Journal of Gerontological Nursing

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Feature Article 

End-Of-Life Nursing Education Consortium Geriatric Training Program: Improving Palliative Care in Community Geriatric Care Settings

Kathe Kelly, RN, BSN, OCN; Mary Ersek, PhD, RN, FAAN; Rose Virani, MHA, RN, C, OCN; Pamela Malloy, RN, MN, OCN; Betty Ferrell, PhD, RN, FAAN

Abstract

Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)–Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC–Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC–Geriatric Training Program and follow-up evaluation of the “train-the-trainer” model to disseminate comprehensive palliative care education in geriatric settings.

Abstract

Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)–Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC–Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC–Geriatric Training Program and follow-up evaluation of the “train-the-trainer” model to disseminate comprehensive palliative care education in geriatric settings.

Ms. Kelly is Coordinator, ELNEC–Geriatric Training Program, Ms. Virani is Senior Research Specialist, and Dr. Ferrell is Research Scientist, Nursing Research and Education Department, City of Hope, Duarte, California; Dr. Ersek is Director of Research, Center for Nursing Excellence, Swedish Medical Center, Seattle, Washington; and Ms. Malloy is ELNEC Project Director, American Association of Colleges of Nursing, Washington, DC.

This article is based on the End-of-Life Nursing Education Consortium Project (ELNEC)–Geriatric Training Program, which was supported by a grant from the California HealthCare Foundation to the City of Hope (Betty Ferrell, PhD, RN, FAAN, Principal Investigator) and the American Association of Colleges of Nursing (Pamela Malloy, RN, MN, OCN, Co-Investigator).

The authors acknowledge the invaluable contributions of the ELNEC–Geriatric Training Program faculty who have participated in the program’s development and implementation: Patricia H. Berry, PhD, APRN, BC-PCM, University of Utah; Barbara Head, PhD, RN, CHPN, ACSW, University of Louisville; and Keela Herr, PhD, RN, FAAN, The University of Iowa.

Address correspondence to Kathe Kelly, RN, BSN, OCN, Coordinator, ELNEC–Geriatric Training Program, Nursing Research and Education Department, City of Hope, 1500 East Duarte Road, Duarte, CA 91010; e-mail: kkelly@coh.org.

It is projected that by mid-century, 40% or more of all deaths in the United States will occur in nursing home settings (Brock & Foley, 1998). Current reports and surveys on the care of individuals who are dying indicate an urgent need for improvement in end-of-life care in geriatric settings. A 2007 report from the Center for Gerontology and Health Care Research at Brown University described the experience of dying in nursing homes as far from ensuring a “good death” (Miller et al., 2007). The current standards of palliative care in geriatric settings are not adequately addressing the physical and psychosocial needs of residents and their families. Improving end-of-life care involves consideration of the whole person, integrating physical, social, cultural, and spiritual needs.

A 2006 California HealthCare Foundation report surveyed 1,778 Californians about their concerns related to death and dying. The results indicated that 68% of respondents were very concerned to somewhat concerned about the experience of pain and discomfort. In the same survey, 59% of respondents were very concerned to somewhat concerned about finding health care providers who will understand and respect their cultural values (Citko & Lake Research Partners, 2006). A study of bereaved family members of nursing home residents found that only 58% reported that their deceased family member experienced “a good death” (Teno et al., 2004). In addition, a recent report noted that 42% of dying nursing home residents are hospitalized during the last month of life, adding to the burdens of the patient and family, as well as to the overall societal costs of health care (Gozalo & Miller, 2007).

Comprehensive palliative care education of health care professionals that includes psychosocial and spiritual care, as well as pain and symptom management, can significantly improve the dying experience for patients and their families. Nurses, especially geriatric nurses, have a vital role in direct care and the coordination of care for older patients, whether in hospice, home care, or nursing home settings (Ersek, Kraybill, & Hansen, 2006).

Improving end-of-life care involves consideration of the whole person, integrating physical, social, cultural, and spiritual needs.

