The need for effective palliative care in resource-poor countries in Africa and elsewhere has been well documented in the last decade, and significant attempts have been made to establish services both in hospitals and in the community.
A fundamental need is for appropriate training in order to ensure a supply of skilled personnel to sustain both embryonic and established services.
Such training ranges from basic short introductory courses for community volunteers, through extended workshops, to multi-professional diploma and degree level studies.
However, completing a training course is no guarantee of successful, sustained application in the field and this has led to a search for more effective approaches to embedding and sustaining the learning gained in formal education.
One such approach has been to follow up a course with a period of face-to-face mentoring on-site, with the aim of supporting newly trained staff, providing appropriate advocacy, and raising the profile of the palliative care service.
Palliative Care Works
Founded in 2008 and working primarily in Africa, Palliative Care Works (PCW) began delivering week-long workshops in palliative care in 2009.
A not-for-profit consultancy (currently seeking Charitable Incorporated Organisation status), PCW has a multi-professional team including nurses, social workers and doctors with a broad range of expertise in both adult and paediatric services, education, research and advocacy.
PCW has worked with the Diana Princess of Wales Memorial Fund, Tearfund, AfrOx, and the University of Edinburgh, and much of its training has been based upon the Palliative Care Toolkit and its companion Trainer’s Manual.
Both of these have been written for a wide, rather than specialist, readership and are designed to be practical, hands-on manuals with a direct, ‘can-do’ approach.
While the immediate feedback from the PCW multi-professional workshops has been gratifyingly and uniformly positive, it has become evident that participants have nevertheless struggled to maintain the learning, sustain their enthusiasm and apply the training in their daily work. This problem has been well documented in the educational literature and is not specific to Africa alone.
One of the reviewers of the Trainer’s Manual suggested a move to the ‘training plus mentoring’ model referred to above.
Based on the combined experience of PCW members and others in delivering training plus mentoring in a range of settings and countries in Africa, PCW has written a comprehensive paper which critically examines the assumptions and aspirations of this model, and highlights the serious challenges facing palliative care delivery in Africa.
Towards effective mentoring
‘Towards effective mentoring’ offers some considered reflections on the outcomes of combining training courses with follow-up, on-site mentoring from an experienced palliative care professional; it identifies the responsibilities of those involved, and assesses the effectiveness of this approach.
Good training is essential but it is only effective as far as the participant understands what has been taught – and, crucially, finds the confidence to put it into practice. This is the key difference which a committed mentor can make. However, mentoring is not an easy option. It is a skilled task that requires careful thought and investment from all three parties – sponsor, host and mentor.
In this paper, the authors set out clearly the various responsibilities of the sending organisation (sponsor), the palliative care service (host) and the allocated nurse, social worker, doctor or other professional (mentor) – in order for the investment to be effective. They go on to identify the positive outcomes in relation to validation, reflection, credibility, confidence and advocacy.
However, as their conclusion notes, follow-up mentoring after training is not enough. It is a necessary but not sufficient component for scaling up or sustaining palliative care services in resource-poor settings.
The need to address the cultural and socio-economic factors is equally important and the goal of state-based support, embedding policy and practice in both education and health and social care institutions, remains paramount.
Nevertheless, mentoring has much to offer and the impact of well-planned, skilled mentoring on both individuals and teams in resource-poor settings should never be underestimated as the account in the box-out section above demonstrates. This case features a child with burns, the learning is equally applicable in any palliative care setting.
Facilitating change is the enormously rewarding task and privilege of the mentor, and an opportunity to pass on to others some of the support and guidance that mentors have themselves received during their own careers.
To find out more about Palliative Care Works, visit their website.