End-of-Life Nursing Education Consortium Research Articles

Outcomes of a National Training Curriculum to Advance Generalist Level Palliative Care.

Background: The adoption of palliative care as an integral component of health care has led to the need for generalist level providers, especially important in serious illnesses such as cancer. Objectives: The goals of this National Cancer Institute-funded training program were to (1) identify the eight domains of quality palliative care applied to oncology practice, (2) demonstrate skills for oncology advanced practice registered nurses (APRNs) in the domains of palliative care, and (3) develop goals for implementing the skills training in practice through process improvement, staff education, and clinical care. Design: The training program led by the End of Life Nursing Education Consortium (ELNEC) project included oncology APRNs in a three-day training course with one-year follow-up for ongoing support and to assess impact. Settings: Five training courses included 430 APRNs from 46 U.S states including both pediatric and adult oncology settings. The project included 25% minority participants. Measurement: Measures included participant goal implementation, course evaluations, and surveys to assess implementation and palliative care practices (precourse, 6 and 12 months postcourse). Results: The ELNEC oncology APRN training course resulted in changes in practice across domains, improved perceived effectiveness in clinical practice, and valuable insight regarding the challenges in generalist level palliative care implementation. Conclusion: The ELNEC oncology APRN course serves as a model for the palliative care field to advance generalist level practice. Future training efforts can build on this project to reach more oncology professionals and those in other areas of serious illness care.

Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: a quasi-experimental study

BackgroundEnd-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU).MethodsThis quasi-experimental study was conducted with a pretest–posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected based on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR).ResultsA significant difference was observed between the intervention and control groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001).ConclusionsEnd-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.

Perceived end-of-life educational needs by clinical trials nurses at a comprehensive cancer center

ObjectiveDetermine palliative care end-of-life (EOL) educational needs among clinical trials nurses (CTNs) at an urban comprehensive cancer center. MethodsThe End-Of-Life Professional Caregiver Survey (EPCS) was used to determine the EOL educational needs of CTNs and collect demographics on years of experience, education, past EOL-specific training, and possession of their own advanced directive. The “Surprise Question” was also asked to explore the percent of patients on clinical trials who may be nearing EOL. ResultsTwenty-nine CTNs completed the survey. Mean years of experience as an RN and CTN was 10.45 and 2.5, respectively. 79% and 17% held a bachelors or master's degree, respectively. Twenty-seven percent reported previous End-of-Life Nursing Education Consortium (ELNEC) or similar training and 20% stated they had their own advanced directive. Mean total score for the EPCS was 94.83, with subscale means of 42.41 for the Patient and Family Centered Communication (PFCC), 26.9 for Cultural and Ethical Values (CEV), and 25.52 for the Effective Care Delivery (ECD). Highest scoring items included confidence in communicating with colleagues about EOL care, being present with dying patients, and recognizing patients who are appropriate for hospice referral. Lowest scoring items included participating in code status discussions, resolving ethical issues and family conflicts at EOL, and addressing requests for assisted suicide. Responses to the Surprise Question indicated that 27.5% of the CTNs would not be surprised if half or more of their patients died within the next 12 months. ConclusionsMany patients with cancer on clinical trials may be nearing EOL. CTNs perceive the need for education to increase confidence in handling difficult communication.

Effectiveness of End-of-Life Training Program for Nurses in a Long-Term Palliative Care Setting: A Pilot Study

Introduction: Palliative training programs, such as the End-of-Life Nursing Education Consortium (ELNEC) curriculum, can equip nurses with the necessary skills and knowledge to cope with patients during end-of-life (EOL) situations. Still, limited studies were conducted in Asia to evaluate its impact on nurses' death anxiety and attitudes in Asia. Methods: This pilot study utilized a quantitative single-group pre-and post-test design and was conducted at a community hospital in Singapore between January 2018 and June 2019. Eighty-two nurses participated in ELNEC program, where a questionnaire was administered before and one month following the two-day workshops. Results: The ELNEC program improved death anxiety (FATCOD) scores from 117.98 to 129.09 (t = -11.38, p&lt;0.01), which indicated a more positive attitude and reduced anxiety towards death encounters. Participants’ communication apprehension, using the CA-Dying scores, decreased from a pre-intervention mean of 92.96 to a post-intervention mean of 76.70 (t = 18.25, p&lt;0.01). Implication: Faculty can utilize ELNEC resource to improve nurses’ knowledge and attitudes towards end-of-life situations in a long-term palliative care setting. Conclusion: This study supported the effectiveness of the ELNEC curriculum in equipping nurses with the necessary skills and knowledge to cope with patients during end-of-life (EOL) situations.

