A palliative care link nurse programme in Mulago Hospital, Uganda: an evaluation using mixed methods

Abstract

BackgroundIntegrating palliative care (PC) and empowering the health care workforce is essential to achieve universal access to PC services. In 2010, 46 % of patients in Mulago Hospital, Uganda had a life limiting illness, of whom 96 % had PC needs. The university/hospital specialist PC unit (Makerere/Mulago Palliative Care Unit –MPCU) implemented a link-nurse model to empower hospital nurses to provide generalist PC. Over two years, 27 link nurses were trained and mentored and 11 clinical protocols developed. The aim of the study was to evaluate the impact of the palliative care link nurse programme at Mulago HospitalMethodsAn evaluation approach utilising mixed methods was used integrating qualitative and quantitative data including: pre and post course assessment confidence ratings; course evaluation forms; audit of clinical guidelines availability; review of link-nurse activity sheets/action plans; review of MPCU patient documentation; Most Significant Change (MSC); individual and focus group interviews.ResultsA significant difference was seen in nurses’ confidence after the training (p < 0.001). From July 2012 to December 2013, link nurses identified 2447 patients needing PC, of whom they cared for 2113 (86 %) and referred 334 (14 %) to MPCU. Clinical guidelines/protocols were utilised in 50 % of wards. Main themes identified include: change in attitude; developing new skills and knowledge; change in relationships; improved outcomes of care, along with the challenges that they experienced in integrating PC. Since the start of the programme there has been an increase in PC patients seen at the hospital (611 in 2011 to 1788 in 2013).ConclusionThe link-nurse programme is a practical model for integrating PC into generalist services. Recommendations have been made for ongoing development and expansion of the programme as an effective health systems strengthening approach in similar healthcare contexts, as well as the improvement in medical and nursing education.

Healthcare professionals and volunteers education in palliative care to promote the best practice–an integrative review

“…Nine studies are from the America , seven from Europe , three from Africa and two from Asia . Most studies were obtained in a paper format and four theses . The geographical spread highlights the worldwide attention to the field of palliative care and the achievements in implemented education initiatives.…”

“…As to class attendance, three initiatives presented a mandatory attendance after volunteer enrolment , and only one initiative exhibited mandatory enrolment and attendance . The outstanding initiatives have shown optional attendance or related with recruitment numbers . None of the research initiatives reported how recruitment figures were calculated.…”

“…The ‘course delivery mode’ presented eight face‐to‐face studies , seven distance learning or computer‐based learning studies , four studies incorporated both classroom and computer‐based learning , and three initiatives did not describe the delivery mode . Some courses included face‐to‐face learning or computerised learning with placement experience .…”

“…The initiatives provided an overview of the major aspects of working with people at a palliative care set. Most of the content covered the patient area: control of symptoms , communication and difficult conversations emotional distress and psychiatric issues , artificial nutrition and hydration , spirituality and bereavement , palliative care input in noncancer patients , ethical, legal, cultural and social issues and dying and cultural complexity .…”

“…Other content was related with the definition of palliative care, end of life, hospice and model of palliative care , models of care and role of insurance companies .…”