Introduction Generic palliative care knowledge, skills and attitudes vary significantly in nursing home staff. A previous education model of 1 day study days (provided by our palliative care team) did not seem to have a lasting impact: knowledge/skills were not retained; high staff turnover meant ‘educated’ staff were lost, and, the focus on palliative care faded behind other priorities.
Method An alternative model has been successfully piloted in three homes, with four core elements: (1) Little but often: a short teaching session monthly which representatives from each home attend. This reduces the impact on the rest of the working day so increasing attendance, keeps palliative care on the ‘radar’ and accommodates a high turnover workforce. (2) Focus on generic palliative care skills: communication; recognising dying; End of Life pathway. (3) Patient focused and reflective: each session is built around reflection on patients at the homes, previous difficult conversations form the basis of communication skills role-play. (4) Ownership by nursing home staff: who set the learning objectives, identify a link nurse at each home and maintain a ‘resource box’ for use with palliative patients.
Results This education model has had a direct impact on: (a) confidence in core palliative care competencies (self-rated by the attendees); (b) clinical care (using use and completion of the end of life care pathway as a marker); (c) advance care planning with care home residents; (d) referrals to specialist palliative care (which have become notably more appropriate and timely but with an overall reduction in workload at these homes as they are now competently delivering generic palliative care themselves).
Results/Conclusion This model is cost neutral, time efficient (volume of work for specialist palliative care from these homes has actually reduced) and has had a direct effect on improving confidence and skills in generic palliative care.
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