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Workforce Education - Synthesis

Introduction

To support older Australians living in residential aged care and community care as they come to the end of their life, there needs to be a high-quality and well-prepared health workforce. This workforce comprises, registered and enrolled nurses, careworkers, allied health professionals and GPs. Education is a key part of initial training and preparation and of ongoing professional development.
 

Quality Statement 

This synthesis utilised evidence from twenty systematic reviews. Three dealt specifically with topics relating to palliative care in aged care while seventeen were either aged care only or palliative care only. The overall quality of the systematic review evidence was good with appropriate searches and methods for extraction and analysis.  Few reviews included prospective controlled trials.

 

Education for Aged Care Workforce

There are different types of education reported in the literature from one-off events to sustained programs with specified learning outcomes.  Assessing the effectiveness of education can focus on staff knowledge and practice, and on patient related outcomes, educational provision for nursing home staff is poor. Reports of activity are common but there is less rigour in the evaluation of the effect and outcomes. Although education is widely regarded as the single most important way of improving end-of-life care delivered by nursing home staff, existing educational interventions appear unlikely to promote better patient outcomes and evidence to demonstrate their effectiveness is not robust. [1] There is a need to design credible educational interventions and evaluate their impact on patients, families and staff in nursing homes with economic evaluation.


However, despite the widespread use of careworkers, little is known about the roles they play in palliative and end-of-life care in the community. Their work is located at the intersection between professional and informal care.  A recent review highlighted five core domains where care workers contributed to this care of older people: personal care, emotional and social support, domestic support, respite care for family carers and collaborating with professional and family carers.  A substantial proportion had no nationally recognised qualification, no training on appointment or felt inadequately prepared for their job. [2]


There are a number of tools available that have been identified to evaluate current palliative care competency among nursing assistants. [3] One of these instruments measured nursing assistants' level of comfort in providing end-of-life care. The six remaining instruments measured palliative care knowledge, palliative care practice, self-efficacy, knowledge and attitudes towards people with advanced dementia, beliefs and attitudes to death, dying, palliative and interdisciplinary care across the aged care workforce. Usefulness of identified tools may be limited by language skill and literacy skills of many workers.


There is increasing recognition of the importance of staff training and education and their effectiveness as interventions that achieve outcomes for staff and for the people for whom they provide care. Given the aged care workforce characteristics, training interventions that focus not only on knowledge but on organisational support for workers may be critical in improving and sustaining workforce capacity and preparedness. [4,5]


Palliative Care Education

Nursing students also feel unprepared to deal with issues related to death and dying and there are indications that schools of nursing may not be adequately educating nursing students to care for patients at the end-of-life. [6] Palliative care education for nurses is delivered at a variety of stages in their nursing program, using a mix of both didactic and experiential educational strategies. [7,8] Course facilitators span palliative care specialists, educators who have attended ‘train-the-trainer’ courses in palliative care, and nurses with hospice experience. Education underpinned by transformative and experiential learning theories is reported as effective in improving students’ attitudes towards care of the dying. [7] Experiential learning strategies and practical experience provide students with opportunities to integrate knowledge and experience and promote meaningful learning experiences through reflection. [6,9]


Continuing professional development is an important part of ongoing education and training for nursing and this may be especially important for those in rural and remote locations. [10] Interprofessional educational effectiveness is also being explored. [11]


There are indications that there is greater consistency in the content being delivered as part of end-of-life care education within medical schools. [12] In medical curricular, palliative care topics included patient assessment, communication, pain and symptom management, psychosocial and spiritual needs, bioethics and the law, role in the health care system, interdisciplinary teamwork, and self-care. [13] A wide variety of interventions have also been used to build residents awareness, knowledge and skills in end-of-life care including didactics, group discussions, debriefings, designated rounds, clinical experiences, simulations, roleplays, and decision support tools. Training programs need to develop and implement more effective role modelling, simulation, and feedback methodologies to better support residents. [14]


Including palliative care in undergraduate education is an important way of providing knowledge, skill, and competences about palliative care and can improve attitudes toward caring in advanced disease and at the end-of-life. Experiential learning appears to be valuable. However, there is only indirect evidence that palliative care training at university leads to better clinical care of patients. [13,15] A lack of universally applicable validated questionnaire to assess the effectiveness of undergraduate palliative care education also limits evaluation. [16]


Patient - Professional Communication Education

Communication education is the focus of education and training studies. Three core themes relating to education around patient-professional communication have been identified: using education to enhance professional communication skills, using communication to improve patient understanding, and using communication skills to facilitate advance care planning. [17] There is some evidence that specific educational interventions around communication for health care professionals (HCPs) may improve self-efficacy, knowledge and communication scores compared to no formal training. [18]


Other Issues

The health professional’s role in providing education to patients has also been noted. [19]


End-of-life care simulation is an innovative strategy that may help to prepare undergraduate nursing students to provide quality end-of-life care. [6] Computer-aided education has been used for advance care planning training. [20]