Many barriers to improving end-of-life care in nursing home and long-term care (LTC) settings exist. The most often cited include lack of financial resources and lack of time, reimbursement issues, state and federal policies, staff turnover, poor administrative support, and inadequate end-of-life knowledge and skills (Ersek & Wilson, 2003; Miller et al., 2007). Thus, promoting enhanced palliative care education for nurses in nursing homes can significantly influence and improve the quality of end-of-life care.

One barrier to the delivery of end-of-life and palliative care is an assumption that nurses have had adequate education to deliver this specialized care. Evaluations of nursing education programs at the undergraduate and graduate levels have shown that this is not the case (Ferrell, Grant, & Virani, 1999; Ferrell, Virani, & Grant, 1999; Ferrell, Virani, Grant, Coyne, & Uman, 2000). A 1999 study by Ferrell, Virani, et al. found only 2 of 72 chapters from three gerontology nursing textbooks were devoted to end-of-life care and that, overall, less than 2% of content in nursing textbooks was related to any palliative care topic. Many nurses working in hospitals, clinics, and community geriatric settings are without the specialized knowledge and skills needed to provide quality end-of-life care (Ersek & Wilson, 2003; Ferrell & Coyle, 2002; Malloy et al., 2006).

History of the End-Of-Life Nursing Education Consortium

In response to the need to improve palliative care education for nurses and to provide comprehensive palliative care to individuals who are dying and their families, the End-of-Life Nursing Education Consortium (ELNEC) was launched in 2000. In 1998, the American Association of Colleges of Nursing and the City of Hope medical center initiated a collaboration to develop a national palliative care education endeavor for RNs. Nursing faculty, clinical educators, and researchers with extensive experience developed the first curriculum, ELNEC–Core. ELNEC–Core, the first training program, was implemented as a national nursing education program in January 2001. Since then, five additional ELNEC curricula have been developed to meet diverse specialty needs: pediatrics, geriatrics, oncology, graduate education, and critical care. Information about ELNEC is available at http://www.aacn.nche.edu/elnec.

Funding for the initial ELNEC program was provided by The Robert Wood Johnson Foundation, and additional support has been provided by the National Cancer Institute, the Aetna Foundation, the Archstone Foundation, and the California HealthCare Foundation (CHCF).

Development of the Elnec-Geriatric Training Program

The ELNEC–Geriatric Training Program builds on the successful outcomes and experiences of previous ELNEC programs and the “train-the-trainer” format. Nurses who complete ELNEC courses become ELNEC Trainers and are provided with a hard copy of the 1,000-page course syllabus, a CD-ROM of the entire syllabus, the master reference list, PowerPoint® slides, a palliative care textbook, assessment tools, and other resources to teach ELNEC content to colleagues and affiliated staff.

The ELNEC–Geriatric Training Program differs from the other curricula in that it includes innovative teaching modules to educate nursing assistants (NAs) and other unlicensed staff, as listed in Table 1. These modules were developed because the majority of care in nursing home, LTC, and other community geriatric care settings is provided by NAs, including home health aides (HHAs) (National Clearinghouse on the Direct Care Workforce, 2006).

Elnec-Geriatric Training Program Curriculum Modules and Modifications

Table 1: Elnec-Geriatric Training Program Curriculum Modules and Modifications

Six organizations reported that they have incorporated ELNEC modules as part of their new hire orientations.

The ELNEC–Geriatric project was initiated in February 2006 and represents the merging of the ELNEC–Core curriculum with the Palliative Care Educational Resource Team (PERT) program (Swedish Medical Center, 2007). The PERT program is a comprehensive palliative care curriculum for licensed nursing staff and NAs working in nursing homes. In its original format, the program consisted of four monthly, full-day sessions delivered directly to frontline licensed staff and NAs.

