Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care

Abstract

Current palliative care workforce projections indicate that the growing palliative care needs of older adults in US nursing homes cannot be met by specialists, leaving them vulnerable and at risk for poor end-of-life outcomes. The purpose of this article is to describe the development, implementation, and initial evaluation of a program to support primary care nursing home nurse practitioners (NPs) in palliative care. The program aimed to improve geriatric NPs' knowledge and skills related to palliative care and to provide a structured protocol for integrating palliative care encounters into NPs' practice. It comprised three phases consisting of asynchronous online learning modules, a 1-day face-to-face communication skills and patient simulation workshop, and ongoing monthly virtual meetings to support NP clinical practice. Over a 1-year period, the program was developed and implemented with 12 practicing NPs in a national organization. Through an online survey and face-to-face feedback, NPs reported satisfaction with the curriculum and expressed it as valuable to their clinical practice. Future work will focus on sustaining implementation of the program, measuring patient level outcomes, and refining the curriculum based on NP feedback.

Nursing Home Palliative Care During the Pandemic: Directions for the Future

“…Our findings align with the literature that suggests that palliative care challenges may be best overcome by increasing internal capacity for providing palliative care, as in-house staff are well situated to deliver this care ( Carpenter & Ersek, 2021 ; Ersek et al, 2022 ). Through their everyday interactions with residents, staff learn about residents’ values and goals and could use this knowledge to inform patient-centered care.…”

“…Although in-house staff mustered palliative care resources during the pandemic, the DONs interviewed missed the advice of the hospice and palliative care consultants, underscoring their value. But palliative care consultations to nursing home residents were not widely available even pre-pandemic and are difficult to identify in claims data ( Carpenter & Ersek, 2021 ; Miller, Lima et al, 2016 ). Future research considering access to palliative care should document how nursing homes reach out to external consultants post-COVID-19, with an eye to policy development to strengthen consulting relationships ( Dunleavy et al, 2021 ).…”

Patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting in Norway

“…As one nurse participant revealed, many staff had decided to leave. Nurses may be reluctant to go to work if they have insufficient professional competence (Heggestad et al, 2020; Lida et al, 2021) or may be uneasy when unable to gain new knowledge and thus become better nurses (Bergdahl et al, 2011; Carpenter & Ersek, 2022). Additionally, the patients, relatives and nurses alike described concerns about hospital readmissions.…”