Nursing Education Consortium Research Articles

Studying the Effects of the End-of-Life Nursing Education Consortium at the Institutional Level

The purpose of this study was to assess the ongoing impact of the End-of-Life Nursing Education Consortium training program on RNs' death anxiety, concerns about dying, and knowledge of the dying process utilizing the principles of the Comfort Theory and Practice by Kolcaba (New York: Springer Publi

Beyond Bad News

v Communication skills are paramount in effective delivery of palliative care. The emphasis in much of the previous literature has been on physician communication and also has been largely focused on the singular topic of breaking bad news. Much less emphasis has been placed on communication as a vital skill of nurses and on the opportunities for nurses, as they are often the key professionals at the bedside after ‘‘bad news’’ is shared. The study was conducted as a survey of nurses (N=333) attending anEnd-of-Life Nursing Education Consortium conference. The survey assessed nurses’ perspectives of the most challenging aspects of communication in their work and elicited examples of both positive and negative communication. Results of the survey indicate important areas for future research and education to enhance nurses’ abilities to communicate effectively and compassionately. Respondents identified several key areas in need of improvement related to communication. Examples of the most difficult areas of communication include discussing bad news, talkingwith physicians about palliative care issues, discussing spiritual concerns, and talking with patients/families from different cultures. Nurses are the primary, constant healthcare providers across clinical settings, and effective skills in communication are critical to nursing practice and to ensure quality care. Education regarding communication skills is needed in basic and graduate nursing education programs as well as in continuing education for practicing nurses. K E Y W O R D S

Assessment of Advanced Practice Palliative Care Nursing Competencies in Nurse Practitioner Students: Implications for the Integration of ELNEC Curricular Modules

Advanced practice nurses (APRNs) have key roles in the care of patients who are nearing death and those living with a disabling chronic disease. This article describes a mixed-method formative assessment of 36 graduate nursing students' knowledge about and attitudes toward palliative care preliminary to curricular integration of the End-of-Life Nursing Education Consortium (ELNEC) graduate core modules. Students' knowledge about palliative care was assessed using the 106-item ELNEC examination. In addition, qualitative data were gathered regarding students' definitions of palliative care, the role of the APRN in palliative care, and their definitions of a "good" and "bad" death. Results revealed students' limited knowledge about palliative care. Qualitative findings indicated that most students exclusively linked palliative care with end-of-life care and believed that the treatment they provide should have the goal of prolonging life over maintaining quality of life. Implications for curriculum design, advanced practice role development, and collaboration with community health partners are discussed.

Addressing Life Limiting Illness in Elders

Background: Elder patients often experience chronic life limiting conditions, such as vascular diseases, malignancies, renal or liver failure, stroke, advanced heart or lung disease, neurodegenerative disorders, and dementia. The 1995 SUPPORT study demonstrated a pervasive lack of communication between patients and their health care providers about goals of end of life care, significant levels of inadequately treated pain in seriously ill and dying patients, and, most importantly, discrepancies between stated preferences of care and continued use of aggressive care. Purpose: To address this issue in elder patients, Massachusetts General Hospital developed The RN Residency: Transitioning to Geriatrics and Palliative Care, an innovative program funded by the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration. Methodology: The RN Residency program is a nine-month residency program. This program utilizes cohort learning to build skills and competencies to improve practice and initiate unit based quality improvement. The National Consensus Project for Quality Palliative Care's Clinical Practice Guidelines serve as the blueprint for end of life education, along with The End of Life Nursing Education Consortium Curriculum and other resources from the Center to Advance Palliative Care and Hospice and Palliative Care Nurses Association. The John A Hartford Foundation Evidence-based geriatric curriculum serves to structure education for the older adult patient. Findings: Evaluation is ongoing, including qualitative assessments and pre- and post-test of skills and attitudes toward seniors. Summary Concluding Statement: The RN Residency provides nurses knowledge and expertise through state of the science, evidence-based palliative care and geriatric education, thereby improving end of life care for elder patients.

