Atlanta Veterans Administration Medical Center 1670 Clairmont RD Decatur GA 30033

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1 Marie A. Mompoint, DNP, FNP-BC, CHPN, OCN Linda Parker, CNS, AOCNS Veronica Reynolds, MSN, Nurse Manager Tesla Graham, MSN, OCN Sun ja Watson, BSN, MSN-Student Atlanta Veterans Administration Medical Center 1670 Clairmont RD Decatur GA 30033

2 Does palliative care education increase staff knowledge, improve nursing skills and enhance competency?

3 Deficiencies exist in palliative care education, skills, and knowledge of nurses. (Ferrell, 2006) It is estimated by the year 2030, one out of five Americans will be 65 or older, and the number of people over the age of 85 will double. (US Census Bureau, 2007) These statistics reveal a need to implement an evidence-based palliative care educational program.

4 Empower generic nurses in caring for the aging population Lack of nursing education in palliative care Enhance nursing knowledge Assess nurses knowledge and learning needs Need for further education and training in end-of-life. (Ferrell, Dahlin, Campbell, Paice, & Mallory, 2007)

5 Rosswurm and Larrabees s (1999) Six Step Process 1. Assess need for change in practice 2. Link problem interventions and outcomes 3. Synthesize best evidence 4. Design practice change 5. Implement and Evaluate change in practice 6. Integrate and Maintain change in practice

6 Facilitate the learning process and prepare healthcare professionals to provide quality end-of-life care. Establish a new educational culture Implement evidence-based palliative care education by incorporating the End-of-Life Nursing Educational Consortium(ELNEC) Curriculum Assess staff knowledge of end-of-life patient care

7 IRB approval by Samford University IRB approval by the Medical Center Participants may withdraw at any time Participants were provided with an identification number and used throughout the project Participants did not receive compensation or an incentive Participants names were anonymous/confidential

8 A pre- and post-test design: Palliative Care Quiz for Nurses (PCQN) was used to measure the level of knowledge regarding palliative care nursing. 20 items: True, False, and don t know questions Three content areas of the (PCQN): Philosophy and Principles of Palliative Care; Pain and Symptom Management; and the Psychosocial Aspects of Care.

9 The study was conducted at a Medical Center Hospital in the Southeast of the United States. A convenient sample of 33 nurses were selected in the area of in-patient, out-patient, and Community Living Center.

10 Educational content was guided by a framework of the essential nursing competencies by incorporating the End-of-Life Nursing Consortium Educational (ELNEC) Curriculum. The ELNEC Curriculum was developed in February 2000, in partnership with the American Association of College of Nursing and the City of Hope Cancer Center. The project focuses on improving the knowledge, skills, and abilities of staff by carrying out a plan for providing excellent palliative care.

11 Module 1: Palliative Nursing Module 2: Pain Management Module 3: Symptom Management Module 4: Ethical Issues in Palliative Care Nursing Module 5: Cultural Considerations in EOL Module 6: Communication Module 7: Loss, Grief, and Bereavement Module 8:Final Hours Module 9: Achieving Palliative Care. Activities: Role-play, video, case-studies and evaluation

12 n=33 (28) Registered Nurses, (3) Advance Practice Nurses, and (2) Licensed Practical Nurses

13 Results were determined by areas of strength that necessitate reinforcement and weaknesses for additional training Displayed a crucial need for educational initiative to improve palliative care Most nurses in this study were not knowledgeable about palliative care education

14 Type Overall Symptoms Philosophy Psychosocial Pre-training 70% 76% 54% 67% Post-training 82% 86% 69% 81% Increase in % of Post- Training 14% 12% 21% 17%

15 Pre-test scores indicated that 25 (86%) of the nurses had no formal education in palliative care. 8 (58%) nurses had at least 10 years of experience in various nursing departments. Overall, pre-training knowledge strength was 70%. Post-Training strength changed to 82%. Overall, post training increase strength was 14%.

16 Nurses were highly motivated and gave positive responses. On a scale of 1 to 5, with 1 = poor and 5=excellent, the scores for the overall course objectives ranged from 4.20 to The case-study sessions received the highest ratings.

17 The results of this study support the use of a Palliative Care Education training program to increase nurses knowledge in the provision of end-oflife care for patients and families. This suggested that nurses knowledge can be increased by attending continuing education on endof-life care. The more education and discussion about end-of-life, the better prepared nurses will be to meet the many needs of patients and their families

18 American Association of College of Nursing. About ELNEC (2004). Retrieved August 20, 2008 from htpp:// Anning, P., Bowen, S., Holman, H., Leedham, K., & McGill, M. (2002). A framework for nurses working in specialist palliative care: competencies project. London: Royal College of Nursing. Billings J.A., Block S.: Palliative care in undergraduate medical education: Status report and future directions. JAMA 278: , 1997 Brumley, R. D. (2002). Understanding Palliative Care and the TriCentral PC Program : What is - palliative care? Retrieved December 27, 2008, from TriCentral Palliative Care Toolkit : Drakes, R. Frost, J., & Collins, J. J. (2003). The symptoms of dying children..journal of Pain and Symptom Management, 26, Casarett, D.J., Hirschman, K.B., Henry, M.R., (2001). Does hospice have a role in nursing home care at end-of-life? Journal of Geriatric Society 49 (11), Ersek, M., Grant, M. M., & Kraybill, M. B. (2005). Enhancing end-of-life care in nursing homes. Journal of Palliative Medicine, 8(3), Ferrell, B.R., & Coyle, N. (Eds.). (2002). Textbook of palliative nursing. New York: Oxford University Press.

19 Jemal, A., Siegel, R., Murray, T., XU, J., & Thum, M. J. (2007). Cancer statistic, A Cancer Journal for Clinicians, 57, Linder, J. F., Blair, J., Enders, S.R., Melberg, S.E., & Meyers, F. (1999) Palliative education: a didactic and experiential approach to teaching end-of-life. Journal of Cancer Education, 14(3) Mallory, J. L. (2003). The impact of a palliative care educational component on attitudes towards care of the dying in undergraduate nursing students. Journal of Professional Nursing 19, (5), Matzo, M. L. (2004). Palliative care: Prognostication and the chronically ill. American Journal of Nursing, 104 (9), Max, M., Cleary, J., Ferrell, B., Foley, K., Payne, R., & Shapiro, B. (2008). American pain society. Retrieved September, 18, 2008, from American Pain Society Web Site soc.org/advocacy/treatment.htm McLoughlin, N. (2007). Dying to Know: Advancing Palliative Care Nursing Competence with Education in Elderly Health Settings. Wellington: Victoria University of Wellington Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia:.Lippincott Williams & Wilkins Morrow, A. (2007). About.com guide to palliative Care. Retrieved August, 20, 2008, from

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