patients believe that post-exertional symptoms indicate they are harming their body so they worry & limit their activity.
• Many delay exercise until post-exertional symptoms wear off (“Boom-Bust”).
I think most patients are more worried about the impact of post-exertional symptoms on function and quality of life than hypothetical 'damage' of the body, but this mob like to frame it as hypochondria. Post-exertional symptoms can cause relapses which significantly worsen function and quality of life for months at a time, that is why we "worry".

Why is gradually increasing activity plan important?
• There is no persistent virus, muscle disease or damage.
• Activity or exercise cannot harm.

• Muscles need regular exercise to work efficiently and without pain.
• Periods of rest or irregular activity over months & years leads to deconditioning.
• Severity of CFS symptoms depends on amount of regular activity since start of CFS.
Tell that to patients whose lives have been destroyed from too much activity or exercise during the earlier stages of illness. How are FINE defining harm exactly? A patients' life being affected by activity and exercise is harmless as long as there is no objective evidence on routine testing? Reminds me of PACE, adverse effects of exercise are not significant unless they result in massive drops in function for several weeks at a time, therefore CBT/GET are "safe".

Safest level of exercise to start:
• Start activity at level less than capable of.
• If activity = present stamina, difficult to do activity plan & daily tasks, & become overwhelmed by symptoms.
• Like athletes do not expect full potential in 1st weeks of training- build up over months.
• As stamina and fitness increase muscle pain and fatigue will disappear.
• Increases in daily activities should be timed and gradually increased to sustain progress.
If only that was true.

How much aerobic exercise?
• Number of aerobic exercise sessions depends on each patient’s circumstances.
• Aim 4 x 15 min aerobic sessions over day.
• Then 2 x 30 sessions of differing exercises.
• Swimming and aerobics can be added.
• After symptomatic recovery 30 min of enjoyable physical activity of moderate intensity. Minimum of 3 times a week.
• Record progress in activity diary - focus on achievement and symptoms will subside.
Did a SINGLE patient achieve this in the FINE Trial?

What to do on a bad day
• Bad days with increased physical activity, mental stress & infection.
• Increase in physical or mental exertion will increase autonomic nervous system/adrenaline activity - overwhelming sx.
• If possible on bad day do same amount as day before but no more. No harm will occur.
• After bad day, increase on next good day.
• With time, break up activities with rest over day so decrease in frequency of bad days.
Don't trust them.

When ill [...] • Avoid lying down to rest or sleeping in day.
Trying to take away my critical nap time, especially when ill? Fuck off. No thanks. Whether or not daily rests and naps affect nighttime sleep and/or overall condition, is an individual variable and should not be generalized like that.

Name benefits of exercise:
• Effects on deconditioning symptoms.
• Effects on accurate sensory information.
• Effects on sleep.
• Effects on hormones.
• Effects on mood, anxiety, mental stress.
• Effects on withstanding physical stress.
• Effects on intellectual functioning.
For many of us, most of these become worse after regular exercise!
 
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