Evidence that continuing professional development (CPD) impacts positively on patient and families outcomes is necessary to sustain an on-going investment in learning activities. In order to optimise the opportunities afforded by emerging web-based technology, rural nurses' need to develop and maintain their computer competencies. Further investigation of the impact of specialist clinical placements on rural nurses' palliative care capabilities is also indicated. [10]


Evidence Gaps

  • There is a need for a tool to assess the effectiveness of palliative care education.
  • Educational assessment needs to address patient outcomes as well as knowledge outcomes. 
  • The possibilities associated with simulated learning in palliative care needs to be explored. 
  • The impact of clinical placements on palliative care capabilities needs to be assessed and patient outcomes needs to be assessed.
  • Understanding the impact of consumer, carer and patient input into education interventions is lacking.
  • Allied health education with regard to end-of-life care in the aged care industry is not well researched.

Page updated 23 May 2017
  • References

  1. Anstey S, Powell T, Coles B, Hale R, Gould D. Education and training to enhance end-of-life care for nursing home staff: a systematic literature review. BMJ Support Palliat Care. 2016 Sep;6(3):353-61.
  2. Herber OR, Johnston BM. The role of healthcare support workers in providing palliative and end-of-life care in the community: a systematic literature review. Health Soc Care Community. 2013 May;21(3):225-35.
  3. Karacsony S, Chang E, Johnson A, Good A, Edenborough M. Measuring nursing assistants' knowledge, skills and attitudes in a palliative approach: A literature review. Nurse Educ Today. 2015 Dec;35(12):1232-9.
  4. Elliott KE, Scott JL, Stirling C, Martin AJ, Robinson A. Building capacity and resilience in the dementia care workforce: a systematic review of interventions targeting worker and organizational outcomes. Int Psychogeriatr. 2012 Jun;24(6):882-94.
  5. Spector A, Orrell M, Goyder J. A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Res Rev. 2013 Jan;12(1):354-64.
  6. Gillan PC, van der Riet PJ, Jeong S. End of life care education, past and present: a review of the literature. Nurse Educ Today. 2014 Mar;34(3):331-42.
  7. Bassah N, Seymour J, Cox K. A modified systematic review of research evidence about education for pre-registration nurses in palliative care. BMC Palliat Care. 2014 Dec 10;13:56.
  8. Lippe MP, Carter P. End-of-Life care teaching strategies in prelicensure nursing education: An integrative Review. Journal of Hospice and Palliative Nursing. 2015 Feb;17(1):31-9.
  9. Pulsford D, Jackson G, O'Brien T, Yates S, Duxbury J. Classroom-based and distance learning education and training courses in end-of-life care for health and social care staff: a systematic review. Palliat Med. 2013 Mar;27(3):221-35.
  10. Phillips JL, Piza M, Ingham J. Continuing professional development programmes for rural nurses involved in palliative care delivery: an integrative review. Nurse Educ Today. 2012 May;32(4):385-92.
  11. Sockalingam S, Tan A, Hawa R, Pollex H, Abbey S, Hodges BD. Interprofessional education for delirium care: a systematic review. J Interprof Care. 2014 Jul;28(4):345-51.
  12. Fitzpatrick D, Heah R, Patten S, Ward H. Palliative care in undergraduate medical education-how far have we come? Am J Hosp Palliat Care. 2016 Jan 1:1049909.
  13. DeCoste-Lopez J, Madhok J, Harman S. Curricular innovations for medical students in palliative and end-of-life care: a systematic review and assessment of study quality. J Palliat Med. 2015 Apr;18(4):338-49.
  14. Kottewar SA, Bearelly D, Bearelly S, Johnson ED, Fleming DA. Residents' end-of-life training experience: a literature review of interventions. J Palliat Med. 2014 Jun;17(6):725-32.
  15. Nevis I. Educational intervention in End-of-Life Care: An evidence-based analysis. Ont Health Technol Assess Ser. 2014 Dec 1;(17):1-30.
  16. Frey RA, Gott M, Neil H. Instruments used to measure the effectiveness of palliative care education initiatives at the undergraduate level: a critical literature review. BMJ Support Palliat Care. 2013 Mar;3(1):114-9.
  17. Barnes S, Gardiner C, Gott M, Payne S, Chady B, Small N, et al. Enhancing patient-professional communication about end-of-life issues in life-limiting conditions: a critical review of the literature. J Pain Symptom Manage. 2012 Dec;44(6):866-79.
  18. Chung HO, Oczkowski SJ, Hanvey L, Mbuagbaw L, You JJ. Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis. BMC Med Educ. 2016 Apr 29;16:131.
  19. Flemming K, Closs SJ, Foy R, Bennett MI. Education in advanced disease. J Pain Symptom Manage. 2012 May;43(5):885-901.
  20. Green MJ, Levi BH. Teaching advance care planning to medical students with a computer-based decision aid. J Cancer Educ. 2011 Mar;26(1):82-91.