Improving End-of-Life (EOL) Care in California Nursing Homes through Education: The End-of-Life Nursing Education Consortium (ELNEC) Geriatric Program

Introduction/Objective: Nursing's mandate is to provide compassionate care and dignity to persons at the EOL. Approximately, 25% of US deaths occur in nursing homes and the proportion increases with age of residents. The ELNEC Project is a partnership of the City of Hope and the American Association Colleges of Nursing (AACN). ELNEC's Geriatric train-the-trainer program is a synthesis of knowledge in EOL care and teaching methodology to develop expertise and skills for nurses responsible for care of older adults in nursing homes, skilled nursing facilities, hospices, home care, assisted living, etc., as well as in staff education programs.

Promoting Perinatal, Neonatal, and Pediatric Palliative Care Nursing Education (510)

1.Identify a national project to coordinate nursing efforts in perinatal, neonatal, and pediatric palliative care.2.Identify models of excellence in implementing palliative care in perinatal, neonatal, and pediatric settings.3.Describe barriers to implementing palliative care across perinatal, neonatal, and pediatric settings. The purpose of this presentation is to describe the End-of-Life Nursing Education Consortium Pediatric Palliative Care (ELNEC-PPC), a comprehensive national effort to improve palliative/end-of-life (EOL) care provided by healthcare professionals in perinatal, neonatal, and pediatric settings. The project is based on the original End-of-Life Nursing Education Consortium (ELNEC) training, which is a partnership between City of Hope and the American Association of Colleges of Nursing (AACN). This project is a synthesis of research and knowledge in palliative care and is intended to assist with implementing evidence based practice. Based on the AACN Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Nursing Care and the 1997 Institute of Medicine report, the ELNEC-PPC curriculum focuses on 11 EOL areas: overview of palliative care; pediatric consideration; pain; symptom management; perinatal and neonatal palliative care; loss, grief, and bereavement; communication; ethical issues; quality improvement; and care during the final hours. The ELNEC-PPC curriculum includes detailed supplemental teaching materials to integrate palliative care content into continuing education/in-services for practicing nurses in a variety of clinical settings, and classroom/clinical teaching for students. Since the first course was held in August 2003, eight national train-the-trainer courses have been held, with 735 nurses attending from diverse pediatric settings across the United States and Canada. For more information about the ELNEC-PPC Project, visit http://aacn.nche.edu/ELNEC. Structure and Processes of Care

Evaluation of palliative care nursing education seminars

Purpose More than 50 million people die each year around the world. Nurses are crucial in providing care to these individuals and their families as they spend the most time at the bedside with patients and families. Yet many nurses have received little or no education about palliative care. Methods/Sample The Open Society Institute (OSI) and the Open Medical Institute (OMI) partnered with End-of-Life Nursing Education Consortium (ELNEC) to develop an international nursing palliative care curriculum. This international curriculum was implemented with two training courses held in Salzburg, Austria in October 2006 ( n = 38) and April 2008 ( n = 39) representing 22 Eastern European/Central Asian countries. Participants were asked to establish goals in disseminating the palliative care information when they returned to their country. The participants were mentored/followed for a 12-month period to evaluate their palliative care knowledge as well as challenges encountered. Key Results The participants provided excellent ratings for the training courses indicating that the courses were stimulating and met their expectations. The 12-month follow-up demonstrated many challenges (i.e., lack of funds, institutional support, fear of death), in advancing palliative care within each participant's setting/country as well as many examples of successful implementation. Conclusions There is an urgent need for improved palliative care throughout the world. The ELNEC-International curriculum is designed to address the need for increased palliative care education in nursing. In order to improve the quality of life for those facing life-threatening illnesses around the world, ongoing support is needed for world-wide palliative care educational efforts.

