End-of-Life Nursing Education Consortium. Geriatric Training Program: improving palliative care in community geriatric care settings

Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)-Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC-Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC-Geriatric Training Program and follow-up evaluation of the "train-the-trainer" model to disseminate comprehensive palliative care education in geriatric settings.     

Global efforts to improve palliative care: the International End-of-Life Nursing Education Consortium Training Programme

AIM: This paper is a report of an evaluation study to determine the feasibility and effectiveness of the End-of-Life Nursing Education Consortium-International training conference in providing education and support materials to participants so they might return to their home countries and disseminate palliative care information. BACKGROUND: More than 50 million people die each year, many without access to adequate pain control or palliative care. Numerous barriers to implementation of palliative care exist, including lack of education provided to healthcare professionals regarding these principles. Because they spend the most time with patients and their families, nurses have the greatest potential to change the way palliative care is provided. METHOD: A Course Evaluation Form and a Postcourse Activity Evaluation was completed by a convenience sample of 38 nurses from 14 Eastern and Central European, former Soviet, and Central Asian countries. The data were collected in 2006 using Likert scales and open-ended questions. FINDINGS: Evaluations of speakers ranged from a mean of 4.4 to 4.9 on the 5-point scale, with five denoting the highest level. The mean rating of the conference overall was 4.9. Strengths included the professional level of presentations, practical, clinically based content, extensive resources and availability of the educators. CONCLUSION: The first End-of-Life Nursing Education Consortium-International training programme demonstrated the feasibility of providing high-quality, essential education to nurses from a variety of countries. Because End-of-Life Nursing Education Consortium is designed as a train-the-trainer programme, assistance with translation to native languages, along with textbooks and other resources, is needed to allow participants to fully implement this curriculum.     

Achieving quality care at the end of life: a focus of the End-of-Life Nursing Education Consortium (ELNEC) curriculum.

This article introduces the didactic content and teaching strategies presented in the End of Life Nursing Education Consortium (ELNEC) curriculum on the topic of "Achieving Quality Care at the End of Life." The American Association of Colleges of Nursing joined forces with the City of Hope National Medical Center to begin a national education initiative, entitled the, "End of Life Nursing Education Consortium" (ELNEC) (available: http://www.aacn.nche.edu/elnec/). Funded for nearly $3 million from the Robert Wood Johnson Foundation, ELNEC was launched in February 2000 as a consortium of many organizations to ensure a collective professional approach to improve end-of-life care. The ELNEC curriculum is a train the trainers course with the expectation that those trained in the ELNEC curriculum will disseminate knowledge related to end-of-life care.     

Expanding palliative care nursing education in California: the ELNEC Geriatric project

In the past decade, the Robert Wood Johnson Foundation's 2002 report Means to a Better End: A Report on Dying in America Today and other studies brought attention to deficiencies in care of the dying in the USA. Palliative care's mandate is to promote a 'good death' through expert symptom management and compassionate care that addresses the psychosocial needs and dignity of persons at the end of life. The End-of-Life Nursing Education Consortium (ELNEC) Geriatric 'train-the-trainer' project was launched in 2007 to increase the knowledge and educational skills of nurses and unlicensed staff providing end-of-life care for older adults in nursing homes, skilled nursing facilities, long-term care, and hospices. From 2007 through 2009, 351 California-based nurses and nursing home staff attended one of four ELNEC Geriatric courses. This paper describes programme development, implementation, follow-up evaluations, and examples of participants' use of the ELNEC Geriatric curriculum.     

End-of-life nursing education consortium for pediatric palliative care (ELNEC-PPC)

Pediatric nurses must often care for children with life-threatening illness. Although the child may be a neonate with multiple organ failure, a young adolescent diagnosed with HIV, or a 7-year-old child involved in a serious bicycle accident, pediatric nurses are an essential part of the interdisciplinary team that plans, organizes, implements, and manages the care of these children and their families. To date, more than 600 pediatric nurses have attended a national End-of-Life Nursing Education Consortium-Pediatric Palliative Care (ELNEC-PPC) training program. Many of these nurses have returned to their institutions dedicated to making a difference in the palliative care provided to children and their families. Because pediatric palliative care education is so important, many trainers have incorporated ELNEC-PPC into their nursing orientation, annual competencies, and undergraduate and graduate nursing education. They are developing standards of care and serve on key hospital/hospice committees, such as policy, education, clinical care, and ethics committees. This article showcases various activities of ELNEC-PPC trainers and demonstrates their commitment to improve pediatric palliative care not only in their institutions but also on local, state, national, and international levels.     