The evaluation of the original PERT curriculum demonstrated its effectiveness in increasing participants’ knowledge, confidence, and skills related to end-of-life care (Ersek, Grant, & Kraybill, 2005). To extend the dissemination of the program, the curriculum was translated into a train-the-trainer format. Eighty-seven participants evaluated the PERT Train-the-Trainer workshop. Of the total group, 87% of participants conducted at least one inservice session within 6 months of completing the program. Participants rated the curriculum as very clear, comprehensive, up to date, and very useful in improving end-of-life clinical practice in their facilities. Confidence in teaching end-of-life content increased significantly for participants who used the course materials (Ersek et al., 2006).

To create the ELNEC–Geriatric Training Program curriculum, the PERT and ELNEC investigators combined the teaching materials of the two programs. Content was added and updated as needed. The entire ELNEC–Geriatric Training Program curriculum was reviewed by nationally recognized experts in geriatric and palliative care nursing.

Funding for the development and implementation of the ELNEC–Geriatric Training Program curriculum and pilot ELNEC–Geriatric course was provided by the CHCF in recognition of the vital role of nurses in meeting the needs of Californians at the end of life and in support of innovative teaching strategies to improve end-of-life care in geriatric settings. Table 1 lists modifications in creating the ELNEC–Geriatric Training Program curriculum.

Description of the Pilot Program and Participants

The pilot course, held as a 2-day conference in February 2007, was open to nurses working in California geriatric care settings. The ELNEC–Geriatric Training Program curriculum contains nine modules addressing critical aspects of end-of-life care and the role of geriatric nurses (Table 1). Table 2 includes the agenda of the pilot ELNEC–Geriatric Training Program. Faculty with expertise in geriatric nursing and end-of-life care taught participants through formal presentations, panel discussions, review of videos and movies, case studies, and role-play demonstrations to model teaching of the ELNEC content.

Elnec-Geriatric Training Program Agenda

Table 2: Elnec-Geriatric Training Program Agenda

Applicants were competitively selected to attend in teams of at least two participants from California nursing home, LTC, or skilled nursing facilities or hospices serving LTC facilities. Program costs were partially covered by the CHCF grant. As part of the evaluation plan, the application process included a precourse survey, agreement to participate in three follow-up surveys, the creation of precourse goals for dissemination of ELNEC–Geriatric Training Program content, and a letter of support from the agency or facility administrator to ensure participants were supported in goal implementation. Participants were able to revise their precourse goals during the conference as they gained knowledge about palliative care and ELNEC materials.

A total of 76 nurses, social workers, and other health care professionals attended the course in two-person teams, with a few in three-person teams. Teams were composed of an RN (the primary applicant) and a second member from the same geriatric care facility, who could also be an RN or other professional. Participants reported an average of 9.7 years of experience working in LTC settings. Table 3 lists demographic details of the participants.

Demographics of Elnec-Geriatric Training Program Participants (n = 76)

Table 3: Demographics of Elnec-Geriatric Training Program Participants (n = 76)

Goals and Evaluation

A primary goal of the ELNEC–Geriatric Training Program is to educate nurses in end-of-life care. Another key objective is to provide participants with educational resources and materials to educate other nurses, NAs, and other members of multidisciplinary teams. The train-the-trainer model promotes dissemination of ELNEC content with a goal of creating a pool of nurse experts prepared to provide improved end-of-life care education.

In the precourse survey, a majority of participants indicated that their institutions had offered educational programs on end-of-life care topics during the previous 2 years. They rated the importance of end-of-life education very high: On a scale of 1 to 10 (1 = least important to 10 = most important), this item received a mean rating of 9.79 (SD = 0.47). However, participants rated the effectiveness of their facility in teaching the content much lower (mean = 6.71, SD = 2.18; 1 = least effective to 10 = most effective).

In addition to the precourse application, surveys were administered 1 month, 4 months, and 12 months postcourse. The purpose of the survey after 1 month was to evaluate how goals and planned activities were received in the facilities of the pilot course participants. The 4-month postcourse survey gathered information on the ability of the trainers to use the course materials and resources to implement educational programs, and the 12-month postcourse survey will assess the cumulative effectiveness of the train-the-trainer model in disseminating end-of-life content.

