In January 2014 we completed a Training Needs Analysis (TNA) based around the five key competencies in end of life care identified by the National End of Life Care Programme1.
The reason for this work was to ascertain the confidence levels of staff who look after patients at end of life, so that education and support could be provided.
We discussed our plans with the Clinical Audit Department and got the go-ahead to proceed with a survey of staff on the inpatient wards at both Colchester General Hospital and Essex County Hospital, including the Emergency Admission Unit and Intensive Therapy Unit.
After discussion among members of the specialist palliative care team, we designed a proforma with questions covering the key competencies:
- communication – sensitive discussion with patients and families
- symptom management – physical, psychological and spiritual
- assessment and care planning – including holistic assessment
- advance care planning – supporting individuals to decide on their preferences and wishes
- overarching values and knowledge – including legal and ethical issues.
Each staff member who completed the survey was asked how confident they were in relation to these five competencies, with a score ranging from 1 to 10 (1 being least confident and 10 being most confident).
We had 208 responses, 169 nursing staff and 39 doctors.
We analysed the responses and categorised them into two groups based on their scores – one group for those who scored up to 5 out of 10 and another for those scoring above 5 out of 10.
The results showed that staff were more confident with communication skills and symptom management (66% scored above 5/10) but less confident with assessment and care planning, advance care planning, and legal and ethical issues (50% scored up to 5/10).
The proforma also included a section for general comments, and feedback here included calls for more on-going training and study days on end of life care, and the suggestion that end of life care training should be mandatory. One said “I am very conscious that there is only one chance to get end of life care right and I don’t want my inexperience to detriment on the plan of care.”
We disseminated the results of the TNA by presenting in our team meeting, at Grand Round within the hospital and at clinical governance meetings.
Following these meetings and discussion with the hospital team, an action plan was formed. This led to the following actions, carried out by the palliative care team:
- We met all the new doctors on their induction day to introduce the palliative care service and provide a brief introduction to end of life care.
- We restructured the regular teaching sessions for doctors in the oncology department to cover the areas they were less confident in.
- We conducted an additional teaching session for foundation doctors on symptom control.
Ongoing actions include:
- Each month we identify a team member who is providing excellent care and reward them with certificate of ‘excellence in palliative care’ and chocolates.
- Liaising with named link nurses in end of life care in each hospital ward.
- Staff shadowing our team members for introduction and for one-to-one support.
- Annual study days for hospital consultants and nursing staff with a focus on holistic assessment, advance care planning and ethical and legal issues.
- Study days for junior doctors and specialty doctors.
We are also working towards mandatory training in end of life care and the provision of e-learning modules and ad-hoc training on individual wards to meet the needs of staff in their environment.