Making a difference through QELCA: a time to engage community nurses

Abstract

We have recently witnessed increased requests from patients and a huge ‘push’ from government for more people to die in their own homes across England. Most of the patients wishing to die at home tend to be experiencing life-threatening and limiting illnesses, and their care demands knowledge and skills in dealing with their palliative care needs. As a result, there is an inevitable added pressure on community nurses to care for all these people. The result is that patients presenting with complex end-of-life care needs may end up being cared for predominantly by generalist health professionals. Some community nurses may feel inadequately trained and prepared to care for the needs of patients at the end of life, and as a result, be left with a sense of having failed their patients. The End of Life Care Strategy (Department of Health, 2008) makes it clear that workforce development is a priority if patients are to receive high-quality and appropriate care at the end of life. However, current austerity measures inhibit the training of health professionals to care for dying patients in the community. If we have fewer skilled carers in the community, the risk is that dying patients will not receive adequate and appropriate care, which respects their wishes and dignity. In addition, the impact of poorly delivered care on the bereaved relatives and friends will inevitably manifest in bereavement complication, like traumatic distress, anxiety and even depression. For caring health professionals working at the generalist level of palliative care, more training and education is needed if we are to benefit all dying patients, regardless of where they are being cared for. In recognition of these needs, a specially designed education programme: ‘Quality End of Life Care for All’ (QELCA), has been developed by St Christopher’s Hospice in Sydenham, London to empower generalist nurses to deliver confident, competent end-of-life care. One of the key aims of QELCA, in addition to empowering nurses with knowledge about palliative and end-oflife care, is to develop and equip nurses to remain engaged in meaningful emotional contact with patients and their relatives. At the same time, it aims to ensure that nurses can preserve their professional and personal integrity without becoming emotionally exhausted and experiencing burnout. This is an important and brave goal, as it will require adept skills from the facilitators in order to instil the balance and ability in nurses to separate personal feelings from professional care and respect for the feelings of the dying patient. It is well documented in literature on burnout that when this delicate balance is not achieved properly, nurses experience emotional exhaustion that can lead to burnout, and patients may feel unsupported and without a sense of being treated as a unique individual (Maslach, 2003). QELCA consists of a 5-day training programme with follow-up sessions using action learning sets, and offers a platform for sharing ideas and experiences while learning new skills to improve on patient care. Of course, in today’s financial climate, there are challenges of funding, time and staff shortages, but it has been shown that QELCA training can help nurses make the best use of their limited time while learning vital skills that they can use to care for all patients at the end of life (Bryan et al, 2011). It is hoped that long-term benefits will include a more confident generalist practitioner, reduced incidents of absenteeism, and continuity of care for dying patients. The evaluation to date shows that, on the whole, QELCA is making a difference among generalist and community nurses in particular, who at first thought palliative care was not their remit or role. Senior managers need to support all community nurses to attend and help improve the care of all dying patients, regardless of setting. It is an aim of QELCA to train trainers in order to spread the benefits across the country, and quickly. In addition, such knowledge and skill will help ameliorate emotional exhaustion and eventually, burnout. Although QELCA may be aimed at generalist nurses, it could be equally helpful to other professional groups, ensuring that patients receive the best care possible from all health professionals. BJCN