Baccalaureate nursing students' engagement with end-of-life curriculum: A grounded theory study

BackgroundThe art of being prepared to support patients and their families during end of life experiences is not always emphasized in nurse education. Despite the efforts from the American Association of Colleges of Nursing and End of Life Nursing Education Consortium (ELNEC), only 25% of nursing schools across the United States are using their modules. ObjectiveThe purpose of this study was to explore how student nurses engage with end of life education. DesignQualitative study using a grounded theory approach. SettingBaccalaureate nursing program located in the rural agricultural western United States. ParticipantsUsing purposive sampling, a single cohort of baccalaureate student nurses in two focus groups (n = 17; n = 23). MethodsUsing a grounded theory approach, student experiences and engagement with the curriculum were explored. Using the constant comparative method, three researchers coded the data independently and then came together to reach consensus on themes and for the development of the conceptual model. ResultsThree categories emerged from the data to describe the student engagement with the curriculum: Novice, Evolving, and Prepared. The central theme for the Novice students was Being Afraid. Students expressed fear over the unknown and not knowing what to say or do. Becoming Aware was the central theme for the Evolving students which included a blend of being aware of their deficiencies as well as the important aspects of end of life care. The final category was Prepared. The theme for this category was Becoming Accomplished, which included recognition of respectful care, disrespectful care, team work, and advocacy. ConclusionEnd of life education is essential for nursing students to provide appropriate care at end of life, as well as providing improved knowledge, attitudes, and confidence of students. The End of Life Nursing Education Consortium modules, placed strategically within the curriculum, allow nursing students to move through the process of Being Afraid, to Becoming Aware, and finally Becoming Accomplished upon graduation.

Impact of ELNEC-undergraduate curriculum on associate degree nursing student primary palliative care knowledge

BackgroundPrimary palliative care (PPC) education is deficient in nursing curricula. The Endof-Life Nursing Education Consortium (ELNEC) curricula are frequently utilized PPC educational interventions; however, there is limited evidence exploring the impact of the new undergraduate curriculum on student knowledge. PurposeThe purpose of the study was to determine the impact of ELNEC-Undergraduate curriculum on associate degree nursing students’ knowledge of PPC. MethodsThe quasi-experimental study implemented a pretest/posttest design with a single cohort of associate degree nursing students enrolled in their final semester. Knowledge was assessed using the Undergraduate Nursing Palliative Care Knowledge Survey. Paired sample ttests analyzed change in knowledge. Hierarchical linear regressions analyzed the effect of student demographics on knowledge. ResultsKnowledge significantly increased after the implementation of the ELNECUndergraduate curriculum. No significant effects of demographic variables were identified. ConclusionThe ELNEC-Undergraduate curriculum is effective in improving associate degree nursing students’ knowledge of PPC.

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned.

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.

Preparing Advanced Practice Registered Nursing Students to Provide Primary Palliative Care.

Advanced practice registered nursing students need primary palliative care education to care for the growing number of patients with serious illness and their families and to fill the serious resource gaps in specialty palliative care. There has been a lack of primary palliative care education in most graduate nursing programs and little direction as to competencies and essential content. In an effort to support faculty to teach palliative care content, the End-of-Life Nursing Education Consortium (ELNEC) has created an online curriculum that meets the new American Association of Colleges of Nursing Graduate-Competencies and Recommendations for Educating Nursing Students in primary palliative care for master's degree and doctor of nursing practice students. During the first 9 months of its release, more than 170 nursing programs have accessed the ELNEC Graduate curriculum, and there have been more than 200 student completions. Primary palliative care education is essential for all advanced practice nursing students. The new ELNEC Graduate curriculum offers the opportunity to provide quality education remotely.

Preparing New Graduate RNs to Provide Primary Palliative Care

More than 90 million Americans are struggling to live with serious illness and are in need of palliative and end-of-life care. Yet, many novice RNs have not been adequately prepared during their undergraduate programs to care for them. A large southwestern Magnet comprehensive cancer center piloted integrating the End-of-Life Nursing Education Consortium (ELNEC)-Undergraduate Curriculum into their nurse residency program during 2018 with 55 new RNs. A pre-and posteducation evaluation questionnaire measured comfort with caring for patients with serious illness, competence, and knowledge in six areas of palliative care. All eight evaluation questions demonstrated statistically significant improvement posteducational intervention. Many nurse residents reported a change in clinical practice 1 month posteducation. The nurse residency is an opportune training time to prepare novice nurses to provide primary palliative care for all patients with serious illness and their families. [J Contin Educ Nurs. 2020;51(6):280-286.].

