1. WELSH PILOT PROJECT TO DEVELOP A DISTANCE LEARNING PROGRAMME FOR THE EDUCATION AND SUPPORT OF DISTRICT & COMMUNITY NURSES IN PALLIATIVE & END OF LIFE CARE
MEL LEWIS
MACMILLAN NURSE ADVISOR SEWCN
HELEN WAY
PRACTICE EDUCATOR CARDIFF & VALE NHS TRUST

2. BACKGROUND TO PROJECT
“It is unlikely that patient choice about place about place of death is being met within the Network” Tebbit (2005)
Proportion of deaths dying in hospices is lower than national average
Percentage of deaths dying in hospital is higher than the national average
Percentage of deaths dying in care homes is lower that the national average

3. EVIDENCE FROM NICE (2004)
Lack of preparation for patients wishing to remain at home
Poor recognition of symptom problems
Poor recognition of care needs, leading to crisis management
Inappropriate admissions to secondary and hospice services
Variable use of specialist pall care services
Poor recognition of the dying phase

4. UK NATIONAL DRIVERS
NICE Guidance for Supportive & Palliative Care for Adults (2004)
Population Needs Assessment TEBBIT (2005)
Designed to Tackle Cancer (2006)
Health & Social Services Committee: Review of Cancer Services (2007)
Marie curie ‘supporting the choice to die at home’ campaign
Preferred Place of Care Project (2006)

5. CANCER NETWORK CONCERNS
District nurses role in end of life care
Disparity and inequity in access to palliative care education for district nurses
England has delivered on DN education

6. PROFILE OF CARDIFF & VALE NHS TRUST
200 WTE qualified nurses
25O/70 Staff members
Population of nearly half a million

7. CARDIFF AND VALE NHS TRUST
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

8. MAKING IT HAPPEN Develop bid for DN Project Secure Resources
Engage partners
Commission Cardiff University to design, develop and implement module
Develop Project Board
Practice Educator Post
Validate module
Audit outcomes

9. PARTNERSHIP PROGRAMME

10. KEY PRINCIPLES OF MODULE
Distance practice based learning module
Iteratively evaluated
Practice educator
An internal requirement for all band 5 and 6 nurses
Limited study days
Should compliment current education pathways
Should be at degree level
Flexible for part-time staff
Assessed by achievement of competencies
Could be adapted as an All-Wales Programme
That it will impact on and link to better outcomes for patients and staff

11. 3 YEAR PROJECT PLAN
Phase one – design and develop learning materials, phase 1 implementation in Cardiff and Vale and evaluation.
Phase two – potential development for use across Wales
Phase 3 - potential to adapt programme for HSCSW’s

12. 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

13. PALLIATIVE AND END OF LIFE CARE MODULE
Validated at level 3
30 CAT’s points
300 hours of study
Can be utilised as part of the BSc Clinical Practice Pathway
Or as a stand-alone module that links to professional development requirements

14. ASSESSMENT Formative Summative Completion of workbook and:
Clinical log
Summative
EMCQ
Problem based short answer question paper

15. EDUCATION DELIVERY Outcomes linked to KSF
Web based or paper copy formats
DVD
Supported blended learning approach
Access to all CU academic tutorial and learning resources
Blackboard VLE

16. PRACTICALITIES
300 learning hours (150 in practice setting) leaving 150 hours of self directed study and facilitator time
Aprox. 26 weeks to complete
1 day in University for registration purposes and attendance at university for end of module assessment
4 x half day face to face facilitation at local base with additional access to PE as required
20 students enrolled on first cohort July 09

17. EVALUATION OF PROGRAMME
Pre and post module palliative self assessment exercise. Reassessment at month post module
Numbers of palliative patients on caseload
Number of patients on ICP
Audit of referrals and advice calls from DNs
Reduction in inappropriate out of hours admissions to secondary / tertiary and specialist care
Patient carer satisfaction surveys
Evidence of communication with patients regarding their care and advanced care planning

18. PALLIATIVE CARE SELF ASSESSMENT EXERCISE
7 sections producing quantative and qualitative data. Use of Bristol-on-line survey tool.
Palliative care provision
Physical care skills
Communication skills
Psychosocial skills
Life closure / end of life skills
Self care
Team leadership skills

19. PALLIATIVE CARE PROVISION

20. LIFE CLOSURE EOL SKILLS

21. IN THEIR OWN WORDS
“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 am not comfortable at all in talking about my own feelings of death.”

22. “As individuals and as a team I think we could be more knowledge based and use the services available to us to access evidence based practice.”
“ 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.”

23. “I would like to be able to assess patients pain , to obtain knowledge and recommend interventions to the GP”
“ Would like to feel more confident in discussing possible actions with GP.”
“ I need to update my knowledge of pain and symptom management and be able to recommend a course of action to GPs”

24. THE FUTURE OF THE MODULE
Measurable outcomes – strategic, organisational, operational and personal / professional
? Usefulness and appropriateness of module for other areas in Network or throughout Wales
? Appropriateness of use with other disciplines
Icp, ooh admissions, critical incidents, confidence & competance