Abstract
BackgroundA ‘blended’ (e-learning and facilitated workshops) training course for Group C staff (i.e. staff with relatively infrequent contact with end of life care) has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes. This paper evaluates the impact of the course on participants’ understandings of and confidence in delivering end of life care in one nursing home, while also considering barriers to change in practice.MethodsA mixed-methods case study approach, incorporating pre- and post-course questionnaires (SHA East of England End of Life Care Education Programme ‘ABC’ Project Work Force C or Non Nurse Workforce B Pre and Post Course Questionnaire; E-Learning in End of Life Care Study Pre and Post Course Questionnaire), documentary analysis, semi-structured interviews, and observation of course workshops. Participants were 20 members of staff at a nursing home in a city in the East of England, including 14 Health Care Assistants (carers) and 6 others (administrative, activities, hosting, and catering staff). The questionnaires and interviews assessed understandings of and confidence towards end of life care delivery.ResultsImprovements in participants’ confidence in delivering end of life care were observed, particularly in the core competency areas of symptom management, communication, and advance care planning. A shift towards more detailed and more holistic understandings of end of life care was in evidence; some participants also championed end of life care in the home as a result of the course. Several barriers to changes in practice were encountered, including uneven participation, the absence of mechanisms for disseminating new insights and knowledge within the home, and a widespread perception that nurses’ professional dominance in the home made sustainable change difficult to enact.ConclusionsWhile blended e-learning courses have the potential to generate positive change in participants’ understandings of and confidence about End of Life Care, organizational and inter-professional obstacles must be overcome in order to translate these changes into improved end of life care delivery in nursing (and residential) homes.
Highlights
A ‘blended’ (e-learning and facilitated workshops) training course for Group C staff has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes
The extent to which blended e-learning courses enable care home staff to acquire appropriate knowledge, skills, attitudes, and confidence for the delivery of high-quality end of life care remains opaque. This paper addresses this gap by evaluating the impact of a particular blended e-learning course - the aforementioned ABC course - on members of staff in one nursing home in the East of England, focusing in particular on (a) staff members’ understandings of and confidence in delivering end of life care and (b) barriers to translating new understandings into practice
In line with the overarching research questions, the two broad themes presented below relate, respectively, to: (a) changes in confidence and understandings regarding end of life care; and (b) barriers to change in practice
Summary
A ‘blended’ (e-learning and facilitated workshops) training course for Group C staff (i.e. staff with relatively infrequent contact with end of life care) has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes. The provision of high-quality end of life care in nursing and residential care homes has been shown to reduce emergency admissions to hospitals, reduce levels of distress in residents, families and care home staff, improve staff-resident communication and adherence to residents’ wishes, and, more widely, promote greater openness about death and dying among staff [1,2,3,5,6]. Barriers to the provision of such care include variable levels of training, high staff turnover, underfunding and excessive staff workload, misunderstandings about end of life care, emotional and spiritual challenges, and wider societal taboos relating to talking about death and dying [1,7,8,9,10]
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