The End-of-Life Nursing Education Consortium (ELNEC) Project.

The End-of-Life Nursing Education Consortium (ELNEC) Project.

Preparing Nurses for Palliative Care in the NICU.

Neonatal intensive care unit (NICU) nurses require knowledge and skill to meet the unique needs of infants and families. Increasingly, principles of palliative care are being integrated into the NICU setting to improve the quality of care. The purpose of this article is to describe the efforts of the End-of-Life Nursing Education Consortium (ELNEC) project and its Pediatric Curriculum, which began in 2003 to provide this education, and to also describe efforts by nurses to implement the training into their practice settings. The ELNEC Pediatric Palliative Care (ELNEC-PPC) project is a train-the-trainer educational program and evidence-based curriculum. Participants attend a course or receive online training and then apply the education to implement improved practices in areas such as symptom management, care at the time of death, and bereavement support for families. Experiences with ELNEC-PPC have demonstrated that nurses can implement the curriculum to improve care. Continued attention to palliative care in this setting is needed, and future research is needed to evaluate the outcomes of this education and practice change.

Improving Nurse Knowledge and Confidence in End-of-Life Care Utilizing the End-of-Life Nursing Education Consortium Curriculum: A Pilot Project (QI615)

•Describe the need for integrating palliative care education into hospital training for nurses.•Analyze the effect that the End-of-Life Nursing Education Consortium (ELNEC) Core course has on nurse ability to provide palliative care and its implications for nursing practice. Due to the sensitive nature of palliative care (PC), many nurses are overwhelmed by PC and underprepared to manage its intricacies. Because PC is a relatively new field, nurses who graduated in the past several decades likely did not receive any PC education. Despite recent inclusion of PC in undergraduate programs, coverage in textbooks is marginal. Faculty lack sufficient time and training to prepare nursing students to provide PC; this translates into nurses having insufficient preparation in PC. This pilot project's purpose was to introduce the ELNEC curriculum to staff nurses at a Midwestern Level 1 Trauma Center in order to increase nurses' knowledge and confidence in providing PC. An ELNEC course was held and its effectiveness evaluated via the End-of-Life Professional Caregiver Survey (EPCS) given prior to and at the conclusion of the workshop. Nine nurses attended the course; six participants attended both days and completed both surveys. The survey data indicates that the ELNEC Core curriculum contributed to a statistically significant improvement (P=0.026) in EPCS scores. Paired t-tests were completed for each domain of questions in the EPCS. Mean scores from the Patient and Family Centered Care (PFCC) domain improved significantly (p=0.01), as did Effective Care Delivery (ECD) scores (p=0.01); the change in Culture and Ethical Values (CEV) was not statistically significant (p=0.27). As a pilot project, this study highlights the potential of PC education via the ELNEC curriculum to increase nurse confidence in communicating with patients and families and providing effective care for patients requiring PC. This poster will discuss the lack of education for practicing nurses and examine how the ELNEC Core curriculum can be integrated in hospitals to improve nursing knowledge and confidence regarding provision of PC.

End-of-life nursing education: Enhancing nurse knowledge and attitudes

AimTo evaluate the effectiveness of a palliative and end-of-life care nursing education program on nurses' knowledge and attitudes toward caring for patients with advanced serious illness or nearing death. BackgroundIt is projected that 9 million Americans will be over 85 years old, in the year 2030; many will be living with disabilities and serious medical conditions.Expanding access to palliative care resources and knowledgeable providers is essential for meeting the future demands required by the aging population. MethodsA quasi-experimental research design with pre-test and post-test measures was utilized. Potential sample included 134 nurses who participated in a 6-week, 12-hour End-of-Life Nursing Education Consortium (ELNEC) Core Curriculum© educational program. Changes in knowledge were measured using The Palliative Care Quiz for Nursing (PCQN) (n = 61), while changes in attitudes in caring for dying patients were measured using the Thanatophobia Scale (TS) (n = 57). ResultsResults suggest that while post-test PCQN knowledge scores increased significantly (t = −7.498; p = .000), practicing nurses were somewhat lacking in EOL care knowledge answering 13/20 questions correctly before, and 15/20 questions correctly after the educational intervention. Results also indicated that the sample had positive attitudes in caring for this patient population initially, but that attitudes improved significantly post-intervention (t = 3.944; p = .000). ConclusionsResults support the use of the ELNEC© curriculum for EOL education among this sample, suggesting that educating practicing nurses about EOL is an effective mechanism for both increasing knowledge and improving attitudes. Results also suggest that more education is warranted.