Validation of the End-of-Life Nursing Education Consortium Knowledge Assessment Test

Theneedforimprovednursingknowledgeaboutend-of-life care is well documented; however,efficient measures to evaluate knowledgeattainmentfromend-of-lifetrainingprogramsarelacking. The authors tested a 50-item versionof an original 109-item knowledge assessmenttool developed by the End-of-Life NursingEducation Consortium. Items with highestitem-to-total correlations were selected torepresent each of the nine domains in theoriginal instrument. One hundred forty-onegraduate and undergraduate nursing studentspretested the shorter version. Thirty graduatestudents also completed the original version.Item analysis, equivalence, and internalconsistency estimates were conducted toevaluatethevalidityofthe50-itemversion.Scoreson the 109-item and 50-item versions were highlycorrelated (

Award-Winning Facility Cultivates Palliative Care

Award-Winning Facility Cultivates Palliative Care

End-of-Life Nursing Education Consortium: 5 Years of Educating Graduate Nursing Faculty in Excellent Palliative Care

Since January 2001, over 4,500 nurses, representing all 50 U.S. states and the District of Columbia, have attended 1 of 50 national End-of-Life Nursing Education Consortium (ELNEC) train-the-trainer courses. Of the 4,500 nurses who have attended a national ELNEC course, 300 graduate nursing faculty members participated in one of four National Cancer Institute (NCI) grant-funded courses, ELNEC-Graduate, that focused on the needs of faculty teaching graduate nursing students. These nursing faculty members represent every state in the United States and 278 (63%) out of 438 graduate nursing programs. The final NCI-funded ELNEC-Graduate course took place in June 2006. Due to the continued need for this education, additional courses were offered at the 2007 American Association of Colleges of Nursing (AACN) master's conference, and another course was presented in February 2008 at the same AACN meeting. The purpose of this paper is to describe the history of the ELNEC-Graduate project and to demonstrate its impact in empowering graduate nursing faculty members to improve their teaching methods and strategies regarding end-of-life (EOL)/palliative care education. Because of ELNEC-Graduate, graduate nursing faculty members are better equipped to provide this education to their students so that these students are prepared to care for patients and their families experiencing EOL/palliative care issues.

Appraisal of the Pediatric End-of-Life Nursing Education Consortium Training Program

Major deficiencies continue to exist in pediatric palliative and end-of-life nursing education. The End-of-Life Nursing Education Consortium (ELNEC)-Pediatric Palliative Care (PPC) train-the-trainer curriculum was developed to create a nursing education program to improve care for children and their families confronted with life-threatening illnesses (www.aacn.nche.edu/ELNEC). Two ELNEC-PPC training programs were held in August 2005 and August 2006. The purpose of this article is to present data from the precourse and 12-month postcourse follow-up of participants who attended the two courses. Findings from these assessments demonstrate a positive link between educational initiatives and clinical outcomes.

Statewide Efforts in Promoting Palliative Care

In 2002, Means to a Better End: A Report of Dying in America Today, a Robert Wood Johnson Foundation (RWJF) report, was issued that included grades for each state on their ability to provide end-of-life care. Most states, including California, rated as mediocre and the report called for extensive efforts at a state level to improve the quality of palliative care. The purpose of this paper is to describe implementation and evaluation of a comprehensive statewide effort to improve end-of-life care education for 350 California nurses as an example of state-level change as recommended by the RWJF report. Funded by the Archstone Foundation (Long Beach, CA), this effort was based on the End-of-Life Nursing Education Consortium (ELNEC) "Train the Trainer" project, a national educational initiative to improve end-of-life care by providing training to nurses (www.aacn.nche.edu/ELNEC). ELNEC is a partnership between City of Hope, Duarte, California, and the American Association of Colleges of Nursing, Inc., Washington D.C. Three courses were held from October 2005 through March 2007 in which 350 nurses from various clinical settings across California applied and participated in the training program. MEASUREMENTS/RESULTS/CONCLUSION: In order to be accepted in the course, participants agreed to follow-up for 12 months postcourse in order to evaluate the impact of their attendance on their institutions' commitment to palliative care. This paper reports findings from this California effort as an example of a state-intensive effort and to encourage other statewide palliative care initiatives in order to improve care for the dying.

