Interview with Breda Trimble-Moloney, palliative care Nurse Tutor

Categories: Education.

Could you tell me about your job?

I am employed as a Nurse Tutor in Milford Care Centre, Limerick. 

Within the facility we have a dedicated education service involved in palliative care and gerontology related education for in house staff and the public throughout the area and beyond. Many members of the organisation, including the clinical, quality and safety, social work, volunteer, bereavement and HR teams work with the service to lead or actively contribute to parts of the education agenda as members of a wider education team.

My role focuses on palliative and gerontology nurse education within Milford and to external areas through on site teaching and distance learning facilitation including associated clinical skill competencies e.g. syringe driver training, male catheterisation and venepuncture.

Participants attend from mainly generalist practice; nursing home staff, community carers, acute hospitals, however we are seeing an increase in attendance from individuals with a background in specialist areas i.e. dementia care, renal dialysis, intellectual disability and paediatrics.  I believe this is reflective of the national age profile chronic disease trends and increasing recognition of the necessity of a palliative approach within these specialties.

Through evaluations and ongoing feedback from in house staff, cognizance of local and national policy developments, we publish a yearly education directory with a compilation of study days and mini tutorials; from a 3 day gerontology program to an 8 week certificate program which encompass the essential requirements when caring for patients with palliative needs. The overall goal to provide practitioners with up to date evidenced based education in improving the quality of life for patients and their families. This remains a core motivating factor for me in my teaching endeavours.

Highlights of the job include being in a position to support individuals who are experiencing or have experienced challenges in providing good practice for those receiving care at end of life. Providing participants with up to date evidence based information resolves gaps in knowledge and increases competency requirements. It is a facilitative process of problem solving and reflective practice approach which I believe truly complements participants learning experience.

I find there is certain vulnerability with participants when engaging in reflective practice/writing particularly in palliative care education. By recognising strengths and weaknesses, it raises consideration of personal experiences of death and dying, which for some individuals, may be the first opportunity these have been explored in any great depth and therefore can be quite emotive from a personal viewpoint. For me, being a witness to their learning and development over a period of time, their endeavour to make their patient’s death more dignified and comfortable is a considerable motivating factor for me in providing a quality learning opportunity.

Is there anything you find challenging in your Nurse Tutor role?

It is important that individuals are supported in their work place to attend updates and education sessions. However, while a formal education system may well be available it can be a struggle for practitioners to actually attend on a given day due to last minute clinical dependency levels or staff shortages which prevents their attendance. Staff release for education must be preserved, as outlined by the Irish Hospice Foundation palliative care projections – there is a need for a competent workforce which can meet patient needs within a range of role remits and care settings. In my experience from working in Milford providing in house education updates for individuals and accessing e-learning activities has shown to be positive platforms for supporting staff to avail of education.

What has been your experience providing palliative care education to different health care professionals and volunteers?

As outlined by the EAPC recently whereby the interdisciplinary nature of palliative care different professionals are encouraged to work together, I feel “learning together” the core constituents of palliative care is another strand pivotal to facilitating a true MDT approach in providing quality care for patients and their families. MDT education makes for learned collaboration and communication strategies that can create improved understanding between disciplines with an appreciation of the different discipline responsibilities.

I read that one of your areas of interest is the impact of palliative care education for care givers. Could you tell me a bit more about that?

My interest in exploring the impact of palliative care education arose as a result of my role in teaching nurses and health care assistants and conducting continuous post course evaluations. At the end of any palliative education program participants document improved confidence levels and knowledge gained. However, I really want to ascertain to what extent does this improvement in knowledge transfer to their work areas in providing quality palliative care for patients. Due to their increasing hands on interaction with patients and families, health care assistants are often the first to witness the physical and psychosocial symptoms that occur in patients. Research would indicate despite their significant role, they can be ill prepared to care for dying patients. In 2010, I conducted research which explored whether a palliative care education program is robust and sustainable for health care assistants who require this level of educational support.

Objectives were to compare candidate’s knowledge and confidence level pre and post study day and six weeks post program delivery. Using a Knowledge Questionnaire (Milford care Centre 2010) and Efficacy Questionnaire (Ersek et al 2008), results demonstrated significant improvement in palliative care knowledge and an increase in confidence levels for health care assistants after attending a one day education program on end of life care. This increase was sustained at 6-weeks post course. 

I am currently involved in research examining the impact of palliative education for Nurses and Doctors. In light of the work being undertaken by the EAPC and the Irish Palliative Care Clinical Programme regarding core competencies required to care for palliative patients, it is vital all education programs are evaluated at this point in time to ascertain the extent they meet those core educational competencies.

Look out for Monday’s edition of ehospice, where Breda tells us about her involvement in the provision of the European Certificate in Essential Palliative Care.