Palliative And End Of Life Module For District And Community Nurses. Helen Way, Melanie Lewis, Kay Jeynes, Sally Anstey

Cardiff and Vale NHS Trust Concerns Low use of the ICP for the last days of life Lower than average numbers of home deaths High numbers of admissions during out of hours periods Variable levels of dedicated palliative care/end of life care education reaching DN’s 200 WTE staff, 250/70 DNs serving a population of nearly half a million.

KEY PRINCIPLES OF MODULE Distance practice based learning module Iteratively evaluated An internal requirement for all band 5 and 6 nurses Limited study days Should compliment current degree pathways Could be adapted as an All-Wales Programme That it will impact on and link to better outcomes for patients and staff

Module Content Principles of palliative and EOL care Exploring the patient and carer experience Assessment skills Management of symptoms. Communication. Psychosocial care Ethical and legal dilemmas Care in the last days of life. Loss grief and bereavement

Assessment. Completion of workbook and formative activities: EMCQ Summative EMCQ Problem based short answer question paper.

Evaluation Academic achievement/ numbers through cohorts? Student self evaluation pre and post module. Patient and Carer Outcomes.

Student Numbers July 2008 – Nov 2009 Cohort Number of Students Completed Pass Refer/ Extenuating Circumstances Other 1 20 15 14 1 Referral, 2 IOS and 2 extensions. 1 DNA 2 17 Exam Board 1 IOS, 1 DNA 3 23 In Progress 1 rejoining from IOS cohort 1. Total 60

Student Self assessments Cohort 1 & 2.

In their own words Pre module “I sometimes distance myself emotionally from patients and families. I feel this is because I am scared about the possibility of loosing a close family member” “ I do not feel confident in implementing ICP for the last days of life. Would like to be able to discuss issues comfortably but find it very difficult”

Post module I have discovered I am no longer “closed” in an emotive situation and dare to say “tell me how you feel”, instead of thinking “oh no they’re going to cry”. I feel very confident in implementing ICP and have done so on a few occasions despite GPs initial reluctance.”

Themes To Explore Further Self awareness - pre course I thought my knowledge was satisfactory but I realise now it probably wasn’t. I now feel my knowledge is at a “safe” level. Exposure to and communicating with palliative patients – “I had an unrealistic view of the patients perceptions”. “ I have only ever discussed end of life issues with a patient twice in my career ( band 6 for past 18 months.) Leadership, team working and allocation of palliative patients. “ I would like to be familiar with ICP but at present it’s not utilised in my team.”. “Only senior members of the team are allocated the palliative patients – until it’s our weekend on call”

Linking Positive Student Self Assessments to Improved Patient And Carer Outcomes Increased use of ICP - variance analysis, audit of notes. Improved communication skills – audit of notes Evidence of Advanced Care Planning.- audit of notes

Qualitative Research Explore the factors that facilitate or mitigate against knowledge gained during the module being put into practice. Internal factors External Factors. Examples of changes in practice rather than intention to change.