Jan Waldock Lead Clinical Nurse Educator Arohanui Hospice

Transcription

1 The challenge of being a drop in the ocean when we aspire to be a wave How do we evaluate the impact of palliative care education in aged residential care? Jan Waldock Lead Clinical Nurse Educator Arohanui Hospice

2 Outline Future need for palliative care in aged residential care (ARC) Education Interface with ARC Evaluation Resource Network Group (RNG) Other forms of evaluation Are we making a difference?

3 Palliative Care in Aged Residential Care

4 Changing Landscape Older people are living longer Increased number of older people Living longer with multiple co-morbidities Up to 38% of older people will die in ARC with 50% of this population being over 85 years Increased need for a palliative approach Palliative care education is essential

5 Projected Place of Death New Zealand 2016 and 2038 Over the period of 22 years, deaths in residential care are projected to increase from 34.2% to 42.6% of total deaths. Over the period of 22 years, deaths in residential care are projected to increase from 34.2% to 42.6% of total deaths. Source: National Model of the Need for Palliative Care

6 Source: National Model of the Need for Palliative Care Projected Need Palliative Care Residential Care The need for palliative care is projected to increase by 37.5% in public hospitals and 84.2% in residential care by 2038.

7 ARC Education Interface 2003 Education role established Formal engagement with ARC Resource Group 2004 Ongoing Integrated with the Liverpool Care Pathway role (pilot) Terms of Reference and Roles and Responsibilities redefined Strong relationships continue to develop Networking opportunities and growth in education Study days and National programmes Resource Network Group

8 Education Provided Individual Facility Education (36 facilities) Palliative Care Partnership with General Practice Teams HNZ Fundamentals of Palliative Care HNZ Syringe Driver Competency Last Days of Life Symptom Management Themed Study Days Loss and Grief Bereavement Resource Network Group The need for palliative care is projected to increase by 37.5% in public hospitals and 84.2% in residential care by 2038.

9 Engagement with the Resource Network Group RNG Members ARC Meetings per year 4 meetings 1 study day 4 meetings 1 study day 4 meetings 1 study day 3 meetings 1 study day The Average need for Attendance palliative care is projected to increase by 37.5% in public hospitals and 84.2% in residential care by Palmerston North (15-33) 19 (16-22) 13 (5-15) 12 (6-22) Horowhenua (0-13) 8 (3-10) 4 (2-6) 5 (2-7) Tararua (5-7) 6 (3-9) 3 (0-6) 3 (0-6) Study Day Attendance 58 (73%) 57 (69%) 38 (53%) 39 (61%) Registered Nurses Enrolled Nurses Health Care Assistants

10 RNG Survey Members responses: RNG valuable/extremely valuable: 93-98% Organisational support for the role: 94-79% Enablers to fulfilling the role: Good managerial/organisational support Planned release time/rostering Rostering days off to be able to attend Attending in own time

11 Barriers to fulfilling the role These were consistent across the 3 years: Organisation Funding cost of backfill RNG low priority Staffing Skill mix No time to share education New managers unaware of the role Only 1 RN/shift Communication RNG meeting content not shared with staff members Conflict of schedules Roster schedules Care givers sharing is limited Staff Low staff numbers No cover No release time provided High workload Responsibilities of the RN s is increasing Daily acuity Priorities on the day

12 How will the learning be applied? Educate others Group discussions Sharing with others Role model Communicate Apply the Learning Listen more Handovers Update resources 1:1 with staff RN/team meetings

13 Facility Managers Perception of the Role of the RNG Members Positive comments: Nurses well informed Share and support others Absolutely makes a difference Role model Improved EOL care Better able to talk to residents & families Makes a huge difference Manage the resources Any education makes a difference

14 Facility Managers Perception of the Role of the RNG Members Constraints: Members don t feedback Hard to find time to share information with staff Some managers unaware of the role Depends on the nurse Difficulty attending the meetings One facility, no members as experienced nurses Staff turnover Managers from 2 facilities said it made no difference

15 Other Forms of Evaluation of Education The need for palliative care is projected to increase by 37.5% in public hospitals and 84.2% in residential care by 2038.

