Abstract
BackgroundThe ABC End of Life Education Programme trained approximately 3000 care home staff in End of Life (EoL) care. An evaluation that compared this programme with the Gold Standards Framework found that it achieved equivalent outcomes at a lower cost with higher levels of staff satisfaction. To consolidate this learning, a facilitated peer education model that used the ABC materials was piloted. The goal was to create a critical mass of trained staff, mitigate the impact of staff turnover and embed EoL care training within the organisations. The aim of the study was to evaluate the feasibility of using a train the trainer (TTT) model to support EoL care in care homes.MethodsA mixed method design involved 18 care homes with and without on-site nursing across the East of England. Data collection included a review of care home residents’ characteristics and service use (n = 274), decedents’ notes n = 150), staff interviews (n = 49), focus groups (n = 3), audio diaries (n = 28) and observations of workshops (n = 3).ResultsSeventeen care homes participated. At the end of the TTT programme 28 trainers and 114 learners (56 % of the targeted number of learners) had been trained (median per home 6, range 0–13). Three care homes achieved or exceeded the set target of training 12 learners. Trainers ranged from senior care staff to support workers and administrative staff. Results showed a positive association between care home stability, in terms of leadership and staff turnover, and uptake of the programme. Care home ownership, type of care home, size of care home, previous training in EoL care and resident characteristics were not associated with programme completion. Working with facilitators was important to trainers, but insufficient to compensate for organisational turbulence. Variability of uptake was also linked to management support, programme fit with the trainers’ roles and responsibilities and their opportunities to work with staff on a daily basis.ConclusionWhen there is organisational stability, peer to peer approaches to skills training in end of life care can, with expert facilitation, cascade and sustain learning in care homes.
Highlights
The ABC End of Life Education Programme trained approximately 3000 care home staff in End of Life (EoL) care
Two further care homes were recruited as replacements, which resulted in a total of 17 participating care homes
A care home’s readiness to participate in an intervention or not at a particular point in time was shaped by the roles and responsibilities of trainers and where they were located in the care home structure, the opportunities for learning that occurred as part of the everyday workflow, and the level of organisational turbulence in terms of staff turnover and sustained engagement of senior management
Summary
The ABC End of Life Education Programme trained approximately 3000 care home staff in End of Life (EoL) care. An evaluation that compared this programme with the Gold Standards Framework found that it achieved equivalent outcomes at a lower cost with higher levels of staff satisfaction To consolidate this learning, a facilitated peer education model that used the ABC materials was piloted. In October 2012 NHS Health Education East of England (formerly East of England Multi-professional Deanery) commissioned a local specialist palliative care service to develop the Train the Trainer (TTT) End of Life Care Education Programme for care home staff. When the ABC programme was compared with another EoL training framework (Gold Standards Framework)[8] for care homes it achieved equivalent outcomes in terms of impact on staff satisfaction, confidence and competence, and in satisfaction of next-of-kin [8]. It was considered to be the more cost effective of the two schemes reviewed [8] and reported a modest reduction in death rates in hospital, unscheduled admissions and bed days
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