End-of-life care in end-stage renal disease: renal and palliative care

The numbers of patients with end-stage renal disease are growing, with a disproportionate increase among those who are elderly, dependent and with multiple co-morbidities. More of these patients are choosing to be managed conservatively, without dialysis. Palliative provision for these patients within UK renal services is limited, but the recent National Service Framework for Renal Services (Department of Health, 2005) has promoted service development. However, few models of service provision have been described. This article describes a retrospective review of a new service for conservatively-managed patients with end-stage renal disease. The range and complexity of the health needs of this population is demonstrated, and an example of service development described. A model of the stages of the conservative pathway and appropriate interventions was developed. The absence of research evidence prevented development of formal audit standards, and highlighted the urgent need for evaluation of models of care.     

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.     

Using the improving palliative care in the intensive care unit (IPAL-ICU) project to promote palliative care consultation

Background

The Improving Palliative Care in the Intensive Care Unit (IPAL-ICU) project is an initiative designed to improve the quality of palliative care in the intensive care unit. One of the problems to be addressed is the underutilization of palliative care.

Measures

The percentage change in number of palliative care consults in the Medical ICU (MICU) and Surgical ICU (SICU) compared with the same time period the previous year was used as an objective measure to indicate increased utilization of palliative care.

Intervention

Two hundred seventy-three patients were screened for potential palliative care consultation. After each patient screening, the attending physician was offered the opportunity to consult the palliative care consultation team.

Outcomes

In comparison with the same time period the previous year, an increase in palliative care consults of 113% in the MICU and of 51% in the SICU was noted during the screening period.

Conclusions/Lessons Learned

The IPAL-ICU project framework and recommendations can be effectively used to increase the number of palliative care consults in the ICU.     

End-of-life care in UK critical care units--a literature review

Aim: To appraise literature concerning end‐of‐life care (ELC) in adult critical care units in the UK in order to improve clinical practice. Objective: To understand the interplay between legal and ethical, political, societal aspects of ELC for sustainable quality care. Background: Significant changes in health care policy for the critically ill patient have occurred since 1999. Simultaneously, the government is committed to improving care for the dying by integrating the palliative care ethos across the National Institutes of Health (NHS) to include non‐cancer sufferers. Death continues to be a feature of critical illness, particularly following the decision to withhold/withdraw life‐prolonging treatments. Search strategy: A search of MEDLINE, BNI, CINAHL and PSYCinfo using key words revealed very few results; consequently, the search was broadened to include ASSIA, King’s Fund, TRIP, Healthstar, NHS Economic Evaluation Data, Cochrane, professional journals and government documents. Conclusions: The literature reveals a paradigm shift from critical to palliative care, in other words, from a reductionist approach to a more humanistic approach in the acute setting. When treatment is deemed futile, quality ELC involving the assessment, ongoing assessment and care after death becomes the new goal for the critical care team. To practice ELC competently, nurses require organizational and educational support at local and national levels. Relevance to clinical practice: Although medico‐legal decision‐making is not part of their professional role, critical care nurses have an extraordinary opportunity to make a difference to the dying patient and their family and their acceptance of death.     

End-of-life care in the community: attaining a critical balance

There are not many people who will argue against the need for high-quality care in all healthcare settings, and particularly at the end of life. The recently published report by the Care Quality Commission (CQC, 2011) makes a number of negative observations about poor quality of care in the 100 hospitals they inspected. The report concluded that many hospitals are failing to meet basic needs of older people. It is important that we nurses provide essential care, as there is nothing basic about patients' needs, wishes and aspirations at the end of their lives.     

Residential aged-care facility palliative care guidelines: improving care

The Guidelines for a Palliative Approach in Residential Aged Care (Australian Government Department of Health and Ageing, 2004) are the result of the synthesis of evidence from three disciplines: geriatrics, gerontology and palliative care. Each paradigm challenges and informs the others, together developing a balanced and enriched understanding of palliative aged care. The guidelines address the challenges of the clinical and service delivery contexts of palliative care in residential aged care facilities, including the impact of complex, co-morbid illnesses with unpredictable trajectories; shorter, more dependent inpatient stays; and an evolving accreditation process.