Undergraduate Nursing Students' Perception of End-of-Life Care Education Placement in the Nursing Curriculum.

Nursing students, who have been receiving the End-of-Life Nursing Education Consortium (ELNEC) Core training throughout their Bachelor of Science in Nursing program, have a unique perspective of the benefits of this training. In addition, they have insight as to where an online ELNEC module series specifically for undergraduate nursing students would best be integrated within the curriculum. This study used a mixed methods strategy to evaluate students' opinions on the placement of end-of-life care education within the curriculum and their experience of having received ELNEC training previously throughout their program. Senior-level nursing student opinions on the placement of the ELNEC modules within the curriculum were equally divided, with one-third suggesting placement at the sophomore level, one-third suggesting placement at the junior level, and one-third suggesting placement at the senior level. Students also offered a recommendation for an end-of-life care simulation integration into the Bachelor of Science in Nursing curriculum. Students who have been receiving ELNEC training integrated throughout the curriculum reported feeling comfortable with providing end-of-life care after graduation. Themes extracted from students' suggestions on improving end-of-life care education were as follows: (1) The quality and consistency of instruction needs to be enhanced, (2) palliative care education should be delivered using various methods, and (3) methods to assess education on palliative care should be improved. Students reported that ELNEC training helped them to gain insight into the key elements in palliative care, to understand the differences and similarities between palliative care and hospice, and to understand the nurse's role in palliative care and hospice.

Innovative Applications of ELNEC Curriculum: Eighteen Years Equipping Nurses to Deliver Palliative Care in Diverse Care Settings (FR413)

•Define primary palliative care and name three reasons why primary palliative care is important for all patients and families.•Describe the ELNEC program and model for dissemination of primary palliative care education and give three examples of how ELNEC curriculum has been adapted in diverse care delivery settings to provide clinicians with primary palliative care education The End-of-Life Nursing Education Consortium (ELNEC) was established in 2000 as a national education initiative to expand the capacity of nurses in diverse care settings to integrate palliative care into practice. ELNEC uses a train-the-trainer model and adaptable curriculum materials. ELNEC has expanded to offer multiple specialty courses; and in 2017, the ANA and HPNA recommended that all nurses have ELNEC training as the basis of primary palliative nursing practice. We use case examples to demonstrate how ELNEC curriculum has been successfully adapted for diverse learners. ELNEC curriculum has been implemented to educate acute care nurses, graduate students in a palliative care certificate program, and care managers and social workers within a health plan:1.A metropolitan medical center administered a needs assessment survey to all inpatient nursing staff. Based on the survey results, multiple 30-minute unit-based educational sessions using portions of ELNEC modules are being piloted to increase nurses’ knowledge of palliative care.2.Clinical staff at a community hospital wanted to better support families after they had received bad news. ELNEC Core curriculum was used to provide a 3-hour training on communication.3.Learning strategies from the ELNEC modules are being threaded throughout graduate level interdisciplinary palliative care courses housed within the School of Nursing at a university.4.An ELNEC Course was offered to more than 250 care managers and social workers for a health plan to increase awareness of the comprehensive needs of members with serious illness and encourage early referral to palliative and community resources. Across care settings, nurses, care managers, and social workers are ideally positioned to identify and address unmet palliative care needs in the populations they serve. These examples demonstrate how ELENC curriculum can be adapted to disseminate primary palliative care knowledge, enabling clinicians to improve quality of life for their patients living with serious illness.

