The underpinning ethos of the MSc Integrating Palliative and End of Life Care, delivered by a partnership between Edge Hill University Ormskirk, Lancashire and Queenscourt Hospice, Southport, was to provide a course that would have a real impact on improving palliative and end of life care.
Part of this programme included an Advanced Practice Project that allowed the students to select a study appropriate to their clinical area.MSc Integrated Palliative & End of Life Care (edgehill.ac.uk)
Ewelina Kopec, works at Queenscourt Hospice Southport where she was a Palliative Care Nurse Associate, and a part time student on the programme. Ewelina initially trained as a registered nurse in Poland and graduated with a Bachelor of General Nursing Degree. Following a completion of dedicated module on spirituality and communication Transforming End of Life Communication & Spiritual Care HEA4252 – Edge Hill University, she was aware not only of the importance of addressing and assessing spirituality, but also that sometimes staff providing care lack confidence and that spiritual care was sometimes not receiving as much attention and she selected this topic for her study.
Ewelina was aware of the importance and value of spiritual care as being one of the pillars of good palliative and end of life care, and that its absence can result in spiritual distress and suffering. All healthcare professionals should feel motivated, organised, and inspired, to work in a partnership towards set goals, to maintain continuity of a high standard care. This improves patients’ satisfaction of care, as by achieving desired outcomes, healthcare professionals promote maintaining patients’ quality of life until its end. Yet, routine spiritual assessment did not seem to be occurring.
The hospice reviewed the standards of care for spiritual care and planned a service improvement study to include the components of audit and education as described below by Ewelina:
The study
This retrospective audit took place January to March 2022 (Cycle One) regarding the documentation of spirituality assessment within patient electronic records. Healthcare professionals facilitating this assessment should feel confident to provide support to patients when they voice their concerns, worries, challenges, expectations towards the end of their lives. 30 patients case notes were examined and although the documentation of spiritual assessment was excellent, there were gaps in the information about the provision of spiritual care, with only 13 (43%) responses to chaplaincy offer noted and only 4 (14%) spiritual care plans developed.
An evaluation of the healthcare professional’s confidence in dealing with spiritual assessment was obtained from the clinicians working on an in-patient unit at the local hospice (doctors, registered nurses, healthcare assistants). An anonymous online survey assessed four factors (confidence with regard to a) assessing spiritual needs, b) assessing religious needs, c) providing spiritual care and d) providing religious care). An educational session was created consisting of teaching sessions delivered to clinicians working on an in-patient unit at the hospice. Finally, a second retrospective audit was undertaken from September to November 2022 (Cycle Two), which examined 56 patients case notes.
Following an educational session, which 35/39(90%) staff attended, there was a significant increase in clinicians’ confidence when assessing spiritual needs from 11/37(30%) to 29/35(83%) (see figure 1) and in providing spiritual care from 5/37(14%) to 32/35 (86%) (see figure 2). The documentation audit demonstrated that the spiritual assessment was already well documented and improved slightly in the second cycle. Findings demonstrate a meaningful increase from 13/30 (43%) to 51/56 (91%) of people who have the offer of formal spiritual support and their response documented, 4/30(14%) to 34/56(60%) for a spiritual needs care plan being developed and documented within patient electronic records to improve quality care for every hospice inpatient (see figure 3).
Conclusion
Educated and confident staff are more likely to address patients’ spiritual needs.
Spiritual awareness and its importance for patients’ quality of life at the end of life, empowers healthcare professionals to make changes in the way they deliver care to patients.
Educated and confident staff are more likely to assess and document spiritual needs and care information within patient electronic records, to improve quality care for every hospice inpatient.
Impact
Dr Karen Groves, MSc Clinical Programme Lead, Queenscourt, said “Ewelina’s project has focused on improving the documentation of spiritual care for patients, which is vital for addressing their needs for meaning and hope at this time.
Following thorough education for staff, she has increased confidence of staff in undertaking spiritual and religious assessment and care which has resulted in greater staff awareness and diligence in documenting spiritual needs and the provision of spiritual care, which is often done but not always recognised as such. Since the study was completed, we have a plan for ensuring that new staff have education and existing staff regularly updated to keep it high on their agenda.”
Professor Barbara Jack, MSc Academic Programme Lead (Edge Hill University) said “This is an excellent example of where an academic study can be directly used to improve care. Importantly it has enabled demonstration of the impact of academic programmes, ensuring the spiritual care of patients is improved to the level of the best”.
Ewelina Kopec1
Karen Groves,1
Barbara Jack,2
Jane Hough,1
Charlotte Moen2
1 Queenscourt Hospice, Town Lane, Southport, Merseyside
2 Edge Hill University, Faculty of Health, Social Care and Medicine, Ormskirk, Lancs.
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The full title of this article is: Improving spiritual care in hospice inpatients: the impact of a service improvement study between a hospice and university
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