The conference overall was rated very high (mean = 4.80, SD = 0.44; 1 = poor to 5 = excellent), and the extent to which the course objectives and expectations were met received a mean score of 4.71 (SD = 0.57; 1 = poor to 5 = excellent). An additional indication of participant satisfaction was that 70.3% of attendees indicated they could foresee other nurses from their facilities attending a future ELNEC–Geriatric Training Program course.

1-Month Postcourse Survey

At 1-month postcourse, a short survey was completed by e-mail, fax, or telephone interview. Previous ELNEC courses have used evaluations at 6 and 12 months, but the investigators planned contact at 1 month to provide initial feedback and support for the nursing home and LTC settings. Approximately 94% (71 of 76) of surveys were returned. Participants’ mean rating of the ELNEC–Geriatric Training Program in terms of planning for staff education programs was 9.04 (1 = least effective to 10 = most effective). More than 21% reported having scheduled an educational program for licensed nurses, and 24% had scheduled a program for NAs and other staff.

4-Month Postcourse Survey

All of the participants (100%) responded to the 4-month postcourse survey, which assessed educational inservices or programs conducted using the nine ELNEC modules for licensed nursing staff or unlicensed nursing staff, such as NAs or HHAs. In addition, the survey included updates on the participant goals that were identified at the completion of the pilot course. Participants were also asked to report on barriers to implementing these goals.

At 4 months postcourse, 82% of the participant teams had held educational programs, and all nine ELNEC modules had been used. A total of 157 educational programs were presented to nurses, and 117 programs were presented to NAs or other unlicensed staff. Some educational programs may have included both licensed and unlicensed staff but are presented separately in Table 4.

Number of Elnec Educational Programs 4 Months Postcourse

Table 4: Number of Elnec Educational Programs 4 Months Postcourse

Barriers to Implementation

Although the responses indicated that the majority of trainers rapidly used and disseminated the ELNEC–Geriatric Training Program content, delays in the accomplishment of goals were also reported. A review of comments about the goals found administrative issues or lack of support to be primary barriers. Interestingly, one team from an assisted living facility decided rather than holding formal programs independently, they would “open the door” to hospice to provide end-of-life care and education. However, most of the other trainers indicated that they plan to implement their goals by the end of 2007 or early 2008.

Use of Elnec Modules to Educate Unlicensed Staff

Results indicated that the first cohort of ELNEC–Geriatric Training Program trainers have welcomed and successfully used the teaching modules for NAs and other unlicensed staff. Not only have facilities held inservice sessions, as shown in Table 4, but they also used modules to reinforce preparation for certification. One facility stated that it had used Module 1: Principles of Palliative Care, Module 2: Pain Assessment and Management, Module 3: Nonpain Symptom Management, Module 4: Goals of Care and Ethical Issues, and Module 9: Preparation For and Care at the Time of Death for this purpose. The facility later reported that all unlicensed staff successfully passed their certification examinations. This outcome supports appropriate application of the ELNEC–Geriatric Training Program modules and ease of use by nurses in nursing home and LTC settings to educate NAs and other unlicensed staff in palliative and end-of-life care.

Additional Applications of Elnec Materials and Training

The ELNEC–Geriatric Training Program trainers have rapidly incorporated ELNEC modules and resources into the education of other nurses and unlicensed staff in their facilities. The following are examples of activities that are innovative applications of ELNEC content and materials:

  • Six organizations reported that they have incorporated ELNEC modules as part of their new hire orientations.
  • Three organizations reported that after ELNEC training and learning about requirements for end-of-life care, they made arrangements for hospice organizations to provide end-of-life care in their facilities.
  • One team’s goal was to break down barriers to physician referral to hospice. The team created and presented a “Pain Management at End-of-Life (for Physicians)” PowerPoint presentation, adapted from the Pain Assessment and Management Module and the Ensuring Quality End-of-Life Care Module, to more than 50 physicians.
  • One hospice organization plans to translate the ELNEC modules into Spanish for more culturally sensitive communication.
  • A nursing home used the video presented at the ELNEC course “Detecting Pain in the Cognitively Impaired” (available at http://trc.wisc.edu/) to educate staff. The team members also reported excellent family satisfaction with the improved care and that end-of-life concepts are “taking hold.”
  • One hospice initiated a newsletter to educate staff on cultural considerations and created a laminated guide for discharge planners on when to consider hospice care.