16 ARC Staff Perceptions and Impact of Education Focus Groups: Predominantly positive responses Education important Reduce suffering Anticipate needs Increase in knowledge and confidence including communication Improved confidence in talking with GP s and families Improved clinical assessment Increased awareness of symptom management Evaluation of care?

17 Areas for Consideration in Relation to Education Repetition of content Identifying dying and the need for palliative care Family expectations Staff lack confidence Financial issues

18 Additional Evaluations Programme specific Individual education sessions ARC facility Surveys Annual HNZ posttraining audit

19 Enablers to Participation in Education Organisational support for the role Provision of release time Education as a priority Forward planning Space to perform the role Funding

20 Constraints Staffing Skill mix Communication Release time Workload Acuity on the day No cover Low priority in facility Inability to share information

21 SEQUAL Project: Integrative Supportive Education and Quality Palliative Care CNS s working alongside ARC staff Ensure quality palliative & end-of-life care Empower and support staff (education and care planning) Strengthen integration and coordination Facilitate implementation of a quality framework

22 Summary Considerable education resource is provided to ARC staff Evaluations provide positive commentary Enablers require organisational support and priority Barriers/constraints predominantly focus on workload and staffing issues Anecdotal evidence supports an improvement in care of the residents No formal evaluation of the impact of palliative care education on the quality of palliative care for residents in ARC. SEQUAL Project may provide some evidence through measures used to implement the quality framework

23 We don t need to be a tsunami We just want to be a wave

24 References Connolly, M., Broad, J., Boyd, M., Kerse, N., & Gott, M. (2014). Residential aged care: The de facto hospice for New Zealander s older people. Australian Journal on Ageing, 33(2), doi: /ajag Downing, J., Batuli, M., Kivumbi, G., Kabahweza, J., Grant, L., Murray, S., Leng, M. (2016). A palliative care link nurse programme in Mulago hospital, Uganda: An evaluation using mixed methods. BMC Palliative Care, 15(40), Retrieved from Frey, R., Boyd, M., Foster, S., Robinson, J., & Gott, M. (2015). Burnout matters: The impact on residential aged care staffs willingness to undertake formal palliative care training. Progress in Palliative Care, 23(2), Hasson, F., Kernohan, W., Waldron, M., Whittaker, E., & McLaughlin, D. (2008). The palliative care link nurse role in nursing homes: Barriers and facilitators. Journal of Advanced Nursing, 64(3), doi: /j x Heals, D. (2008). Development and implementation of a palliative care link-nurse programme in care homes. International Journal of Palliative Nursing, 14(12), Retrieved from Latta, L., & Ross, J. (2010). Exploring the impact of palliative care education for care assistants employed in residential aged care facilities in Otago, New Zealand. Sites: New Series, 7(2), Retrieved from Mallee Division of General Practice. (2009a). Palliative care link nurse program. Retrieved from ural-agpn/154-operations-manual.pdf McIlfatrick, S., Mawhinney, A., & Gilmour, F. (2010). Assessing the educational needs of palliative care link nurses. International Journal of Palliative Nursing, 16(11), Retrieved from Morgan, A., MacLeod, R., & Schumacher, M. (2015). Providing palliative care education to staff in elderly care settings in New Zealand. European Journal of Palliative Care, 22(6), Parker, D. (2010). Palliative care in residential aged care facilities. Progress in Palliative Care, 18(6), doi: / x10y Partington, L., Langhorn, H., & Froggatt, K. (2008). Educational needs: Palliative care link nurses in care homes. End of Life Care, 2I(3), Retrieved from Waldron, M., Hasson, F., Kernohan, W. G., Whittaker, E., & McClaughlin, D. (2008). Evaluating education in palliative care with link nurses in nursing homes. British Journal of Nursing, 17(17),