Enhancing End-of-Life Care in Residential Care Homes for the Elderly – A 7Cs Training Package to Empower the Community Geriatric Assessment Team Nurses

Abstract Description

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Authors (including presenting author) :

Ng HYN(1), Ko PS(2), Cheung KK(1), Ma SY(1), Lam WS(1), Ng YB(1), Lee KY(3)

Affiliation :

(1)Palliative Care Unit, Department of Medicine and Geriatrics, (2)Nursing Services Division, (3) Community Nursing Service, United Christian Hospital

Introduction :

Community Geriatric Assessment Team (CGAT) nurses nowadays play an important role in providing end-of-life care (EOLC) to frail elderlies in the Residential Care Homes for the Elderly (RCHEs). Through the EOLC in RCHEs programme, CGAT nurses have to provide onsite nursing support and conduct advance care planning (ACP) discussions with the frail elderlies and their families. Adequate training is essential to equip them for the evolved role. A 7Cs EOLC training package was tailor-made and provided to empower CGAT nurses.

Objectives :

To evaluate the effects of the training package on the empowerment of CGAT nurses to provide EOLC in RCHEs.

Methodology :

The 7Cs package for CGAT nurses comprises a 4-module training programme of Classroom lectures, Communication workshops, Clinical attachment to Palliative Care unit, onsite one-to-one Coaching for ACP discussions, Contemplative reflective journaling, regular Case Conference and Continuing ad hoc support by Palliative Care nurse. Outcome measures were the pre- and post- training scores in Palliative Care Nursing Self-Competence Scale, PCNSC (Desbiens & Fillion, 2011) and the satisfaction of participants. Descriptive statistics were used.

Result & Outcome :

From May 2017 to November 2018, ten CGAT nurses completed the training programme. There was a statistically significant difference in the overall mean PCNSC scores after the training (pre 3.32(SD 0.28) vs. post 3.7(SD 0.2); p< 0.0001). The mean scores were improved in all the ten dimensions of the PCNSC (p< 0.0001). Participants’ self-perceived capability was highest and lowest in the dimensions of providing care related to “physical needs (symptoms other than pain)” (pre 3.64 vs. post 3.92) and “spiritual needs” (pre 3 vs. post 3.42) respectively before and after training. The dimensions with the greatest improvement in self-perceived capability were related to “end-of-life care” (pre 3.2 vs. post 3.7) and “ethical and legal issues” (pre 3.12 vs. post 3.62), both were increased by 16% post training. As for the participants’ satisfaction, all of them gave positive feedback to the training programme. The results suggest that the 7Cs training package has improved the self-perceived competence of CGAT nurses in providing EOLC to the frail elderlies and their families in RCHEs.