Abstract

The importance of developing workforce knowledge, skills and attitudes in the health and social care workforce in order to improve the quality of end of life care is central to the provision of high quality patient care at the end of life. Community nurses deliver end of life care frequently and are required to be confident and competent in the delivery of this care, although how this is achieved is less clear.

The aim of this project was to offer a pathway of learning to community nurses to explore what enhances confidence and competence. The pathway took a learner centred approach underpinned by principles of adult education and built on the 4 competency areas for end of life care.

The philosophy underpinning the pathway development was based upon the belief that education and learning are complex social processes which take place in complex settings. A purposeful sample of eight community nurses followed a pathway which involved the participants being linked with a mentor; undertaking a learning needs assessment; then planning a course of action by choosing from a menu of educational activities, both formal and in formal.

Participants were interviewed at three points during the process and mentors interviewed once. Interviews were transcribed verbatim, anonymised and analysed using an iterative approach drawing on grounded theory principles of constant comparative analysis

A multi facet realistic evaluation methodology was employed allowing exploration of the context, mechanisms and outcomes for the pathway. This approach offers the opportunity of getting inside the ‘black box’ of what actually happens when an initiative is translated into practice, and to unpick what works for whom and in what circumstances.

After participating in the educational activities the Training Needs Analysis results indicated significant changes in perceptions of confidence and competence by the end of the project.