Development of New Undergraduate Palliative Care Knowledge Measure (S846)

1.Describe the process for developing a new palliative care knowledge measure.2.Explore possible ways to utilize the new knowledge measure to evaluate current students' palliative care knowledge. Palliative care nursing education has long been guided by the End of Life Nursing Education Consortium (ELNEC) curriculum, originally released in 2001. However, no measure to evaluate student's knowledge exists that appropriately reflects current palliative care best practice. The purpose of the presentation is to describe the development and psychometric evaluation of a new knowledge measure to be used for the evaluation of undergraduate nursing student's palliative care knowledge. I) Creation of the new knowledge measure was guided by relevant research literature in instrument and scale development. The knowledge measure, titled the Undergraduate Nursing Palliative Care Knowledge Survey (UNPCKS), was developed in four systematic steps: 1) item generation from a team of seven palliative care and nursing education experts; 2) pilot test of UNPCKS; 3) instrument revision with experts; and 4) psychometric testing. The final version of the UNPCKS is a 27-item, multiple-choice instrument that evaluates undergraduate nursing students' palliative care knowledge. Students at three universities (n=262) completed the UNPCKS for psychometric testing. Exploratory factor analysis revealed two primary factors: palliative care principles and nursing-specific responsibilities. Content validity was established by the expert panel. The UNPCKS is a psychometrically strong contemporary measure that can be utilized to evaluate students' palliative care knowledge.

Prelicensure Nursing Students' Attitudes and Perceptions of End-of-Life Care.

It is important that education on palliative care begin early in prelicensure nursing education because of the complex care needs of patients requiring end-of-life care. Nursing students often lack confidence and skills in providing quality care for these patients. Nursing students' attitudes on end-of-life care were assessed using the Frommelt Attitudes Toward Care of the Dying scale. Students were tested as sophomores, then again as seniors, in a nursing program where the End-of-Life Nursing Education Consortium (ELNEC) curriculum had previously been integrated. Seniors reported improved comfort levels providing end-of-life care. Assessing for improved comfort levels among nursing students who receive ELNEC training could help support ongoing efforts to integrate this education in all nursing programs. Students who had formal education in end-of-life care were more comfortable caring for patients at end of life and had a better understanding of their role.

Helping Bridge the Great Divides: Supporting Nurse Communication at End of Life.

Many, especially newer, nurses lack the experience for nuanced skillful communication at end of life. This study incorporated the End-of-Life Nursing Education Consortium (ELNEC) Core Curriculum Communication module into a nurse residency program and tested for change in attitudes toward end-of-life (EOL) care. Researchers found significant differences in attitudes toward care of the dying before and after the ELNEC training, and between nurses with greater than and less than 5 years experience. Findings support that ELNEC education can significantly impact nurse attitudes about EOL care.

The Impact of the End-of-Life Nurse Education Consortium on Attitudes of Undergraduate Nursing Students Toward Care of Dying Patients.

This mixed methods study explored the impact of the End-of-Life Nursing Education Consortium (ELNEC)-Undergraduate Curriculum on perceived preparedness of undergraduate nursing students in the care of dying patients and the relationship between personal loss experience and undergraduate nursing students' attitudes regarding the ELNEC-Undergraduate Curriculum. Of the 36 undergraduate nursing students who completed ELNEC, 24 reported a personal loss of a close family member or friend to death and 12 reported no loss. Findings confirmed the overall positive impact and acceptability of ELNEC, but this effect was observed differently between students with and without previous loss. Students with personal loss were more aware of the challenges of end-of-life care before taking ELNEC and incorporated the content into a greater sense of preparedness. Study recommendations include placing ELNEC within didactic instruction by well-prepared faculty, creating simulation debrief groups composed of both students with and without loss, and faculty attention to the loss experiences of students.

Training and Mentoring End-of-Life Nursing Education Consortium (ELNEC) Educators in India

India is the world's most populous nation with an estimated 1 million new cases of cancer a year, yet less than 1% has access to palliative care. There are excellent centers offering palliative care but not enough to meet the need for education and care. Nurses outnumber physicians in India and are essential in building a strong national palliative care program. This pilot project has aimed to use a culturally adapted version of End-of-Life Nursing Education Consortium train-the-trainer and distance mentoring to enable trainees to educate nurses in their institution. A secondary goal was to evaluate the training on nurses' knowledge and attitudes to pediatric palliative care and pain management. The 2-day train-the-trainer End-of-Life Nursing Education Consortium seminars, with online mentoring between the sessions, provided palliative care education for 26 nurse trainers from across India. A pretest and posttest showed an increase in knowledge and a positive change in practice. Because of lack of reliable computer access for the nurses, mentoring was conducted online via Facebook. There were good results including multiple trainings across India and important lessons learned from this pilot project to help international training and mentoring projects.