Nursing Implications

Nurses spend more time with patients facing the end of life and their families than do any other health professionals. Nurses are intimately involved in all aspects of end-of-life care, and they address the myriad needs individuals experience at this time of life. Geriatric nurses have the potential to greatly reduce the burden and distress of those facing life’s end and the ability to offer support for the many physical, psychological, social, and spiritual needs of geriatric patients and nursing home residents and their families. Geriatric nurses with training in end-of-life care—individually and collectively—have the unique opportunity to significantly influence the quality of care of patients who are terminally ill.

Geriatric nurses with training in end-of-life care...have the unique opportunity to significantly influence the quality of care of patients who are terminally ill.

Geriatric nurses are encouraged to attend the ELNEC–Geriatric Training Program to gain enhanced education in end-of-life care and the resources to educate other nurses and staff to promote improved quality of care.

Conclusion

Many barriers remain to improving the quality of end-of-life care. As the population of older adults increases, tremendous pressure will be placed on nursing homes and other facilities to provide high-quality palliative care that leads to a “good death.” This can be accomplished by providing care that reduces suffering and addresses the needs of patients and their families and that is consistent with their values and beliefs. Geriatric LTC settings differ from hospitals and other clinical settings in that they have a higher unlicensed staff-to-licensed health care professionals ratio. They also manage complex chronic care needs in older residents with limited social support. Geriatric nurses in these settings can benefit from enhanced end-of-life education and resources to improve care of patients who are dying.

Although the ELNEC precourse surveys indicated that a majority of the participants’ facilities had previously held end-of-life education programs, the participants did not rate these programs as highly effective. On the ELNEC–Geriatric Training Program 1-month postcourse survey, participants rated the course experience as extremely helpful in planning and providing end-of-life education. At 4 months postcourse, 82% of the California ELNEC pilot program team participants had held educational programs based on all nine modules for nurses and unlicensed staff. These results demonstrate that the ELNEC–Geriatric Training Program prepares nurses to effectively use and disseminate the ELNEC teaching materials.

Given the rapid application and examples of creative uses of the educational materials, the ELNEC program fills a need for comprehensive palliative care education in geriatric care settings. The training provides geriatric nurses with the knowledge, skills, and confidence to offer care and support for the many physical, psychological, social, and spiritual needs of patients and their families. As one participant stated, “The ELNEC program promotes education in my facility that is leading to a ‘culture change.’”

The results of the course evaluations and 1-month and 4-month follow up indicate that the program is an effective model of educating geriatric nurses in end-of-life care and prepares them to educate other nurses, NAs, and affiliated staff.

