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Scope of Education and Training in EOLC
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Scope of Education and Training in EOLC
8 Universities (Pre-Registration 32/19) 5 Universities (Post Reg 22/12)
11 Acute NHS Trusts 8 Hospices 2 Independent care home companies/I care home 11 PCTs 5 Councils NW Ambulance Service 3 Other
43 Trainers (39) 268 Staff (215)
Sample
Geographical Spread
Geographical SpreadLancashire
Merseyside Cumbria Greater Manchester
Cheshire
Acute Trust
2 2 6 1
PCT 6 1 4
Hospice 4 1 1 1 1
Council 2 1 2
Care Homes
THREE REGIONALLY
Other 1 2
University Pre
Post
1
2
3 3
2
1
1
Nursing (16)
Medicine (5)
Social Work (1)
Spread of pre-registration courses
yes no
(missing)
66%
34%
Have you revalidated your course since 2008
(40%)
Interprofessional learning 5 out of 31 respondents said their courses
had shared learning across disciplines on the course
Of those this included:◦ Nurses◦ Medical students◦ AHPs◦ Social Workers◦ Assistant Health Care Practitioners
16%
18%
16%
19%
15%
15%
Discussions as EOL approachesAssessment, care planning and reviewCo-ordination of patient careDelivery of high quality servicesCare in the last days of lifeCare after death
Content taught:
Specific skills
Use of the "surprise question"
Function of the supportive care register
Advance care planning
Assessment of the patient's capacity (Mental Capacity Act)
Coordination of services
Discharge planning
Rapid response services
Referral to and use of community specialist palliative care teams
Hospital specialist palliative care teams
Out of hours services
Role of out of hospital services
Liverpool care pathway
Preferred place of care
Cultural and religious practices
Bereavement support
Verification of death
Referral to coroner
0 2 4 6 8 10 12 14 16
No
Yes
Symptom Management
Pain
Nausea and vomiting
Intestinal obstruction
Breathlessness
Cough
Haemoptysis
Respiratory tract secrections
Spinal cord compression
Superior vena cava obstruction
Hypercalcaemia
Management of the last few days of life
Terminal restlessness and agitation
Use of steroids
Indications for the use of a syringe driver in palliative care
0 2 4 6 8 10 12 14
Yes
Knowledge of Strategies
Never heard of it
Have a copy Have read it Use in teaching (missing)0
10
20
30
40
50
60
70
80
A
NHS Northwest EOL Care Model
Liverpool Care Pathway
Preferred Priorities for Care
Gold Standards Framework
End of Life Care Strategy
Educational Approaches
Teaching Assessment
Commonly face to face teaching, simulation and use of case scenarios
Service users/carers involved in 1/3 of cases
Personal values and reflection covered (1/3)
By a men-tor in practice
Role play
Blended approach (multiple methods)
Practice based involving service user feedback
Assessment of specific competencies in practice
Needs assessment of patient
Developing a care plan that records carer preferences
Ensuring that all health and social care staff have access to the care plan
0
5
10
15
20
25
30
Yes
(missing)
Recognised educator to work alongside pre-registration teams
Incorporate generalist palliative care from year 1 medicine
Access to skilled mentors Theme through three years Module dedicated to EOLC at end of course More patient and carer input Use new nursing standards
What could be done to improve education
5 Universities
22 Course/Module Leaders (12)
Post Registration Courses
Professional groups on post reg courses
Nurse
sGPs
Hospi
tal/o
ther
med
ical
Allied
Hea
lth P
rofe
ssio
nals
Para
med
ics/am
bula
nce
staff
Social
wor
kers
(miss
ing)
0
2
4
6
8
10
12
14
Do you teach any of the following
Set up an organisational action plan
Identify those patients approaching the end of life
Offer a care plan to those patients approaching the end of life
Ensure patient choices are documented and communicated
Ensure carers' needs are assessed and recorded
Co-ordinate care across organisations
Ensure services are in place 24 hours a day, seven days a week
Establish workforce development in end of life care
Use the Liverpool Care Pathway or equivalent
Monitor and audit quality
0 1 2 3 4 5 6 7
23%
16%
16%16%
16%
13%
Discussions as EOL approaches
Assessment, care planning and review
Co-ordination of patient care
Delivery of high quality services
Care in the last days of life
Care after death
Other
EOLC content
Yes No Never heard of
it
Heard of it but use
other tool
(missing)0
2
4
6
8
10
12
4 43
11Do you use the PPC Tool?
