1. St Leonard’s Care Home ProjectBy
Alison Skelton and Lynda Ruddock
Clinical Nurse Educators

2. Background to the Project
To celebrate St Leonard’s 30th Year, a fantastic opportunity was sanctioned by the trustees to deliver palliative and end of life care training to care homes across the Vale of York as part of a two year project.
A thank you to people in the locality who have supported the hospice during this time by providing education and training back into the community.
As part of the two year project the training provided is delivered free of charge.

3. Aims and Objectives
Improve care home staff confidence and skill in relation to palliative and end of life care.
Build on and develop existing knowledge around palliative and end of life care and care delivery for care home staff.
To empower staff members both registered and non registered to be able to deliver good quality end of life care.
Reduction in inappropriate hospital admissions and emergency call outs at the end of life.
To represent and promote the ethos of the hospice within the wider community.

4. Where did we start? Started in post November 2015. Research
Introductions at the CCG Care Home Forum.
Independent Care Group, communicated through their networks.
Dr David Mazza, cascaded information regarding the project and contact details for the team to Vale of York GP’s.
Meeting with Saint Catherine's Hospice – Education and Clinical Support for Care Homes.
1st training session delivered 18th January 2016.
Research
National Legislation – “End of Life care Strategy” (2008), “One Chance to get it right” Leadership Alliance for the care of dying people (2014), following on from Baroness Julia Neuberger’s review “More care Less Pathway” (2013), “NICE Guidance, Care of the Dying Adults in the last days of Life, published December” (2015) and more recently, “The review of choice in end of life care” (2015) and the “What’s Important to me document” by the choice in end of life care programme board as well as the government response to the review named “Our Commitment to you for end of life care”.
In addition to this research from medical and nursing journals, books, you name it we have read it!!
This enabled us to identify which topic areas we needed to cover in relation to national recommendations as a starting point.

5. What do we do?
Identify care homes which have shown an interest in undertaking the training.
Meet with care home managers/senior nurses to discuss their organisation and training needs of their team and to negotiate training dates and venue.
Using research undertaken from the onset of the project, training sessions are structured around the needs of the care home, but also in line with national legislation in particular focusing on the 6 C’s.
Nursing Homes – 2 day training per session.
Others – 1 day training per session.
Identify care homes which have shown interest in the training – Interest is generally made via telephone call to the team or .
Meet with care home managers to discuss their organisation – this then enables the training to be very specific to the need of the care home staff and enables the training to be linked to relevant practice.
Others – Residential, care agencies, assisted living homes.
In addition to this all has to be planned around holidays, IPU shifts (2 x per month) and other training commitments encountered at the hospice i.e. CPR and Confidence and Courage Training days.

6. Palliative and End of Life Care Training Day One
NURSING HOME

7. Palliative and End of Life Care Training Day Two
Spirituality – This session is dependant on the different organisations as some care homes have their own spiritual teams or have not wanted this session covering.
Also included is a Tour of St Leonard’s Hospice if the training is delivered on site to raise the awareness of the hospice and show people what a fantastic place we work and what we can offer just in case any of their residents or families need to use the hospice facilities. If the training is being delivered off site, then information is left with the care home staff.

8. Palliative and End of Life Care Training
Time
Session
09:00 – 09:30
Introduction and Housekeeping
09:30 – 10:45
Dignity and Choice
Symptoms
10:45 – 11:00
COFFEE
11:00 – 11:45
Nutrition and Hydration
11:45 – 12:00
Mouth care
12:00 – 12:30
Tour of St Leonard’s Hospice
12:30 – 13:15
LUNCH
13:15 – 14:15
Long Term Conditions
14:15 – 15:15
Skincare
15: :30
15:30 – 16:30
Grief and Bereavement (Karen Stonehouse)
16:30 – 17:00
Questions and close of the day
Residential Home / Care Agency

9. Training Sessions delivered
Number of education sessions delivered since January 2016 – August 2016 – 34
Total number of care home staff attended training-150
Number of training sessions cancelled – 4
Mean average number of attendees per group – 5
Training delivered either at St Leonard’s Hospice or off site.
Training sessions cancelled 4 – 1 reason was non commitment of the care provider and the second reason was a decision made to cancel training and rearrange a further date due to a care home over committing there staff
Mean Average – Although the mean average looks low, this is a mean average, in some groups we have had 5 – 6 people attend and in other groups 11 – 12 people attended the sessions, it very much depends on the organisation and sizes of the workforces.

10. Training Venues

11. Follow up

12. How do we evidence?
Pre and post training questionnaires using the Linkert Scale.
Knowledge around palliative and end of life care and measurement of confidence.
Training Evaluation
6 month knowledge and confidence questionnaires.
Impacts on service
Linkert Scale – Similar approach to measurement of service impact used in Scarborough
It is the most widely used approach to scaling responses in survey research. The format looks at the responses rating from high to low asking respondents to indicate how much they agree or disagree, approve or disapprove for example. Such statements which we ask are how confident does the person feel in recognising that a person is dying? In regards to knowledge asking certain statements around nutrition and hydration at the end of life for example and myths that are associated around certain topic areas.

13. What has the evidence shown so far? Knowledge
Results from 2 care homes
Positive responses in regards to Thoughts around Palliative and end of life care, focusing on knowledge highlighted in areas around:
Nutrition and Hydration
The purpose of palliative care inclusive of dignity and choice
Awareness of spirituality
Symptom awareness and management
Results from care homes - other work is currently incomplete so we cannot evidence this at this time.
Results are taken from staff attending the training self assessing their knowledge and confidence but have generally been found to be quite honest.

14. What has the evidence shown so far? Confidence
59% increase in confidence around Advance care planning
41% increase in confidence around recognising when a person is dying
59% increase in awareness of who to contact to provide specialist advice and support
31.5% increase in recognising own limitations and where to access support in order to give the best possible care
24% increase around understanding the spiritual needs of a person and why this needs to be addressed
37% (Nursing Home) increase in confidence understanding the term dignity and choice at the end of life
48% increase in communication around end of life

15. Potential Cost Savings
Audit carried out identified high admission rates for care home residents at the end of life between
Audit looked at individuals dying in the acute setting within 72 hours of admission
Following the completion of training post 6 months, amount of deaths and place of deaths reviewed at particular care home
Pre training the care home had 7 residents at the end of life all of whom were admitted to hospital and died within the acute setting
Post training 8 deaths between Jan 2016 – Aug hospital admission
7 residents died in THEIR home and were nursed by the care
home staff

16. Challenges faced
Discussion causing staff to become emotional and reflect on their personal experiences during breaks or at the end of sessions
Staff Professionalism
Staff engagement
Size of care home training rooms vs. size of staff groups
Non attendance of staff
Technology
Time Keeping
Culture/Language

17. What have we learnt? Ground Rules Self sufficiency Flexibility
Self Care
Timing of evaluation forms
Ice breakers/Interactive group work
Assertiveness
Professionalism

18. Support To enable us to deliver the training. Each other Line Manager
Director of Clinical Services
Education sub-committee
Lead Nurse for End of Life Care for York and Scarborough
Macmillan Nurses
Community Matron

19. What’s next? Beaumont Care November 2016
Contact made with Arc Light and training sessions planned for December 2016
Contact made with HMP Full Sutton and training sessions planned for early 2017
Continuation of training to perspective care homes across the locality

20. And after a long day………

21. Any Questions?