Education and training to enhance end-of-life care for nursing home staff: a systematic literature review

Abstract

BackgroundThe delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles.ObjectivesTo identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care.DesignThirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically.ResultsTwenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported.ConclusionsThere is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis.

Outcomes of collaborative and interdisciplinary palliative education for health care assistants: A qualitative metasummary

“…Changes to patient and family related policies were a direct result of the educational intervention in two other studies (Curry et al, ; Phillips et al, ). Innovative methods of assessment are needed to ensure that outcomes of palliative educational interventions are not limited solely to perceptions of improved care but are indeed measureable and meaningful improvements for patients living with life‐limiting chronic illness (Anstey et al, ; Karacsony, Chang, Johnson, Good, & Edenborough, ; Pesut & Greig, ).…”

“…Finally, determining if an educational intervention has statistically improved communication, teamwork, practice, patient care or care of family members is challenging (Anstey, Powell, Coles, Hale, & Gould, 2016;Pesut & Greig, 2017;Raunkiaer & Timm, 2013). Most authors reported what the participants perceived as outcomes for patients and families.…”

Returning Nursing to Nightingale: The Bigger Picture of Mainstreaming Kenya-Nursing Process

“…The principle threat to implementing NP, in our view, is inadequate knowledge and incompetence, which can be addressed effectively through mainstreaming, effective continuing education program [75] and application of Benner's stages of clinical competence [16][17][18].…”

Teaching nurses to teach: A qualitative study of nurses’ perceptions of the impact of education and skills training to prepare them to teach end‐of‐life care

“…This resolution called upon World Health Organisation (WHO) and Member States to improve access to palliative care as a core component of health systems. Good end‐of‐life care demonstrates that patients and their families are being treated with kindness, respect and empathy, and helps those approaching death to remain comfortable (Anstey, Powell, Coles, Hale, & Gould, ). When distressing symptoms are managed, patients are more likely to die with dignity and their families are more likely to be satisfied with the care received (Teno et al, ).…”