St. Gemma’s Hospice Academic Unit of Palliative Care in Leeds and the School of Dementia studies at the University of Bradfordhave worked collaboratively to develop a peer facilitator dementia care training programme for hospice staff. In a pilot project funded by Health Education Yorkshire and Humber this training was delivered tostaff from six hospices in the region.
The demographics of growing numbers of people living with dementia will have an impact on hospice services in a variety of ways. There is likely to be an increase in the number of people requiring specialist palliative care who have other terminal conditions and dementia as a co-morbidity; family members need support through bereavement; and support and teaching on end-of-life care to community and care home staff will need to address the needs of those with dementia, given it is present in around 80 per cent of nursing home residents1.
Hospice UK2 promotes equity by recommending dementia awareness and care be integrated across all hospice services from those in contact with the public to those providing direct care for patients and families. To achieve this, staff and volunteers should have the appropriate level of skill and competency to support their role.
A ‘Train the Trainer’ model creates a resourceful way of disseminating training to an extensive workforce, as well as developing champions to act as leaders in practice development. In this model experts train a core group of staff within an organisation to facilitate a programme of learning for their colleagues3.
In a pilot project commissioned by Health Education Yorkshire and Humber, the School of Dementia Studies, University of Bradford worked in partnership with St Gemma’s Hospice Academic Unit of Palliative Care. They developed and delivered bespoke dementia care peer facilitator training for six hospices in the region. Peer facilitators from each hospice attended a five day training programme held at St. Gemma’s Hospice. Their knowledge and skills to deliver dementia care training to their own staff was assessed against a set of competencies by the programme trainers who then provided a follow-up support visit to each hospice individually.
The peer facilitators were trained to deliver dementia care training which addresses Health Education England’s framework for core skills4. It offers foundation level training on person-centred dementia care. This is for all hospice staff and volunteers who have contact with patients and families including receptionists, housekeeping and hospitality staff.
Clinical teams are provided a further intermediate level training in enhanced communication and end-of-life care. The training is based on a model successfully implemented by the School of Dementia Studies to care homes and acute hospital trusts. The training materials and content of the training were adapted to meet the needs of hospice staff and volunteers. Case studies reflected potential hospice patients and the intermediate module on end-of-life care was newly developed.
All the participants from this pilot project achieved peer facilitator status and reported an increase in their competence and confidence in caring for people with dementia. They have gone on to implement the training in their individual hospices as part of rolling programmes of staff education. Their learners (doctors, therapists, nurses, healthcare assistants and volunteers) in turn have reported the positive impact of experiential learning and case study discussions, supported by the programme workbooks.
Some examples of hospice staff and volunteer evaluations of the training programme delivered to them by the peer facilitators:
“A lot of information given today has highlighted things that probably have not been recognised before and I will take this back to practice.”
“This has helped me to step back a bit and think of overall care – a holistic approach.”
“It feels really positive that the hospice is taking the initiative around this and looking to make our own service/environment more dementia friendly.”
It is noteworthy that the peer facilitators identified that a significant level of time and commitment is required in attending and delivering the training, and support from management is necessary for effective implementation.
3 Connell, C.M., Holmes, S.B., Voelkl, J.E., Bakalar, H.R. (2002). Providing dementia outreach education to rural communities: Lessons learned from a train-the-trainer program. Journal of Applied Gerontology 21 (3), 294–313