Giving patients at the end of life a choice in where they want to die underpins recent UK policies and was embedded in the End of Life Care Strategy of 2008. The opportunity to die at home is becoming a realistic alternative to the long-standing trend of dying in hospital, with home deaths increasing from 18% in 2004 to 22% in 2012.
Numerous studies suggest that given the choice, the majority of people would prefer to die at home if assured high quality care and proper support. Unfortunately many home care workers have significant unmet training needs, despite having a key role in providing such care to enable a home death.
The importance of hospices transferring their knowledge and best practice to other care settings has been widely recognised. As a staff nurse and educational practitioner at Oakhaven hospice, I have been leading a project aimed at increasing capacity in the delivery of end of life care. The purpose of this project was to use ‘situated learning’ to provide education, training and support in palliative and end of life care for staff working in care homes and more recently the home care sector.
Into the community
Situated learning is learning that takes place in context in which it is to be applied. Studies suggest that improving end of life care in the home care sector can be achieved by increasing the confidence and capacity of staff through education and support while they are providing care for those wishing to die at home1.
To gauge interest, letters were sent to all domiciliary agencies within our catchment area, introducing myself and the project and how I could support staff.
By questioning staff, specific areas of education they would like can be identified. Using a a questionnaire and informal interviews, to assess perceived confidence, I am able to build a picture of their educational and supportive needs and therefore design an intervention accordingly.
It was also necessary to take into account potential barriers to providing educational initiatives within the home care sector, such as staff travelling distances between their clients and potentially appointments overrunning. Because of this, it was not always possible to meet staff prior to a session.
Due to these pressures, I realised that I would have to be more ‘flexible’ to accommodate the needs of all the staff who were able to attend and often sessions would not go as planned! However, I quickly learnt to adapt to a ‘change of direction’ and this appeared to make the sessions relevant to their needs at the time, a vital component of situated learning.
How the project has evolved
To date, the project has involved 317 home care workers from 12 agencies. Examples of how situated learning has worked include:
- Working alongside staff in providing end of life care.
- Education sessions on a variety of topics Case studies centred around a client.
- Reflective debriefing after the death of a client.
Part of the sessions also include encouraging those present to share the knowledge and experience gained with those who were unable to attend and for more experienced carers to ‘mentor’ those with less experience.
Giving staff an open forum for discussing issues they face in the community has also become an important part of many sessions. Often carers find it difficult to provide vital care to the dying in such a short space of time before having to ‘move on’ to their next client. I may not have a solution to this but I am able to listen and to support accordingly.
Alongside the situated learning sessions, I have just begun a six-weekly ‘link nurse’ meeting for home care staff that includes updates and news but ultimately providing discussion and support as a group. I also plan to invite ‘guest speakers’, for example at the last meeting an ambulance representative attended and a community matron is attending the next.
Currently we are piloting a family and community staff communication journal to be left in client’s homes, to see if this can improve ‘joined-up’ working.
Having an email database of agencies that have been involved in the project means I am also able to regularly send updates and information, especially useful for those unable to attend the meetings.
Individual projects are evaluated and feedback is encouraged. These have made for pleasant reading with high scores and with comments such as; ‘I really value the support that Oakhaven is able to offer my staff’, ‘the sessions have shown me that providing end of life care can be a rewarding part of my job’ and ‘Jenny’s meetings are great for networking and sharing ideas!’
The project has evolved over the last two and a half years and successfully built sustainable relationships with the care homes and domiciliary agencies within our community. Although initially funded by a grant from the local health authority, due to the hard work of all the education team, it will now continue even though the funding has ended. We all look forward to the future opportunities this project will present!
- Devlin M and McIlfatrick S. The role of the home-care worker in palliative and end of life care in the community setting: a literature review. International journal of palliative nursing 2009; 15 (11):526-532
Jennifer Caine is a staff nurse and educational practitioner at Oakhaven Hospice in the New Forest and is currently studying for an MSc in clinical leadership in cancer, palliative and end of life care at the University of Southampton.
For more information please contact Jennifer on firstname.lastname@example.org