Yes No (missing)0
2
4
6
8
10
12
Do you use the LCP in your teaching
Do you teach the surprise question
27%
5%18%
50%
Yes
No
Never heard of it
(missing)
Do you teach the following
Discussions at the end of life: Assessment, care planning and review
Advance care planning
Coordination of care: Coordination of services
Coordination of care: Rapid response services
Coordination of care: Out of hours services
Care in the last days of life: Liverpool care pathway
Care in the last days of life: Cultural and religious practices
Care after death: Verification of death
0 1 2 3 4 5 6 7 8 9
NoYes
11 Acute NHS Trusts 8 Hospices 2 Independent care home companies/I
care home 11 PCTs 5 Councils NW Ambulance Service 3 Other
43 Trainers (39)
Trainers
71%
24%
2%2%
YesNoDon't know(missing)
Does your organisation have an EOLC Lead
Is your organisation implementing the EOLC strategy?
45%
14%
17%
7%2% 14%
Yes: 2008 Yes: 2009 Yes: 2010Intend to: 2011 No plans (missing)
Do you offer training in?
End
of Life
Car
e St
rate
gy
Gold
Stan
dard
s Fr
amew
ork
Pref
erre
d Pr
iorit
ies fo
r Car
e
Live
rpoo
l Car
e Pa
thway
NHS Nor
thwes
t EOL
Care
Mod
el
DNR Ord
ers
Organ
refe
rral
(don
atio
n)
With
draw
al o
f tre
atm
ent o
rder
Lim
itatio
n of
trea
tmen
t ord
er
None
of a
bove
0
5
10
15
20
25
1216
10
22
6 8
25 4
1
Sypmtom Management
Pain
Intestinal obstruction
Cough
Respiratory tract secrections
Superior vena cava obstruction
Management of the last few days of life
Use of steroids
0 5 10 15 20 25 30
Which staff groups attend
NHS Nur
ses
Assist
ant H
ealth
care
Pra
ctiti
oner
s
Med
ical
Sta
ff
GPs a
nd p
ract
ice
staff
Para
med
ics
Social
Car
e pr
ofes
sion
als
Hospi
ce sta
ff
A&C s
taff
Care
wor
kers
Volu
ntee
rs0
5
10
15
20
25
3024
16
7
1 0
7
14
1
12
2
Team trainers37%
General Nursing staff 29% Specialist nursing staff
85% Medical staff
8% Specialist medical staff
51% GPs 20% AHP 17% Ext company/trainer 14% Other
26%
Who teachers?
Lecture
Discussion
Role Play
Case Studies
Vignettes/Pt stories
Seminars/Small group work
Video
37 29 63 80 37 71 48
Teaching approaches used (%)
What does your training aim to achieve?
31%
28%12%
19%
10% Raise awareness
Develop individual competencies
Discuss Trust ob-jectives
Redesign practice
Other
Number of missing responses Limited sample although reasonable spread Focus tends to be on nursing staff/IPL not well embedded Staff report mixed competence in skills albeit these are
growing PPC not used in teaching on university courses Significant amount of training taught in house Varied knowledge of EOLC tools and strategies Teaching approaches seem in line with skills required Opportunities for learning seem to be there – APPLICATION There appears to be a gap in what is taught, learnt and
applied when one compares views Is practical assessment lacking? Largely taught post qualification and through in-house
training
Implications
