Introduction

There are myriad palliative and end-of-life care education and training resources available in Australia. Yet no systematic catalogue of these resources exists to support healthcare organisations to build staff knowledge and skills in palliative and end-of-life care. Our objective was to identify and map such resources to inform development of an evidence-based staff education and training framework for a health network.

Methods

Resources were identified through snowball scanning (October 2022-) of standards, guidelines, policies, curricula, reports, websites, and peer-reviewed literature relevant to staff education/training in palliative and end-of-life care via search engines with pre-determined keywords and references/links of identified resources. Information relevant to components of palliative and end-of-life care and levels [Tier 1 (infrequently relevant to role), 2 (frequently relevant to role) and 3 (specialist provider)], modes and evaluation of education/training in these components was extracted and evaluated.  

Results

From resources found thus far (n=17), we identified eight palliative and end-of-life care components: 1) need identification, 2) communication, 3) shared decision making, 4) advance care planning, 5) symptom management, 6) after-death care, 7) grief and bereavement, and 8) self-care. Of 10 Australian online educational resources identified, nine have free content, six are interactive, and four cover all components. Depth of learning is Tier 2 in seven resources and Tier 3 in one advance care planning resource. Seven resources incorporate evaluation at Kirkpatrick Model Level 1 (reaction) and/or Level 2 (knowledge). Most resources cite each other for additional learning, with CareSearch cited most.

Conclusions

This mapping process identified the online palliative and end-of-life care educational resources most appropriate for generalist staff. Our next steps are to map post-graduate curricula, conduct a baseline staff survey (structured on these components, levels and modes), and develop an evidence-based health network-level framework for staff education and training in palliative and end-of-life.

Background 

There is a pressing need to drive stronger health care systems that provide safe and quality palliative care in the acute care setting. Delivery of high-quality end of life care in hospitals has proved challenging for multiple reasons including a lack of skills, knowledge and confidence of nursing staff.  

Aim

The aim of this innovative project, which was underpinned by the Knowledge Translation Complexity Network Model (KTCNM), (Kitson et al., 2018) was to strengthen the capability of generalist nursing teams to deliver safe and high-quality care at end of life via the Palliative Care Link Nurse program 

Methods 

We recruited 29 acute care nurses to the program – designed to align with National Safety Quality Health Service Comprehensive Care Standard and National Palliative Care Standards and leveraging the National End-of-Life Essentials program materials. In line with the KTCNM, knowledge and training was combined based on current best practices and the acute care context based on the experiences of the nurses involved. 

Findings 

Our data showed a statically significant increase in nurses’ confidence to provide end-of-life care following the program. This paper further reports qualitative findings and impact at the point of care including acute care nurse led quality initiatives based on their own audits. The program has also resulted in the development of a palliative care traineeship initiative aimed at growing the specialist palliative care workforce

Conclusion 

The palliative care link nurse program has not only built the capacity of the nurses involved but has led to further impact heretofore not expected. It has created palliative care workforce capacity and improved the quality of end-of-life care in the acute care setting.  Further research is needed to investigate patient and family measurable outcomes.

Background

The WACHS Palliative Care Program (PCP) piloted a clinical supervision project for regional Nurse Coordinators over 2021-22. This innovative project was productive and has since been extended to all regional palliative care nurses, social workers, and Aboriginal Health Liaison Officers. 

Geographical locations and distance warrant specific consideration in the vastness of the WA regional districts. WA has the largest land area of any Australian state or territory covering an area of over 2.5 million square kilometres. 

The value of the pilot clinical supervision has subsequently led to a new pilot project aimed specifically at developing a peer support group for NPs. A twelve month pilot project of a monthly facilitated reflective supervision group for NPs commenced in February 2023. 

Aims

This oral presentation will outline the foundations for, and implementation of the facilitated NP reflective supervision group. The aims for establishing a facilitated NP reflective supervision group, are to implement a longer-term, secure peer support group amongst NPs, and to influence a fundamental cultural change within palliative care nursing towards viewing supervision (clinical and reflective) as a natural, acceptable and enabling facet of professional life. Overall, it is anticipated this will improve the quality of palliative care services in rural and remote WA as well as assist in sustaining NPs to remain living, working and contributing to healthy country WA communities. 

Methods

Methods used for determining, forming, and communicating with, the reflective supervision group, including identified challenges and advantages will be included. 

Results/Lessons Learnt

Evaluation of the pilot NP reflective supervision group is conducted using unidentifiable questionnaires pre-commencement, at 6 and 12 months of the NP reflective supervision group. This presentation will provide a mid-pilot review summary of data collection.

Conclusions/Next Steps

An outline for consideration of expanding the pilot beyond the initial reflective supervision group will be given. 