References

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  • Citko, JLake Research Partners. 2006. Death and dying in California. Retrieved October 5, 2007, from the California Health-Care Foundation Web site: http://www.chcf.org/topics/view.cfm?itemID=127057
  • Ersek, M, Grant, MM & Kraybill, BM2005. Enhancing end-of-life care in nursing homes: Palliative Care Educational Resource Team (PERT) program. Journal of Palliative Medicine, 8, 556–566. doi:10.1089/jpm.2005.8.556 [CrossRef] doi:10.1089/jpm.2005.8.556 [CrossRef] doi:10.1089/jpm.2005.8.556 [CrossRef]
  • Ersek, M, Kraybill, BM & Hansen, N2006. Evaluation of train-the-trainer program to enhance hospice and palliative care in nursing homes. Journal of Hospice and Palliative Nursing, 8, 42–49. doi:10.1097/00129191-200601000-00013 [CrossRef] doi:10.1097/00129191-200601000-00013 [CrossRef] doi:10.1097/00129191-200601000-00013 [CrossRef]
  • Ersek, M & Wilson, SA2003. The challenges and opportunities in providing end-of-life care in nursing homes. Journal of Palliative Medicine, 6, 45–57. doi:10.1089/10966210360510118 [CrossRef] doi:10.1089/10966210360510118 [CrossRef] doi:10.1089/10966210360510118 [CrossRef]
  • Ferrell, BR & Coyle, N2002. An overview of palliative nursing care. American Journal of Nursing, 1025, 26–31.
  • Ferrell, BR, Grant, M & Virani, R1999. Strengthening nursing education to improve end-of-life care. Nursing Outlook, 47, 252–256. doi:10.1016/S0029-6554(99)90022-2 [CrossRef] doi:10.1016/S0029-6554(99)90022-2 [CrossRef] doi:10.1016/S0029-6554(99)90022-2 [CrossRef]
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  • Ferrell, BR, Virani, R, Grant, M, Coyne, P & Uman, G2000. Dignity in dying. Nursing Management, 319, 52–57.
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  • Malloy, P, Ferrell, BR, Virani, R, Uman, G, Rhome, AM & Whitlatch, B et al. 2006. Evaluation of end-of-life nursing education for continuing education and clinical staff development educators. Journal for Nurses in Staff Development, 22, 31–36. doi:10.1097/00124645-200601000-00008 [CrossRef] doi:10.1097/00124645-200601000-00008 [CrossRef] doi:10.1097/00124645-200601000-00008 [CrossRef]
  • Miller, SC, Shield, R, Mor, V, Teno, J, Lima, J & Smith, MA2007, July. Palliative care/hospice for persons with terminal illness and/or chronic progressive illness. Retrieved October 9, 2007, from the Brown University Center for Gerontology and Health Care Research Web site: http://www.chcr.brown.edu/PDFS/JEHT_4_FINALREPORT07.pdf
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© 2008/Artville/Getty Images

© 2008/Artville/Getty Images

Elnec-Geriatric Training Program Curriculum Modules and Modifications

ELNEC ModuleGeriatric Modifications
Module 1: Principles of Palliative Care

Added section for education of nursing assistants

Module 2: Pain Assessment and Management

Included more content on assessment of pain in nonverbal patients or those with cognitive impairment and use of specific tools

Included assessment of pain in older adults

Included discussion on balance of opioid analgesia versus sedation and hypotension

Added section for education of nursing assistants

Module 3: Nonpain Symptom Management

Included discussion on delirium versus dementia

Added section for education of nursing assistants

Module 4: Goals of Care and Ethical Issues

Included emphasis on nutrition, hydration, transfer to acute care

Included advance directives in nursing homes and LTC settings

Added section for education of nursing assistants

Module 5: Cultural Considerations

Added section for education of nursing assistants

Module 6: Communication

Added section for education of nursing assistants

Module 7: Loss, Grief, and Bereavement

Included grief in LTC residents, nurses, and nursing assistants

Added section for education of nursing assistants

Module 8: Ensuring Quality End-of-Life Care

Included quality improvement projects for LTC

Module 9: Preparation for and Care at the Time of Death

Included death in LTC settings

Added section for education of nursing assistants

Elnec-Geriatric Training Program Agenda

Day 1
8:00–8:15 a.m.Welcome/introduction
8:15–9:00 a.m.Overview of the ELNEC–Geriatric Training Program curriculum, resources, and goal development
9:00–9:45 a.m.Module 1: Principles of Palliative Care
9:45–10:00 a.m.Break
10:00–10:30 a.m.“Town Hall” discussion of end-of-life care in participant settings
10:30–11:00 a.m.Listening exercise
11:00–11:45 a.m.Module 2: Pain Assessment and Management
11:45 a.m.–1:00 p.m.Lunch (networking with faculty)
1:00–2:00 p.m.Module 2: Pain Assessment and Management (continued)
2:00–2:15 p.m.Break
2:15–3:15 p.m.Module 3: Nonpain Symptom Management
3:15–4:15 p.m.Modules 2 and 3: Pain and Nonpain Symptom Management training session; individual case studies discussion roundtables
4:15–4:30 p.m.Daily evaluation/wrap up
Day 2
8:00–9:00 a.m.Module 6: Communication (mini role-plays and teaching materials)
9:00–10:15 a.m.Module 4: Goals of Care and Ethical Issues
10:15–10:30 a.m.Break
10:30–11:30 a.m.Modules 4, 6, 7, and 9 training session. Role-play—Goals of Care and Ethical Issues; Communication; Loss, Grief, and Bereavement; and Preparation for and Care at the Time of Death
11:30 a.m.–12:45 p.m.Lunch (networking with faculty)
12:45–1:30 p.m.Module 5: Cultural Considerations (self-assessment)
1:30–2:15 p.m.Module 7: Loss, Grief, and Bereavement
2:15–2:30 p.m.Break
2:30–3:15 p.m.Module 8: Ensuring Quality End-of-Life Care
3:15–4:15 p.m.Module 9: Preparation for and Care at the Time of Death
4:15–4:30 p.m.Program summary/evaluation

