Training for doctors and nurses to deal with bereaved relatives after a sudden death: evaluation of the European Donor Hospital Education Programme (EDHEP) in Germany

The sudden death of a person is one of the most extreme and painful experiences for the relatives, and doctors require special communication skills to deal adequately with the bereaved. The Dutch European Donor Hospital Education Programme was developed to train doctors and nurses in talking to the bereaved relatives and to make the donation request. In Germany, the one-day workshop has been adapted to the German language, law, and clinical practice. The evaluation data of 75 workshops and experiences of 760 participants (doctors, nurses, and psychologists) are reported. The framework of, methods used, and issues dealt with in the workshop were clearly appreciated by the great majority of the participants. Criticisms and suggestions were directed mainly at the duration of the workshop. One third of the participants pleaded for a 2-day workshop, two thirds for a refresher course half a year later. The main effects reported were that two thirds of the participants rated that relatives could be helped, talked with, and cared for in a better way. The workshop participants also reported that they themselves were better able to cope with the situation and were more inclined to take on the task following the workshop. Finally, the necessities and limits of psychosocial training for doctors and their staff are discussed.     

Participants' judgements of the European Donor Hospital Education Programme (EDHEP): an international comparison

The European Donor Hospital Education Programme (EDHEP) is a one-day workshop, aimed at providing guidelines for breaking the news of the death of a relative and for raising the issue of organ donation with bereaved relatives. Participants' judgements of the workshop in the Netherlands and in the United Kingdom were compared to determine whether EDHEP meets doctors' and nurses' training needs in breaking bad news and requesting organ donation. In both countries EDHEP appears to be greatly appreciated by intensive care medical and nursing staff; the judgements are more positive in the United Kingdom than in the Netherlands. It seems that, irrespective of their professional experience, intensive care staff consider EDHEP a valuable teaching programme that increases confidence in communicating with bereaved relatives about death and organ donation. Received: 5 June 1998 Received after revision: 1 December 1998 Accepted: 22 December 1998     

The European Donor Hospital Education Programme (EDHEP): addressing the training needs of doctors and nurses who break bad news, care for the bereaved, and request donation

The competence of critical care staff when it comes to death and organ donation can make the difference between a family's agreeing to or refusing the latter. Doctors and nurses often feel uncomfortable approaching relatives about donation and attribute this to a lack of training. Bereaved relatives express dissatisfaction with inappropriate communication and support when brain death is announced and thereafter when a request for donation is made. The European Donor Hospital Education Programme (EDHEP) was designed to meet the training needs of critical care staff in breaking bad news, caring for the bereaved, and requesting donation. EDHEP is a two-part educational package consisting of a presentation about the donor shortage followed by a one-day workshop. The implementation of EDHEP throughout the world has been facilitated through effective national working groups and standardised “train the trainer” courses. Several countries anecdotally report increases in donation following implementation. Controlled evaluation of the effect(s) of EDHEP, which started at the end of 1995, focuses on the satisfaction of the participants with EDHEP, on the competence of the participants in breaking bad news and requesting donation, on the teamwork regarding death and donation, on the satisfaction of bereaved relatives, and on organ donation rates. Received: 5 June 1998 Received after revision: 1 December 1998 Accepted: 18 December 1998     

The European New Car Assessment Programme: A historical review

Established in 1997, the European New Car Assessment Programme (Euro NCAP) provides consumerswith a safety performance assessment for the majority of the most popular cars in Europe. Thanks to its rigorous crash tests, Euro NCAP has rapidly become an important driver safety improvement to new cars. After ten years of rating vehicles, Euro NCAP felt that a change was necessary to stay in tune with rapidly emerging driver assistance and crash avoidance systems and to respond to shifting priorities in road safety. A new overall rating system was introduced that combines the most important aspects of vehicle safety under a single star rating. The overall rating system has allowed Euro NCAP to continue to push for better fitment and higher performance for vehicles sold on the European market. In the coming years, the safety rating is expected to play an important role in the support of the roll-out of highly automated vehicles.     

Teaching communication skills using the integrated procedural performance instrument (IPPI): A randomized controlled trial

Background

The Integrated Procedural Performance Instrument (IPPI) uses various bench-top models positioned to standardized patients (SP) to recreate realistic clinical encounters. This study assessed the effectiveness of using an IPPI format as a teaching tool for communication skills.

Method

Thirty-two participants underwent 2 videotaped IPPI scenarios before randomization into 2 groups—experimental (SP-led feedback) or control (no feedback). Participants then completed 2 further IPPI format scenarios. Videotapes were scored by 2 blinded independent raters using validated assessment scales (communication and technical).

Results

The experimental group performed significantly better on the communication scores following feedback compared with the control group (mean 77% vs 66%, P < .05). No difference in scores for technical skills post-intervention were demonstrated (checklist: experimental mean = 64% vs control = 59%, P = .40; global ratings: experimental mean = 66% vs no control = 62%, P = .37).