End-Of-Life Nursing Education Consortium Geriatric Training Program: Improving Palliative Care in Community Geriatric Care Settings

Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)-Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC-Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC-Geriatric Training Program and follow-up evaluation of the "train-the-trainer" model to disseminate comprehensive palliative care education in geriatric settings.

The Influence of End-of-Life Education on Attitudes of Nursing Students

Palliative care is an important aspect of nursing when comfort and quality of life are the patient goals. The End-of-Life Nursing Education Consortium (ELNEC) developed a comprehensive program of teaching care of the dying to nurses and nursing students. This pretest-posttest study evaluated the influence of the integration of the ELNEC curriculum into a baccalaureate nursing program on students' attitudes toward care of the dying. The Frommelt Attitudes toward Care of the Dying Scale for nurses (FATCOD) was administered to traditional and accelerated baccalaureate students before and after exposure to a nursing curriculum that integrated essential ELNEC elements. Multiple regression analyses indicated that no previous experience with death and an age of 18-22 accounted for the most variance in attitude change. The findings suggest that integrating the ELNEC curriculum throughout a baccalaureate program positively affects the attitudes of nursing students toward the care of patients who are dying.

Global efforts to improve palliative care: the International End‐of‐Life Nursing Education Consortium Training Programme

This paper is a report of an evaluation study to determine the feasibility and effectiveness of the End-of-Life Nursing Education Consortium-International training conference in providing education and support materials to participants so they might return to their home countries and disseminate palliative care information. More than 50 million people die each year, many without access to adequate pain control or palliative care. Numerous barriers to implementation of palliative care exist, including lack of education provided to healthcare professionals regarding these principles. Because they spend the most time with patients and their families, nurses have the greatest potential to change the way palliative care is provided. A Course Evaluation Form and a Postcourse Activity Evaluation was completed by a convenience sample of 38 nurses from 14 Eastern and Central European, former Soviet, and Central Asian countries. The data were collected in 2006 using Likert scales and open-ended questions. Evaluations of speakers ranged from a mean of 4.4 to 4.9 on the 5-point scale, with five denoting the highest level. The mean rating of the conference overall was 4.9. Strengths included the professional level of presentations, practical, clinically based content, extensive resources and availability of the educators. The first End-of-Life Nursing Education Consortium-International training programme demonstrated the feasibility of providing high-quality, essential education to nurses from a variety of countries. Because End-of-Life Nursing Education Consortium is designed as a train-the-trainer programme, assistance with translation to native languages, along with textbooks and other resources, is needed to allow participants to fully implement this curriculum.

Educating RNs Regarding Palliative Care in Long-Term Care Generates Positive Outcomes for Patients With End-Stage Chronic Illness

v There are multiple gaps in providing palliative care to older adults with advanced chronic illness symptoms who never get connected to hospice or palliative care programs. Using a preand posttest design via a retrospective chart review, this study found the symptoms, interventions, and responses to interventions that older patients with end-stage chronic illness experienced. Findings revealed symptoms similar to those listed by End-of-Life Nursing Education Consortium, including fatigue/ weakness, anorexia/cachexia, sadness/ depression, dyspnea, nausea and vomiting, anxiety/fear, confusion/delirium, diarrhea, constipation, and pain. A significant difference (t = 5.538, P G .0001) in long-term care nurses’ preand posttest mean scores also was determined. The results indicated that in this convenience sample, older adults have several burdensome symptoms that palliative care programs could potentially improve. Being aware of frequently observed symptoms in long-term care agencies can assist in anticipating what other long-term care older adults may experience. Results can help to prevent or lessen symptoms and promote best practices for older adult symptom management. K E Y W O R D S

