Background Ambulance clinicians have a critical role in enabling people at the end of life to have their care wishes met (National End of Life Care Programme, 2012). Training historically focused on the 3 Ps model (preserve life, prevent deterioration and promote recovery) and this has led to a lack of confidence and knowledge among ambulance clinicians in managing palliative patients at end of life (Kirk, Crompton, Knighting, et al., 2017. J Paramedic Practice 9:71), plus uncertainty and anxiety in decision-making (Murphy- Jones & Timmons, 2016. Emerg Med J. 33:722). Working closely with hospices and community palliative care providers is key to improving this (Brady, 2014. Int J Palliat Nurs. 20:37 ; Stead, Shirmilla, Nicell, et al., 2018. Eur J Palliat Care. 25:112).
Aim Hospice education staff and a community palliative medicine consultant worked in collaboration with the Regional Ambulance Service to develop a training programme with the aim of upskilling ambulance clinicians to help them better care for patients at the end of their life.
Method An interactive one-day workshop was carefully constructed with practical activities and case-based discussions (some participant directed). This was delivered to small groups of 10. Participants were asked to rate their knowledge and confidence before and immediately following the training. In addition, participants were asked to identify the impact they perceived the training to have on their future practice.
Results Pre-workshop over 80% of participants rated their confidence and knowledge as poor or average. Post workshop around 60% rated their confidence and knowledge as very good or excellent. Participants identified perceived impacts on their ability to act in the best interests of their patients, administer anticipatory medications, and engage in open honest conversations to prevent inappropriate admissions. Following the training participants also highlighted a desire for further joint working opportunities.
Conclusions Tailored palliative and end of life education for ambulance clinicians improves self-rated confidence and knowledge scores. How this translates into clinical practice requires further evaluation. Opportunities for further joint working and education are being explored as a means of improving outcomes and experience for palliative care patients.
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