Conclusions

The IPPI is an effective tool for teaching communication skills in residents and medical students and should be considered for incorporation into undergraduate and surgical curricula.     

The effect of context on communication: a study of the language and communication skills of adults with acquired brain injury

Primary objective: To examine the effects of changing contexts on language and communication skills of adults with acquired brain injury.

Research design: Repeated measures design.

Methods: Four adults with brain injury were observed in four contexts with pragmatic language and communication behaviours recorded. Contexts included baseline, two intervention phases (a 3-day camp and post-camp period) and 2-month follow-up.

Results: Participants demonstrated improvements in constructive language production during intervention phases. Results indicate structure, cueing and positive experiences created language which was observed to overcome the influence of organic damage. However, at follow-up, the language and communication levels returned to baseline levels.

Conclusion: Clinically, these results have implications for the development of sustained interventions for language and communication skills in community-based rehabilitation programmes. Creating supporting contexts may serve as an effective means of improving language and communication behaviours, while also facilitating optimum community inclusion.     

The Anaesthetic Services Programme Encompassing Nova Scotia (ASPENS)

A comprehensive peer review programme for anaesthesia departments in Nova Scotia was implemented in 1987 by the anaesthesia community. Departments are reviewed by peers at the request of the Head, Department of Anaesthesia, and the President of the Medical Staff. A confidential report with recommendations is written. Twenty-six reviews have been completed (to June 1993) and have most often documented deficiencies in: design of the anaesthesia record, anaesthesia staff recruitment, inadequate documentation of policies for anaesthesia and post-anaesthesia care, peer review/quality assurance processes, organizational structure of hospital medical staffs and operating room committees, and use of anaesthesia equipment that does not meet current (at date of review) CSA standards. In the four hospitals that have been reviewed twice, 24 of the 30 deficiencies noted on the first review had been corrected before the second review which occurred three to five years later. Nine new deficiencies were noted. Departments are encouraged to request a review every four or five years.     

Social communication skills in persons with post-acute traumatic brain injury: three perspectives

Objective: To describe social communication skills problems identified by individuals with traumatic brain injury (TBI) compared to significant other (SO) and clinician ratings; and associations between these skills and participation outcome measures.

Design: Cohort study.

Methods: Sixty individuals with TBI ≥ 1 year post-injury were administered measures of social communication, societal participation, social integration and life satisfaction. Clinicians and SOs rated the social communication skills of the subjects.

Results: Subjects were able to identify social communication skills problems, associated with lower ratings of community integration and satisfaction with life. Males reported higher scores in social communication and social integration than females. SOs and clinicians identified more social skills problems than subjects.

Conclusions: Persons with TBI experience social communication skills deficits, associated with decreased societal participation and life satisfaction. Further research is needed to determine efficacy of social communication skills treatment and association with improved participation and satisfaction with life.     

Learning by (video) example: a randomized study of communication skills training for end-of-life and error disclosure family care conferences

Background

Teaching residents to lead end of life (EOL) and error disclosure (ED) conferences is important.

Methods

We developed and tested an intervention using videotapes of EOL and error disclosure encounters from previous Objective Structured Clinical Exams. Residents (n = 72) from general and orthopedic surgery programs at 2 sites were enrolled. Using a prospective, pre-post, block group design with stratified randomization, we hypothesized the treatment group would outperform the control on EOL and ED cases. We also hypothesized that online course usage would correlate positively with post-test scores.

Results

All residents improved (pre-post). At the group level, treatment effects were insignificant, and post-test performance was unrelated to course usage. At the subgroup level for EOL, low performers assigned to treatment scored higher than controls at post-test; and within the treatment group, post graduate year 3 residents outperformed post graduate year ?1 residents.

Conclusions

To be effective, online curricula illustrating communication behaviors need face-to-face interaction, individual role play with feedback and discussion.     

Assessment of communication, professionalism, and surgical skills in an objective structured performance-related examination (OSPRE): a psychometric study

Background

The purpose of this study was to investigate the reliability and validity of a performance assessment of communication, professionalism, and surgical skills competencies for surgery residents.

Methods

Fourteen residents from the general surgery program of the University of Calgary were assessed in 7 surgical simulation stations that included communication and professionalism skills.

Results

The internal consistency reliability of the checklists and global rating scales combined was adequate for communication (α = .75–.92) and surgical skills (α = .86–.96), but not for professionalism (α = 0). There was evidence of validity as surgical skills performance improved as a function of postgraduate year level but not for the professionalism checklist. Surgical skills and communication correlated in the 2 stations assessed (r = .55 and .57; P < .05).

Conclusions

There is evidence for both reliability and validity for simultaneously assessing surgical skills and communication skills. Further instrument development is required to assess professionalism in a structured examination context.