Article Text

Download PDFPDF
Educational needs of nursing home staff: does a needs-based palliative care course make a difference?
  1. Gillian Li Gek Phua1,
  2. Hui Jin Toh2,3,4,
  3. Laurence Tan2,3,4 and
  4. James Alvin Yiew Hock Low2,3,4
  1. 1 Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
  2. 2 GeriCare@North, Khoo Teck Puat Hospital, Singapore
  3. 3 Geriatric Medicine and Palliative Care, Khoo Teck Puat Hospital, Singapore
  4. 4 Education Research, Geriatric Education and Research Institute Ltd, Singapore
  1. Correspondence to Dr Gillian Li Gek Phua, Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore 169610; gillian.phua.l.g{at}


Objective In Singapore, more elderly are living in nursing homes (NHs), with a resultant increase in deaths occurring in NHs. However, palliative care training is limited in Singapore’s core nursing curriculum, and many NHs rely on foreign-trained staff who may not have previous palliative care training. Our study aimed to evaluate whether a needs-based course can improve the palliative care knowledge and attitudes of NH nurses in Singapore.

Methods Twenty-five nurses participated in the study. The intervention was an 8-week palliative care course developed based on needs assessment and led by a multidisciplinary faculty. A 50-item knowledge test was administered at baseline and 0 day and 3 and 6 months postcourse. Semistructured interviews were conducted at 3 months to assess for changes in attitudes and nursing practices.

Results The mean knowledge score increased significantly from 31.4 (±4.4) precourse to 35.1 (±5.1) at 3 months. Knowledge scores in end-of-life care increased up to 6 months, and scores for pain and symptom management increased significantly at 3 months. Participants reported a positive change with improved communication skills and increased compassion. There was a lack of opportunities to apply some new knowledge and skills due to regulations and perceived residents’ preferences to engage more local senior staff.

Conclusion The multidisciplinary needs-based palliative care course using various teaching modalities with follow-up knowledge tests helped to increase knowledge and improve communication skills and attitudes of NH nurses towards palliative care. The increase in knowledge and positive change in attitudes was noted to be sustained for at least 3 months postcourse.

  • education and training
  • nursing home care

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors LT and JAYHL designed the study; HJT conducted the interviews and quantitative analysis; GLGP and HJT conducted the qualitative analysis; GLGP prepared the first draft of the manuscript; LT mentored the whole process; and all authors reviewed and edited the manuscript until it was completed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.