Demographics of Elnec-Geriatric Training Program Participants (n = 76)

Variablen (%)
Gender
  Women69 (90.8)
  Men4 (5.3)
  Not reported3 (3.9)
Ethnicity
  Asian11 (14.5)
  African American1 (1.3)
  Caucasian60 (78.9)
  Hispanic/Latino1 (1.3)
  Other/Not reported3 (3.9)
Kind of facilitya
  Long-term care21 (28)
  Skilled nursing36 (48)
  Hospice for long-term care33 (44)
Participant titles
  Staff nurse7 (9.2)
  Clinical nurse specialist2 (2.6)
  Nurse practitioner6 (7.9)
  Care coordinator16 (21.1)
  Manager/Supervisor/Team leader9 (11.8)
  Director23 (30.3)
  Educator6 (7.9)
  Chaplain1 (1.3)
  Social worker5 (6.6)
  Not reported1 (1.3)

Number of Elnec Educational Programs 4 Months Postcourse

ModulePrograms for Licensed Nursing StaffPrograms for Unlicensed Staff
Module 1: Principles of Palliative Care2120
Module 2: Pain Assessment and Management2615
Module 3: Nonpain Symptom Management2113
Module 4: Goals of Care and Ethical Issues138
Module 5: Cultural Considerations189
Module 6: Communication1311
Module 7: Loss, Grief, and Bereavement1915
Module 8: Ensuring Quality End-of-Life Care1614
Module 9: Preparation for and Care at the Time of Death1012
Total program events157117

End-of-LifeNursingEducation

Kelly, K, Ersek, M, Virani, R, Malloy, P & Ferrell, B2008. End-of-Life Nursing Education Consortium Geriatric Training Program: Improving Palliative Care in Community Geriatric Care Settings. Journal of Gerontological Nursing, 345, 28–35.

  1. Educating geriatric nurses to provide end-of-life and palliative care is an important health care priority.

  2. The End-of-Life Nursing Education Consortium (ELNEC)–Geriatric Training Program is an educational initiative for improving care provided by nurses in long-term care facilities and nursing homes, or in hospices that serve these settings.

  3. Evaluation surveys have found the ELNEC–Geriatric Training Program to be an effective model to promote end-of-life education for geriatric nurses, nursing assistants, and others who care for older adults at the end of life.

Keypoints

Authors

Ms. Kelly is Coordinator, ELNEC–Geriatric Training Program, Ms. Virani is Senior Research Specialist, and Dr. Ferrell is Research Scientist, Nursing Research and Education Department, City of Hope, Duarte, California; Dr. Ersek is Director of Research, Center for Nursing Excellence, Swedish Medical Center, Seattle, Washington; and Ms. Malloy is ELNEC Project Director, American Association of Colleges of Nursing, Washington, DC.

Address correspondence to Kathe Kelly, RN, BSN, OCN, Coordinator, ELNEC–Geriatric Training Program, Nursing Research and Education Department, City of Hope, 1500 East Duarte Road, Duarte, CA 91010; e-mail: .kkelly@coh.org

10.3928/00989134-20080501-06

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