Themes:

Supervision - types / Nurse Practitioners / Sustaining nurses / Building healthy communities / networking / collegial support

Background: Resulting from challenges in recruiting suitable, experienced palliative and bereavement care social work staff, a fast-track education and training program to aid in the development of a robust, skilled and knowledgeable palliative care (PC) and bereavement workforce was designed and delivered.

AIM: The aim of the internship was to equip experienced social work clinicians with understanding, knowledge & practice skills resulting in increased confidence when applying for PC and bereavement social work roles.

Method: The internship was co-designed with a consumer to ensure a comprehensive program. It consisted of two face to face workshops alongside five online sessions with a broad curriculum in all aspects of death, dying & bereavement including suggested journal articles, videos & podcasts. Learning objectives included identifying the socially and culturally constructed nature of dying, death and mourning in modern society including death systems &  the public health approach to PC; the history and overview of PC in Australia and the social work role; exploration of death, dying and bereavement from the perspectives of first nations and culturally diverse communities; opportunities for advance care planning; increased knowledge of death care and funerals; grief and bereavement theory and practice skills through simulation.

Results: Seventeen expressions of interest were received from a variety of clinical areas including community rehab, mental health and hospital which resulted in twelve interns. Findings were informed by pre and post evaluation and a reflective writing exercise. Overall, there were significant increases in death literacy, palliative care & bereavement knowledge and skills.

Conclusion: Interns participated in the program with enthusiasm and motivation. Although the program was a success, we are yet to see its impact on PC workforce in our district. The next step for the program will be the adaptation and co-design of the internship with Chronic Care Aboriginal Health Workers.

 

 

Most deaths in Australia occur in hospitals.  In recognition, the updated National Safety and Quality Health Service (NSQHS) Standards incorporates the ‘Comprehensive Care Standard’ (CCS) which primary aims to improve the quality of end-of-life care in hospitals. End-of-Life Essentials (EOLE) is a Commonwealth funded project aiming to improve the skill, knowledge and confidence of the Australian hospital workforce and freely provides a range of education, training, accreditation, practice change and audit resources.

Aim

To identify ways in which EOLE can engage, promote and assist hospitals to meet the End-of-Life Care Actions within the CCS and improve the provision of end-of-life care.

Methods

EOLE hosted 3 national strategic accreditation workshops in collaboration with the Australian Commission on Safety and Quality in Health Care. Participants included quality and risk managers, clinical staff, clinical educators, and managers. 

Results

A pre-workshop survey received n=58 responses. Of these, n=51 had undergone accreditation against the CCS. Pre-workshop survey results provided information on services’ engagement with EOLE resources, which CCS End-of-Life Care Actions are most difficult to meet (and why), use of performance indicators and other resources used to support accreditation. The survey provided information on workshop content in order to meet the needs of attendees. Workshops were held online in November 2022 with n=34 attendees from around Australia.

Discussion

Attendees discussed and shared strategies and evidence used to support accreditation and assessment to the CCS (End-of-Life Care Actions). A post-workshop summary has been disseminated, a survey administered, and presentations posted on the website, providing more resources for the sector regarding practice change and meeting the NSQHS Standards.

Conclusion

These workshops not only inform the work of the EOLE project, but also assist in engagement with the sector and allow for exchange of ideas, promotion of quality and safe end-of-life care and issues in the hospital sector.

 

Death doulas are working in end-of-life care providing non-medical support for the dying and their families. 

 

Aim 

 

To elicit the perspectives of death doula training organisations on working practices and models of care relevant to the death doula role.

 

Methods 

 

We identified 15 death doula training organisations in Australia, Canada, the UK, New Zealand and the USA. Electronic survey via publicly available email addresses were sent in August 2021. Ethics approval was received. 

 

 

Thirteen organisations based in Australia (4), the USA (4), Canada (2), the UK (1), Sweden (1) and New Zealand (1) responded. Diversity in views were received relevant to standardisation of death doula business models, role enactment, potential funding and reimbursement approaches.

 

 

Many death doula training organisations value individuality in role enactment, viewing standardisation as negating the ability to be flexible and responsive. For some, this may be seen as not in the ethos of the death doula philosophy. However, a lack of standardisation could result in a lack of consistency and clarity regarding client care, with consumers uncertain about how to integrate services to ensure they have all their needs met. From the perspective of some of the training organisations, models of care going forward would need to affirm how the role fits within the health and social care systems and not just incorporate it, without forethought, into current systems.

 

The death doula role continues to emerge and to evolve organically, mimicking the growth and trajectory of the birth doula role, albeit privileging independence, flexibility and fiscal independence. Death doula training organisations are particularly influential in shaping the direction of the role and any movements to interface with, or be incorporated into, existing models of health or social care. Visibility of these organisations in the media is also providing pseudo-legitimation of the role.