End-of-Life Nursing Education Consortium for Pediatric Palliative Care

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Pediatric Palliative Care

To the Editor.—As a nurse working in an intensive care nursery, I have dealt with children who have chronic illnesses and sometimes face death. This is why I found the article by Feudtner et al entitled “Hopeful Thinking and Level of Comfort Regarding Providing Pediatric Palliative Care: A Survey of Hospital Nurses” very enlightening.1 I have learned about palliative care through experience and from our hospital's Pediatric Advanced Comfort Care Team (PACCT). There are still situations in which I am not comfortable speaking about the death of a child, which is why the level of comfort that nurses have regarding palliative care is extremely important. I commend your efforts in providing awareness about pediatric palliative care and agree with the authors' conclusion that many nurses feel proficient regarding pain management and inadequate when talking with children and families about dying. This article showed that there is a need for more education in patient care settings regarding palliative care. By increasing knowledge related to palliative care, a positive effect could be obtained for both patients/families and nurses.Feudtner et al found that “[n]urses' level of hope is associated with their self-reported comfort and competence regarding palliative care.” To increase comfort levels of nurses, hospitals should be encouraged to implement courses like the End-of-Life Nursing Education Consortium, which was developed in September 2001. The End-of-Life Nursing Education Consortium is a training course that informs nurses about communication skills, ethics, cultural considerations, pain/symptom management, care at the time of death, grief, and bereavement.2 Hospitals should also be encouraged to create a pediatric supportive care team like the one my hospital, Children's Mercy, implemented (the Pediatric Advanced Comfort Care Team). These teams can enhance the “quality of life in the face of an ultimately terminal condition.”3New research and education can provide nurses with useful information about palliative care. Interventions should be studied in clinical trials to determine the effectiveness in achieving better patient, family, and health care provider outcomes.1 Because nurses have a distinctive role in promoting and providing care for terminal children and their families, education and teamwork are imperative to provide pediatric nurses the confidence that is needed in these situations. I hope that Pediatrics will continue to support the efforts of palliative care education and look forward to reading more literature regarding this important topic.

End-of-Life Nursing Education Consortium (ELNEC) Training Program

The integration of palliative care in critical care settings is essential to improve care of the dying, and critical care nurses are leaders in these efforts. However, lack of education in providing end-of-life (EOL) care is an obstacle to nurses and other healthcare professionals as they strive to deliver palliative care. Education regarding pain and symptom management, communication strategies, care at the end of life, ethics, and other aspects of palliative care are urgently needed. Efforts to increase EOL care education in most undergraduate and graduate nursing curricula are beginning; yet, most critical care nurses have not received formal training in palliative care. Moreover, educational resources such as critical care nursing textbooks often contain inadequate information on palliative care. The ELNEC-Critical Care program provides a comprehensive curriculum that concentrates on the requirements of those nurses who are working in areas of critical care. Extensive support materials include CD-ROM, binder, Web sites, newsletters, textbooks, and other supplemental items. The ultimate goal is to improve EOL care for patients in all critical care settings and enhance the experience of family members witnessing the dying process of their loved ones.

Oncology End-of-Life Nursing Education Consortium Training Program: Improving Palliative Care in Cancer

To describe an evaluation of the oncology version of the End-of-Life Nursing Education Consortium (ELNEC-Oncology) training program, which is designed to provide oncology nurses with the knowledge and materials necessary to disseminate palliative care information to their colleagues in local chapters of the Oncology Nursing Society (ONS). Participant reports. 124 nurses representing 74 ONS chapters attended the first two courses. Dyads of ONS members from local chapters applied to attend ELNEC and completed surveys regarding their goals and expectations for implementing end-of-life (EOL) education and training after completion of the program. Participants educated more than 26,000 nurses after attending the program, including 7,593 nurses within their ONS chapters and 18,517 colleagues within their workplaces. Barriers to implementation included a lack of funding and time constraints. Participants sought additional palliative care learning opportunities, including attending other workshops, subscribing to palliative care journals, and becoming involved in committees focused on palliative care. The ELNEC-Oncology program is a national collaboration with ONS that provides oncology nurses with the tools and expertise to effectively disseminate palliative care content to colleagues within their local chapters and work settings. EOL care information remains critical to the science of oncology nursing, and ELNEC-Oncology provides an effective strategy for disseminating the information.